The fortnightly newsletter that unpacks system leaders’ priorities for digital technology and the impact they are having on delivering health services. Contact Ben Heather in confidence here.

Digital health companies love to complain, at least in private, about the NHS. Service fragmentation, procurement incompetence, and oscillating central policy are all great sources of teeth gnashing.

But those companies are often the same ones luring away senior NHS folk in the hope their expertise and connections will give them an edge in winning NHS business.

There is no reason NHS staff with digital expertise cannot go on to have careers at a digital health company. But it is a relationship, and a transition, that needs to be carefully managed. Earlier this month, one outgoing senior NHS manager did not meet this standard.

On 14 January, NHS England’s outgoing chief digital officer Juliet Bauer wrote a piece in The Times extolling the virtues of her future employer, Livi (or Kry), a Swedish digital primary care company with big NHS ambitions. In the piece, Ms Bauer identified herself as NHS England’s digital chief officer and did not disclose her relationship to Livi.

NHS England has since distanced itself from the piece and asked for its removal. The chair of the Commons public accounts committee, Labour MP Meg Hillier, told the Financial Times the article was “jaw-droppingly inappropriate” while NHS chief clinical information officer Simon Eccles, a colleague of Ms Bauer, said it was “muddling” and a mistake.

When HSJ revealed Ms Bauer’s move to Livi earlier this month, HSJ readers were already raising concerns about her swift transition from national oversight of NHS digital patient services to a company selling those services to the NHS.

With technology increasingly central to the NHS’ future, there has never been a greater need for a clear line between senior NHS managers and the digital tech suppliers courting them.

A well-trodden egress

It’s worth noting there has been a steady churn of NHS digital folk moving to tech companies, and vice versa, for years.

To name but a few, Beverley Bryant came out of Capita to help lead the digital agenda at NHS England and then NHS Digital, before becoming electronic patient record supplier System C’s chief operating officer in 2017.

Google Deepmind too has recruited heavily from senior government and NHS ranks. Ex-Department of Health director, Will Cavendish, joined the company in 2016 (he left less than a year later). NHS England’s transforming health systems national director, Michael Macdonell, is off there imminently. The company’s medical director, Dom King, has previously worked for the Cabinet Office and has strong links with the NHS.

In the other direction, NHS England deputy chief executive Matthew Swindell’s last job was with EPR supplier Cerner. Going back a few more years, Tim Kelsey founded the health data analytics company, Dr Foster, before becoming digital tsar at the national commissioning body in 2012.

These revolving doors can, if they spin right, be a positive for the NHS.

The private sector will always pay more, particularly in IT, and giving capable people a career path that can move from the NHS and private sphere means they are more likely to spend some time at least in the NHS. When they return to the NHS from a private stint, they can also often bring fresh expertise with them.

The frosted pane

But even before Ms Bauer’s move, the line between digital health companies and those people that can influence NHS policy was blurring at times.

In May 2016, the Care Quality Commission’s strategy director, Paul Bate, moved to Babylon Health, a new digital GP provider regulated by the CQC, to manage the company’s relationship with the NHS. When the CQC inspection subsequently raised some (minor) concerns about Babylon, the company sought to block the publication with an onslaught of criticism of the CQC, questioning the objectivity of its leadership, the competence of inspectors and threatening to sue. There is no suggestion of impropriety on Mr Bate’s part, but The Download has been told his switch from inspector to CQC antagonist sat uncomfortably with some at the agency.

While the health and social care secretary Matt Hancock is still very much in the job and not, to the best of The Download’s knowledge, courting alternative employment, his enthusiasm for digital health companies has also contributed to a blurring of lines.

Mr Hancock has repeatedly and unapologetically endorsed Babylon Health’s NHS service, GP at Hand. Some of his first non-government meetings in the job were with tech start-ups, including Babylon, during which he promised to fight “vested interest”. In a strange portent of Ms Bauer’s editorial faux pas, he even praised GP at Hand in an Evening Standard article that was sponsored by Babylon, leading to accusations that he had breached the ministerial code. The Department of Health and Social Care says it did not know the interview was sponsored. 

There is no suggestion that Mr Hancock has a financial interest in Babylon, or any other digital health company, but such incidents feed suspicions some NHS policymakers have one eye on the job and another on a lucrative exit plan into the private sector.

Open and shut rules

If Ms Bauer worked for the DHSC, she would have had to formally seek dispensation before accepting the job at Livi.

DHSC senior staff, like all senior civil servants, cannot accept a new job in the private sector without getting approval from their department for at least 12 months after leaving the civil service. This is especially true when the new job has some crossover with their previous one.

These rules are far from perfect – some departments seem to ignore them completely – but they do provide some check on the line between a public official’s current role and their next private job.

NHS England is not covered by these rules and it is unclear what, if any, alternative arrangement it has in place (The Download asked NHS England but had not received a response at the time of publication).

The national commissioning body has pointed out that Ms Bauer had already been removed from her digital responsibilities when The Times piece ran (she’d stood down three days prior). It points out she wasn’t involved in writing the digital element of the NHS long-term plan (contrary to a claim made by Livi that she was “integral” to it) – but fails to mention her responsibility for NHS England’s digital patient services policy.

NHS England does not hold any contracts with Livi, it says. This somewhat overlooks its huge power over the regulatory environment in which such businesses fail or flourish.

The civil service rules are designed not just to prevent actual conflicts of interest when a person moves into a private sector job but also “that such movement should not be frustrated by unjustified public concern over a particular appointment”.

The public and NHS staff are entitled to have confidence that those lucky enough to work in the NHS will not exploit their expertise to furnish a future employer with improper advantage.

Clearly stated and enforced rules for these transitions would help this revolving door run smoothly in the future, and protect the reputation of both the NHS and its departing senior managers.