A look back at the past decade in UK health informatics

From the rise of CCIOs to networks promoting diversity in the industry, the UK has seen a fair amount of change, writes Health Education England CIO James Freed.
By James Freed
01:30 AM

In the last few weeks of 2019 I found myself buying my first pair of reading glasses. My brother tells me that average age for this need is 45, so I’m a couple of years early. Two weeks later and I’m writing this blog, predicting what life will be like for us all next year and beyond. I’m finding this difficult, after all, as I don’t have 20/20 vision (awful joke - I am so sorry).

As we move into the third decade of the noughties, it is the right time to look back and reflect on the changes our industry has made and what the world has in store for our workforce in 2020 and beyond.

I think I will start, as so many of our conversations seem to, with the UK National Programme for IT, also known as the “£12 Billion failed NHS Supercomputer programme. NPfIT, latterly entitled Connecting for Health, did a great deal of good, but it failed to keep its main promises. Its legacy however, at least for our workforce, is very much still felt. NPfIT centralised IT for the NHS. In so doing it sent out a very strong message: IT is too hard for you to do. 

Trusts looked at this policy direction at a time of pressure (the NHS has *never* not felt under pressure) and made their decisions. Nascent technology teams were dropped, investment in tech was limited and the NHS ceased to invest in its technology workforce. NPfIT failed and trusts picked up the slack with a now denuded skill base. Still it is a rarity to find a UK hospital with significant software development teams.

From the wilderness came a spark of hope. A small number of angry men met in a pub and out of that meeting came a movement that has evolved into today’s Digital Health CIO community. About six years ago the same publication watched the rise of a new clinical informatics profession in the US and started a campaign for the creation of the Chief Clinical Information Officer role – there are now about 500 CCIOs in the UK and the role is specialising and coming into its own thanks to the new Faculty of Clinical Informatics.

In 2010 the Government Digital Service was born in response to poor technology investments, wasted public money and fundamentally broken services. Part of its legacy was to change the face of how we think about services, and technology’s role in service design. GDS is now home to thirty-nine professions, collectively described as the Digital, Data and Technology (DDaT) professions. Senior leaders in government are encouraged to think about the multi-disciplinary teams they need to construct to create a user-centred service that delivers value quickly whilst creating space to experiment and iterate rapidly. The Federation for Informatics Professions will help to institute this approach in health and care.

Another piece of this puzzle I want to highlight is the growth of the Northwest Skills Development Network, famously conceived as a few finance directors made their way back from a training session in London and discussed how they could arrange the same training locally much more cheaply. Now there is an extremely vibrant Informatics network in the Northwest that celebrates its successes every year with a two day conference.

Finally, but by no means least, is the recognition that the people we identify with as colleagues in digital health are disproportionately white, male and middle-aged. Networks, such as Shuri and One HealthTech, have built up to recognise and combat this, speeding up the trend towards a more diverse workforce, resulting in a better ability to meet our diverse users’ needs. 

In short, we’ve seen a huge amount of activity, almost all bottom up (even the GDS professions work is community-led) that is starting to explain what we mean when we call ourselves professionals.

I sense a real change in the air. Back in 2006, 30% of informaticians polled felt that mandatory accreditation was a good idea. Three years ago I did a straw poll that suggested this figure had risen substantially. Now communities are writing to demand that a bar be set for senior informatics leaders in the NHS.

So, what's in store now?

I think, first of all, we’ll have to agree on a name. Aasha Cowey [programme manager at NHS Central, South and West CSU] undertook a survey this year that indicates some people find the term ‘digital’ a friendlier banner to congregate beneath than ‘informatics’ although there are still many of names for our tribe. I think we’ll probably agree on a term, or set of terms, fairly soon. Then I think we’ll see communities coming together, under professional bodies or perhaps an NHS expansion of the DDaT work to define the three things that make professions happen – a clear and relevant bar, an accreditation process (possibly built into the recruitment process to reduce barrier to entry for non-NHS staff) and linked to relevant and quality assured training. Taken together these things are the bedrock of any profession.

I have the tremendous honour of working in the Building a Digital Ready Workforce (BDRW) team, that has a delegated responsibility from NHSX to help bring this to fruition. Our philosophy is very much assets-based, and, as you can see, there are so many assets to support and glue together.

I suppose you could consider the BDRW programme as a combination of a telescope, a microscope and, yes, some reading glasses (when they are needed) to help us surface and join together the excellent work being undertaken now to help us build our profession. None of us has 20/20 vision when it comes to seeing the future, but as these initiatives build on their mutual success, we’ll all be able to see a little clearer.

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