Inside e-health on wanted: someone to lead NHS IT

The Healthcare Computing 2008 conference takes place next week. One of the keynote speakers was to have been the Department of Health’s acting chief information officer, Matthew Swindells.

Last week, however, Mr Swindells unexpectedly stood down from his job. Journalist Jon Hoeksma muses ponders his departure and the national debate on the future of NHS IT, as commentators, managers and vendors head for Harrogate. 


The Department of Health has recently seen the departure of some of its most senior IT and informatics leaders - and it is not yet replacing them.

At the end of January, Richard Granger departed as the head of NHS Connecting for Health, leaving some mighty big footprints to fill. And last month Richard Jeavons announced that he will quit as its director of service implementation.

The real surpise, though, came last week when Matthew Swindells announced that he would step down as the DH’s acting chief information officer (CIO), before his eagerly anticipated root and branch review of NHS Informatics has been published.

For some months, the DH has been saying that the review will be published in the “spring.” It now appears that it will not be published for some months.

Information is vital

At events where he has spoken recently, Mr Swindells has emphasised that informatics is absolutely central to the delivery of the strategic direction of the NHS. This is hardly controversial. “Not to take in the £12.4 billion programme would have been tantamount to ignoring an 800lb gorilla squatting in the middle of the room.”

This year’s operating framework for the NHS made a similar point: as did the interim report produced by Lord Ara Darzi, who is conducting the Our NHS, Our Future review of the NHS as a whole.

Securing improvements in cost-effective patient care through policies such as choice, competition and payment by results all depend on the effective use of information.

As Mr Swindells has also been saying, that means a whole spectrum of people – from regulators to trust managers and clinicians to patients – need systems that can deliver the information they need in a more or less timely fashion.

The £12.4 billion question

Although the review was not a review of the National Programme for IT in the NHS per se, it could hardly have ignored it and its contribution to date. Not to take in the £12.4 billion programme would have been tantamount to ignoring an 800lb gorilla squatting in the middle of the room.

However, my bet would be that if the review ran into problems anywhere, it would have run into them here. The DH, for instance, may not have taken well to criticism – or even comments that could have been presented as criticism by the programme’s many critics – of its leadership or its record on trust level electronic patient records (EPRs). “Conservative Party leader David Cameron recently promised that if he was elected, there would be no more projects like ‘Labour’s hubristic NHS supercomputer’.”

After all, it has already had to take some pretty tough comment from academics and MPs sitting on the public accounts and health select committees.

How to do IT?

Despite its many real successes, on the key area covered by its Local Service Provider deals - delivery of detailed care records systems – NPfIT has found progress slow and difficult. Yet the DH shows no sign of giving in.

Conservative Party leader David Cameron recently promised that if he was elected, there would be no more projects like “Labour’s hubristic NHS supercomputer.”

He said his party would instead “follow private sector best practice” and set standards so that contracts could be broken up into modular components and delivered by smaller companies.

Talk of a “supercomputer” makes Mr Cameron sound less than well informed to experts in NHS IT, but he is not the only one to be championing a move towards standards.

The IHE-UK organisation and the British Computer Society recently organised a “connectathon” in Oxford to show how standards can be applied to real-world healthcare scenarios, to integrate systems and share documents.

However, Jeremy Thorp, NHS CFH’s director of information systems and business architecture, told the event that while standards were important, they were not enough.

It’s cold out there...

Long-term observers of the NHS IT scene may find themselves thinking of the film Groundhog Day as they head up to Harrogate for this year’s Healthcare Computing conference. Everyone agrees that information and therefore IT is vital for the NHS.

But a debate about the best way to deliver some of the building blocks – centralised contracts for big new systems versus standards setting to allow more vendors to compete for smaller, compliant projects – has been raging for the best part of a decade.

The DH’s approach remains clear. And, in spite of all the criticism and Mr Cameron’s recent attack, one of the features of the national programme has been the remarkable degree of political support that it has enjoyed from ministers.

However, the DH now needs to find credible new IT leaders – both a new departmental CIO and a leader for NHS CFH - willing to stake their reputation on delivering an IT strategy that is proving far tougher than was perhaps anticipated.

About the author: Jon Hoeksma is a journalist specialising in health and IT. He is co-founder and editor of the e-health-insider website and its sister sites on primary care and European IT.