Please! Not another “White Knight”


News has been leaked this week by Computing  of plans by NHS England to create a new post of Chief Information Officer/Chief Technology Officer to replace the role that Tim Kelsey will leave vacant at the end of the year.

On the face of it this seems to be a good idea, but my experience over many years gives me some concerns that such an appointment may not have the positive effect hoped for.

Over my 35 years in the sector I have seen a string of able people come and go in the top leadership positions in NHS IT. Generally they have been presented as the Messiah, someone with simple answers to complex problems, a White Knight (or Dame) with Silver Bullets that will result in IT or what we now call Digital, to enable a radical transformation of health and care.

A radical transformation is clearly what we need Digitally Enabled Services and Big Data are two of a very small number of tools available to us with the potential to make a major contribution to addressing the challenges in health and care readers will well understand. But, the answers to the complex problems we face are not simple, but are themselves are complex, and there are no White Knights or Silver Bullets.

As I said in an earlier blog

I’m pretty certain that the health informatics community know how to create the open digital ecosystem we need to support the emerging new models of care, but I have concerns that a lack of knowledge and experience amongst policy makers, vested interests in the care, informatics and vendor communities and a naive belief in the Tooth Fairy. Might mean we don’t achieve what’s possible.”

Leadership is critical to success, but we need leaders with a profound understanding of the domain who can harness the undoubted skills and goodwill in the care, informatics and vendor communities and who have the confidence to resist those with vested interest who insist they have simple answers.

Lets look at the characteristics of the various people who have held the top jobs over the past 35 years? In general, and there are exceptions, but these people.

  • Are intellectually very able.
  • Have a track record of doing amazing things – Although typically they overestimate the extent to which this was due to their brilliance and much underestimate the fact that they were just lucky.
  • Manage to dazzle those that appoint them, but turnout to be human after all.
  • Have limited prior experience in health or care, particularly on the front line.
  • Suffer from various degrees of narcissistic  personality disorder .
  • They don’t do “critical friend” and thus tend to get surrounded by “yes men” and sycophants.
  • They stay for no more than 3 to 5 years – Many have had the sense to get out before the job destroys them, some have not.

What do I want to see in any CIO/CTO? Well firstly it’s probably not a CIO or CTO but rather its closer to CCIO (Chief Clinical Information Officer), although it’s not exactly any of these things. They need:

  • A profound understanding of how the UK health and care system works at the front line. This is unlikely to be achieved without at least 10 years experience of working at the front line as a health and care professional in the UK or in a role directly supporting such front line staff.
  • A profound knowledge of health policy and practice and of the research/evidence base of how this might be developed.
  • A profound understanding of Health and Care Informatics – To me health and care informatics is the science of how health and care information and knowledge can be represented in a computable format an the techniques for it processing, it is not fundamentally about the specific technologies.
  • Experience of working in a politically and organisationally complex environment with the gravitas and robustness to survive in such an environment.
  • A personal and management style that can build and work with a diverse team of people who will continually challenge what’s being done.
  • A willingness to engage with unprecedented openness and collaboration with all of those in the care, informatics and vendor communities, including citizens, carers, patients and service user.
  • Enough knowledge and experience of software design and engineering to critically appraise what others tell him, but this is not a job for someone with primarily generic CTO/CIO skills.
  • Finally, they need to understand that this job is about making the best health and care systems in the world1, better by harnessing the commitment, knowledge and experience of those in the care, informatics and vendor communities that have put us in the enviable position.

Finding someone to take this role is going to be a challenge, but it is possible. It’s highly likely that the person we need is already working in the system. The last thing we need is somebody from outside of health and care or outside the UK. No matter how able they are they won’t get to point of understanding the challenge in the time we have to meet it (2020?)

Whoever is appointed let’s make sure we don’t place impossible expectations on them. They can only succeed if they can engage with and harness those in the care, informatics and vendor communities who already know what needs to be done, their role is not to tell us what needs to be done, but to enable us to do it.