• NHS England made three big appointments as part of restructure of senior tech team
  • These include controversial ex-Addenbrooke’s chief executive as chief clinical information officer
  • Also follows arrival of Matthew Swindells as national director of operations and information
  • Signals that ducking the digitalisation challenge will no longer wash

NHS England’s appointment of three senior technology directors, including its first chief clinical information officer, marks the beginning of a new chapter in the NHS’s digital policy.

Two of the hires are well known among NHS tech leaders, and are particularly striking.

Former Addenbrooke’s chief executive Keith McNeil has been appointed CCIO while Will Smart, currently chief information officer at the Royal Free Hospital, becomes NHS chief information officer.

Both have been involved, in their own way, in high profile controversial IT projects. Dr McNeil resigned as Cambridge University Hospitals Foundation Trust chief following a problematic high profile deployment of the Epic electronic record system.

Mr Smart, meanwhile, joins from the Royal Free, which has established a groundbreaking relationship with Google DeepMind - a project developing an app to improve acute kidney injury detection, which has also met controversy.

Their appointments are bold and send a message from the centre that ducking the digitalisation challenge will no longer wash. To paraphrase Bob Wachter, the US technology expert and leader who is currently advising the NHS: to try and then fail is not necessarily a good thing - but the worst thing is not to try at all.

Neither Dr McNeil nor Mr Smart are the type of low-profile yes men who would come on board to unconditionally deliver orders from on high.

When Dr McNeil left Cambridge, he was highly critical of system leaders and regulators - describing the Care Quality Commission’s inadequate rating of the trust “galling” and the NHS financial incentive system as “ludicrous”.

Though many enjoyed this well-liked chief executive’s candour, at the time senior NHS figures privately questioned whether Dr McNeil would ever get another senior NHS post after his comments.

The third recruit - Times Newspapers online executive Juliet Bauer, who becomes director of digital experience - is an unknown quantity to the NHS, but her role has a lot of potential to make an impact. She “will oversee the transformation of the NHS Choices website and the development and adoption of digital technology for patient ‘supported self-management’, including for people living with long term conditions such as diabetes or asthma,” NHS England said last week. “Ms Bauer has led delivery of similar technology programmes in many sectors, including leading the move to take Times Newspapers online.”

Aside from the individuals, NHS England’s move to appoint a CCIO came as a surprise to many local NHS tech leaders - not least trust CCIOs, who were left wondering why there was no job advert for such a high profile national role.

The background is that NHS England, anticipating the departure at the turn of the year of Tim Kelsey, who held board level responsibility for technology, initially sought to recruit to the post of chief information and technology officer.

It struggled to find a suitable candidate, however, and opted for a change in tack, which it said would reflect the forthcoming recommendations of Professor Wachter’s government review on the future of information systems in the NHS.

An NHS England statement said: “Rather than appoint a single chief information and technology officer, consistent with the Wachter review the NHS is appointing a senior medical leader as NHS chief clinical information officer supported by an experienced health IT professional as NHS chief information officer.”

It is notable NHS England says the CCIO will be “supported by” the CIO, and not the other way round. This suggests a dynamic in line with many healthcare organisations in the US, whose chief medical information officers are hugely influential.

Professor Wachter - whose review is largely complete but must wait until September for publication - has made public his concerns that NHS CCIOs do not have the influence of their US counterparts, undermining clinically led digitalisation.

Critically, the new team is being shaped under Matthew Swindells, who started work as NHS England national director of operations and information - one of the most senior positions in the top team - around a month ago.

All three new hires will report to Mr Swindells, who joined from US-based IT giant Cerner, where he was senior vice president, and whose previous roles include CIO in the Department of Health, as well as hospital chief executive and IT director.

An important early issue for the new senior tech team will be establishing the dynamic between the roles; they will also need to work closely with NHS Improvement on delivery.

Former Health and Social Care Information Centre chair Kingsley Manning complained in an explosive interview with HSJ that NHS digital policy suffered from a “multi-headed hydra” of decision makers.

Adding three more heads to the beast risks further complication, and the success of the new arrangements will depend heavily on a productive dynamic between all involved.