Interview: Matthew Gould, chief executive of NHSX, on transforming health service technology

Difficult challenges

Gould was previously director general of the digital economy unit at the Department for Digital, Culture, Media and Sport (DCMS), where he was responsible for – among other things – the UK’s implementation of the EU’s General Data Protection Regulation (GDPR).

Further back, he’s been director of cyber security at the Cabinet Office, and director of the EU referendum unit. He was British ambassador to Israel for five years. This is not a civil servant who is afraid of a difficult challenge.

He has already completed a review of the various digital initiatives across the NHS, and shut down several. He has defined the 10 projects NHSX will particularly focus on, and he has laid out the five “delivery missions” for his new digital team.

Given that he hadn’t even started the job at the time, that’s a decent first day of work. Gould is clear that he knows his priority is to give patients and NHS staff the technology they need.

“I’m emphatically not coming in and saying, ‘We’re going to come up with a new solution, a new programme, start everything from scratch and solve everything’. I’m really clear that this is iterative,” he says.

“I am coming into the river midstream. We’re inheriting a lot of good stuff, but we are not going to have a huge new thing. We know what we need to do.”

Gould doesn’t want NHSX to be seen as some big, new central dictate, in the style of the infamous National Programme for IT that wasted £12bn in delivering very little.

Nor does he see the job as “letting a thousand flowers bloom” by allowing every one of the many hundreds of different NHS bodies to do their own thing. But he does want to establish standards, break down silos, and make all the disparate bits of technology work together.

“The most important thing that we will do is set rules so that our systems can talk to each other,” he says.

Equally, he doesn’t want NHSX to do everything. “I want to keep the centre thin. We will not do it all ourselves. We want to create platforms on which other people can innovate,” he adds, citing the NHS App as an example.

NHSX is the brainchild of secretary of state for health and social care Matt Hancock, who set out a new technology vision for NHS England as one of his earliest acts in the job.

The NHS Long-Term Plan, which sets out the 10-year spending priorities for the health service, promised to bring healthcare into the digital age. NHSX will lead that process, and aims to bring clarity to what is currently a confusion of digital leadership organisations.

“One major thing that is different is that [NHSX] can pull the levers. Previously, DHSC would come up with brilliant ideas and get money from the HM Treasury, before handing it over to NHS England to run projects. You had NHS Improvement running spend controls, and NHS Digital running a lot,” says Gould.

“It was [run], frankly, by very good, committed, brilliant people operating as well and as rationally as they could within that system. We’ll see how much difference it will make aggregating those things. But it should mean that we are able to align the programme money, spend controls, the mandates, policy, the ability to frame regulation or legislation and so on,” he says.

Managing expectations

Gould is treading the fine line between pitching a digital vision that promises to transform healthcare in the UK, and trying to manage expectations of both cynics and optimists.

“In a year’s time, perhaps, we’ll be able to see some changes. I hope in two years’ time, we ought to have some demonstrable progress. I’ve said I’ll do the job for five years, because I don’t think it’s something I can do quickly and run off to the next thing. In five years’ time, I would really hope that we’re starting to see something different,” he says.

Gould acknowledges the NHS is starting, even after so many past initiatives, from a difficult place. He tells the story of a visit to one NHS location where he hoped to see the systems they use, but it took so long to log in that he had to leave for his next meeting.

“We need to be able to help the system bring its tech up to scratch. There is no good me standing on a stage, whittling on about login times, if people are using 10-year-old laptops that are never going to be anything other than incredibly slow and clunky. If people are using kit that’s older than my children, that’s just not going to work,” he says.

“I’ve also been to NHS trusts where the network is unable to take the load for what we want to do with it or what they’re doing with it at the moment. The kit is crazily old, the buildings are falling down, and the trust is in deficit. Bandwidth to do digital transformation is pushed out by the need just to get through the day or the week or the month.”

Show us the money

When secretary of state Hancock announced his technology vision in October 2018, he was clear there would be no new money, and he expected NHS IT leaders to use existing budgets to deliver the standards, interoperability and common platforms he wants.

“Ultimately, I see this as a cost-saver once you get the standards in place, and it’s a cost-driver only if you’re implementing technology that doesn’t help you run a more effective and productive health system,” Hancock told Computer Weekly at the time.

Gould, however, acknowledges that NHSX cannot run from questions about money.

“In part, this has to be about money. This has to be about us making a case to the Treasury for why you can’t transform NHS technology on the cheap,” he says.

Gov.uk

“In part, this has to be about money. This has to be about us making a case to the Treasury for why you can’t transform NHS technology on the cheap”

Matthew Gould, NHSX CEO

“There will be an irreducible amount that it costs to upgrade kit across the system. We will need to do a good job persuading the Treasury that this is worth investing in because they’ve also seen the movie before, and they will need a lot of persuading that, this time, they can safely invest and that we will be able to show productivity gains, better outcomes, more patient safety, and so on.”

But in a cash-strapped health service, with serious staff shortages in digital and clinical roles, can he guarantee that any money he gets from the Treasury will be spent in the areas NHSX wants?

“In terms of a ringfence [for extra tech funding], I would love to see trusts being willing to decide that this is something really important,” he says.

“Again, I’m wary of sitting at the centre and saying, ‘You will spend this amount on tech’. What we need to do is make sure that boards have the capability and the confidence to engage on digital stuff.

“Some of them have lacked confidence, some lack expertise but understand its importance. We need to provide parameters and confidence for them that there are ways of doing it that will make an impact, and that we’ve been able to make the case successfully for money to help them do that.”

Culture change

Digital transformation, as the rest of the public sector will attest, is about more than just technology and spending power. Cultural change, in a massively federated organisation, is equally important.

Hancock told NHS executives in February 2019 that he wanted email to become the default method for communicating with patients – instead of paper. Even something as basic as that received a backlash from some NHS leaders.

“The email thing is really important because, to an outsider, it seems strange that this should be an issue,” says Gould.

“But then you dig into it and you realise, actually, there was a legitimate nervousness about patient data, as a result of numerous scares and numerous difficult episodes which made things harder, and attitudes developed, which made people very nervous,” he says.

“A large part of my job is going to be to make networks, to create allies, to find ways to bring people into the vision of what we’re trying to do. I don’t think there’s an easy answer. I’d love to say, we’ll put them all on a course or we’ll sheep-dip them all in digital technology.

“There are things we can do, but again it goes back to the soft stuff. There is going to be an awful lot all of building trust, building expertise, building confidence, helping people build networks. It’s the work of years, not months. I’ve seen it work in places. It’s about people and trust – it’s not about big programmes and technology.”

So is he the man to finally get NHS technology right?

“Please don’t call me that,” he says. But, like it or not, Matthew Gould is now the man in the hot seat and everyone is watching.