FCI described as a ‘Greek Tragedy’

The Faculty of Clinical Informatics, the professional body charged with developing clinical informatics as a profession, is said to be falling apart with the Chair of Trustees and CEO at loggerheads with members and a series of bitter internal power struggles 

One FCI senior figure and former council member described the situation as akin to a ‘Greek tragedy’ and urged members to take back control of their professional body. 

Digital Health News has learned that interim chair of council Dr Mark Bailey was forced out earlier this month, resigning after receiving what he describes as a “threatening” email, and despairing of being able to influence the course of direction. 

His resignation closely mirrors those of chair of council and trustee Prof Jonathan Kay and Dr Anne Marie Cunningham as vice chair of council in December 2022.   

A toxic atmosphere is said to have developed. Some staff, while they remained, are also said to have found the FCI an extremely difficult place to work, with communications cited as a recurring problem. 

The FCI now has no elected council officers in post. Those remaining are all interim. Further resignations have included: Sue Turner, Prof John Williams, a trustee, and Prof Angus Wallace who played a key role in organising several previous Annual Scientific Conference.  

The appointment of chief executive Ken Mackness in May 2022, recruitment of new staff members, an ambitious new CRM project all occurred despite it becoming plain FCI’s previous assumption of receiving up to £650,000 of annual investment from NHS England (NHSE) had become highly unlikely. The last annual grant awarded to FCI two years ago is understood to have been £350,000. 

Warnings ignored

Digital Health News understands that senior figures within the Faculty sounded alarm bells about the receding chances of a NHSE grant when Health Education England (HEE) was about to be merged into NHSE and the need to make sweeping cuts at NHSE. These warnings were largely ignored. 

Despite this changed reality FCI is said to have carried on with the assumption an NHSE grant would still materialise, with the new CEO recruiting additional staff and making limited efforts to find alternative revenue sources. Other than the grant from NHSE FCI’s main revenue source is subscriptions from its 1300 members. 

Over the same time period key projects, central to its central mission of developing a clinical informatics profession, developing an undergraduate and postgraduate curriculum, and development of ePortfolios, appeared to be neglected. 

The home page of the FCI website carries an open letter to Secretary of State Steve Barclay calling on him to invest £500k annually in funding the FCI, arguing the organisation is vital to the development of health informatics as a profession. The open letter has received over 700 signatures.

Over the period senior members of FCI have unsuccessfully sought behind the scenes to raise concerns that FCI’s trajectory is unsustainable and that the grant from NHSE was increasingly unlikely. 

Digital Health News understands that interim chair of council Dr Bailey repeatedly sought to raise concerns with the chairman of trustees, Bill Morgan and chief executive, but felt his concerns were ignored. 

Ahead of a key meeting he said he received an email from Maggie Lay, vice-chair of council, demanding his resignation as relationships and trust had broken down. Frustrated and exhausted he resigned.   

Dr Bailey’s resignation meant that the FCI had lost two chairs of council in just seven months, over which time it had failed to secure funding, let go of all staff, and was facing a growing split between its trustees and chief executive and despairing members.  

Existential threat

Long-serving former council member Dr Alan Hassey said in an email to council members: “Recent events have been very distressing for those concerned, and incomprehensibly obscure to the rest of us.” 

Dr Hassey added: “Meanwhile the Faculty seems to be undergoing its own Greek-style tragedy, facing an existential threat, while heads roll.” 

He called for FCI members to take back control of the organisation: “Council needs to reassert itself and be seen to act in the best interests of our members. This means reaffirming its democratic mandate, offering clarity of purpose, communicating with our membership and ending this dreadful internal power-struggle.” 

Things further came to a head on Wednesday when founding member Prof Angus Wallace wrote a blunt open letter to chair of trustees Bill Morgan, a former partner at accountants PWC, warning that the FCI risked insolvency, as exclusively reported by Digital health News.    

In response, FCI flatly denies that it is facing financial oblivion saying it can meet financial commitments for the next 12-months. It had £56,000 in the bank at the end of June. All staff other than the CEO have been made redundant. The CEO resigned in April and is due to depart in October. 

In a briefing call last week Mackness told Digital Health News: “Angus is a friend of Faculty and he decided to step back from meetings and committees. In this instance he’s not right with his numbers,” he added. “I would hope our horse’s mouth statement is what would be trusted.” 

FCI members who have spoken to Digital Health News, however, say that the organisation faces additional liabilities, not recognised in its accounts, a £35,000 liability is attributed to its November Annual Scientific Conference, which it currently looks extremely unlikely to be able deliver; and an £80,000 liability over a joint project with the Federation of Informatics Professionals (FED-IP), it has been unable to fulfil.   

FED-IP is not thought to be pushing for immediate payment but these two liabilities, if recognised on the balance sheet, would push FCI into the red.  

Asked specifically whether FED-IP would need to be repaid for the project, Mackness told Digital Health News: “So they have not said they do not want the money back. They have said they are happy to channel the money into FCI and I have that in writing.” 

Continued solvency also critically depends on the assumption that the 1300 members will renew their annual subscriptions at the start of January. But with no remaining staff and key projects stalled this may be highly optimistic.  

Members have spoken about the near complete lack of communication by the chair of trustees and CEO over the parlous state of finances over many months, when members might have been able to suggest alternative funding opportunities.   

Lack of email communications is attributed to the new late running £50,000 Customer Relations System project. 

Take back control

In his email Hassey says that the membership were unaware of problems “as there has been no communication, or clarity about the problems we face and absolutely no accountability that I can see”. 

To further complicate matters a divide has opened up between the appointed leaders, neither of whom have any clinical informatics experience, and the actual membership of clinical informatics professionals. 

In a letter to Council members Dr Hassey said it was time to take back control of the Faculty, so clinical informaticians were in control, calling on them to reject a planned restructure that would place the chair of trustees in charge: “The chairman of Council or president of every other medical Royal College is the effective chief officer and chairman of those organisations.” 

He continued: “I can’t believe any other medical Royal College would allow this, so that education, standards and membership are no longer under overall professional control. This is completely unacceptable.” 

One source told Digital Health News: “The money isn’t the biggest problem. That’s the loss of direction following the decision to become a charitable incorporated organisation and the appointment of Trustees and the CE.”  

They added: “The balance of power got worse and was never resolved. That left the membership out of everything that mattered. And you can’t run a professional membership society that way. The resignations all followed from that.” 

They said that the problems had to be dealt with before new elections to the council were held and that the professional membership had to take back control. 

Mackness promised that even without staff the FCI would continue to work for its members: “The Faculty is working hard to continue delivering valued services and benefits for our members. It remains the preeminent body promoting and representing the professional role of clinical informatics in delivering high quality health and care.”