The now-defunct NHS National Programme for IT (NPfIT) was a top-down, centrally-managed NHS digitisation programme, introduced as thesolution for bringing the NHSs’ information technology into the 21st Century.
And yet, 16 years since its inception – and with an £11.4billion-pound hole smouldering in our pockets – we’re still talking about the very problems the NPfIT, which was cancelled in 2011, set out to resolve.
By now, most of us harbour a practical and/or comprehensive understanding of why NPfIT is deemed to have failed – poor clinical engagement, lack of innovation and a top-down, one-size-fits-all approach – and it is with this knowledge and experience that we should expect to build real and lasting changes to IT in healthcare today. But have we really learned from our mistakes?
In answer to that question, we need look no further than Matt Hancock’s recently-assembled Healthtech Advisory Board (HAB) – among which, practising clinicians are the most-notable absentees.
I think it's almost oxymoronic: the idea that very large, highly-centralised institutions and bureaucracies – no matter how good the people within them – can deliver innovation
And it is because their absence that, for some, the appointment of the HAB regretfully serves as yet another example of our healthcare system failing to connect high-level strategy with ground-level action.
Indeed, this is not an isolated instance of disconnect existing between the ‘centre’ and the frontline in contemporary healthcare strategy.
Such is the significance and scale of the problem that, before the HAB had been assembled, the Silver Buccaneers – the advisory board for PR marketing company, Silver Buck – had been discussing it within the context of driving innovation.
The board is made up of some of the most-reputable and experiences names working within the healthcare IT industry, including Jon Hoeksma, chief executive and founder of Digital Health; Richard Corbridge, chief digital information officer at Leeds Teaching Hospitals NHS Trust; and Matt Neligan, director of data transformation and operations at NHS England.
“I think it's almost oxymoronic: the idea that very large, highly-centralised institutions and bureaucracies – no matter how good the people within them – can deliver innovation,” said Hoeksma.
“The best they can do is remove some of the barriers for those that are closer and at the right scale to actually make stuff happen.”
Hoeksma is not alone in his criticisms of a top-down management culture within the NHS, with it often cited as the Achilles heel of innovation in UK healthcare.
However, there is a strong counter argument to the notion that all national organisations are restricting innovation by trying to deliver it themselves.
I believe that the best way to make a success of a team, is by giving them what they need, getting out of their way, and letting them deliver
“Our job nationally is more about trying to make sure that we're not a barrier to brilliant local innovation, rather than taking responsibility for making sure there is top-down driven innovation," said Neligan.
Nevertheless, and while some national organisations might well have begun to understand and recognise how best to foster and drive innovation in healthcare, the Buccaneers agree that the ‘centre’ can do more to maximise UK innovation by permitting and furthermore encouraging more ground-up solutions.
“We need to enable people on the ground to move away from command and control models of leadership,” says Yvonne Goff, chief clinical information officer at the Health Service Executive.
“We need to give them the bandwidth to be able to self govern and self organise.
“I believe that the best way to make a success of a team, is by giving them what they need, getting out of their way, and letting them deliver.
“Innovation is about engaging and empowering people who actually deliver healthcare.”
Of course, this isn’t a new idea – when empowered with the licence and ability to adopt their own healthcare solutions, local organisations can, and are, championing innovation.
Leeds Teaching Hospitals NHS Trust, for example, allows its clinical team to work closely with companies to deliver and refine new, innovative healthcare solutions.
“I think there's nothing better than allowing our clinical team a little bit of space to work in innovative ways with companies,” said Corbridge.
“We’ve had instances where, rather than paying a supplier, we’ve given them a member of our IT staff and an A&E clinician for one day a week. This has completely revitalised them and allowed them to deliver something that I genuinely believe will be huge for how they do stuff.
“Because they have real clinical experience on the frontline, they are able to test things out as part of each of their delivery phase.”
In fact, there’s a strong and growing number of professionals – operational, clinical and technical – rebuffing the more-traditional approach to healthcare innovation and saying ‘we want to do more than just take a product off the shelf’.
“From my experience, a lot of people actually want to go through that process of understanding that journey of the initial idea, right through to development,” said Dom Cushnan, digital programmes manager at NHS Horizons and a member of the panel.
These signs are encouraging, but they need to be sustained and furthermore encouraged by the ‘centre’ – which can, and invariably should, do more to maximise UK innovation.
Indeed, it's time to move away from a system whereby centralised institutions and bureaucracies make decisions on behalf of healthcare professionals, to one that takes more seriously their individual needs and requirements.
