Five key challenges to be tackled by the next NHS CIO

Christine Connelly's departure as CIO from the Department of Health comes as the NHS faces huge challenges. We talked to experts in NHS IT to identify the top five challenges facing the new health CIO.

Christine Connelly's departure as CIO from the Department of Health comes as the NHS faces huge challenges - a major reorganisational shake-up; £20bn worth of cost savings to find; IT problems from past contracts; and drives to push forward a digital agenda. Needless to say, there will be much to keep interim CIO Katie Davis and the next permanent IT chief busy.

We talked to experts in NHS IT to identify the top five challenges facing the new health CIO.

Bringing the NHS into the digital age

Speaking at the Health Informatics Congress 2011 conference earlier this year, health minister Andrew Lansley said he wants an online presence for the NHS which ranks highest in the world. "This is what the information revolution is about - capturing the data and using the imagination and creativity of clinicians," he said.

Around 80% of face-to-face interactions with the NHS are unnecessary, he said. Moving just 1% of those meetings online would save the health service around £250m a year.

Matthew Swindells, chair of health at the British Computer Society, agrees that the new CIO must keep up with the digital agenda. "The government has declared its commitment to information transparency. The department has a huge amount of information that is released under freedom of information (FOI) requests, but it ought to take the view that anything under FOI should be made available to the public by default," he said.

Moving services to be digital by default is another area that the department must push forward. "This is about empowerment of patients and also means we can start moving information around without having to build and implement multiple systems," said Matthew Swindells.

But the British Medical Association (BMA) has argued that the NHS lacks the funding to support government moves to give patients increased access to personal records.

Sort out the CSC contracts

The contracts with CSC under the National Programme for IT are a major sticking point for the Department of Health. According to a recent National Audit Office (NAO) report, two systems would have to be rolled out by CSC every month until 2016 if it was to deliver on time. So far, just three are up and running.

In a recent interview with Computer Weekly, Christine Connelly said: "We agree with the NAO's conclusion that the outstanding CSC contracts cannot deliver as they stand. We have been in significant negotiations with CSC for some time and we believe there is something that can be constructed out of that to drive value, but all options are being considered. That decision needs to be made across government." Concluding the contract renegotiation with CSC is likely to be the first and most immediate challenge facing the department's next CIO.

But the new IT chief must not concentrate on simply clearing up the mistakes of the past, says Wrelton. "The new CIO has to pick up strategy straight away and unfortunately does not have two years to do that. I think the challenge is to map out what is urgent without getting bogged down in contracts from the National Programme for IT [NPfIT]," he said.

Opening up contracts to more suppliers

Lansley recently said the government must break away from complicated, billion-pound contracts and open up deals to more suppliers. "We do want to open the IT market up to any provider, large or small, which can help deliver better care for NHS patients," said the health minister.

David Chan, director of the Centre for Information Leadership at City University London, agrees. "It is absolutely vital that big state organisations do find ways of opening up to SMEs. The notion that systems integrators do everything is not in the public interest," he said.

Chan believes the key is to create a clear set of data standards for SMEs: "The new CIO needs to set out data standards to help create new markets. Interoperable data standards will help small businesses in building things like apps. This would also be consistent with the government's transparency agenda. For any new incumbent, the key challenge in health is that they cannot do anything more than steer and recommend."

Engagement with medical professionals

A lack of consultation with medical professionals in the NHS has been a major criticism levelled at the NHS IT Programme in the past. The new CIO's vision for IT must be driven from the views and experience of people who actually use IT in the NHS, says Chaand Nagpaul, a GP and member of the BMA's working party on IT.

"The new CIO needs to put into practice their stated intent for politicians not to be determining NHS IT policy. We need to avoid scenarios of the past and enable professionals to be able to respond to proposals," he said.

Navigating organisational changes in the NHS

In her resignation statement, Connelly alluded to new roles being created in the NHS following the department's reorganisation. "I have been reflecting on whether I wish to go for one of those roles and decided that I will not," she said.

It is currently unclear what this means in the long term for the role of CIO at the department. But the NAO has already expressed concerns about the impact the controversial structural changes in the NHS will have on IT and who will oversee implementation of the final stages of the NPfIT, with 10 strategic health authorities responsible for the programme's implementation locally due to be terminated before the completion of contracts.

Tola Sargeant, an analyst at TechMarketView, says the shake-up could hinder the ability to push through change. "The challenge of the NHS reorganisation is what that might mean for technology - inertia I suspect. I'm not suggesting IT is put ahead of patient care, but it is important that IT is not only seen as a cost that has to be cut," she said.

Sargeant says that investment in targeted areas of IT, such as allowing patients to self-monitor from home and providing mobile technology to doctors on home visits, could deliver a huge payback and release funds for frontline care.

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