NHS IT needs open leadership

The loss of leaders on the world's biggest civil IT programme is beginning to make a mockery of the phrase "public sector...

The loss of leaders on the world's biggest civil IT programme is beginning to make a mockery of the phrase "public sector accountability".

Lord Hunt, a pioneer of £2.3bn national programme for IT in the NHS, was the first to go. Then another of its pioneers John Pattison, announced he was retiring.

Pattison was the programme's senior responsible owner - a role created, in the main, to ensure that the same person sees a complex plan through from conception to the delivery of benefits.

Now one of his successors as senior responsible owner is to go. Aidan Halligan shares the title with Richard Granger, director general of IT in the NHS.

Halligan's job has been one of the most challenging in the national programme: to gain the buy-in of clinicians. So where does his untimely departure leave the whole strategy?

Medical staff and technologists support the aims of the programme now as ever. They want standardisation. They want antiquated technology to be replaced. They want centralised electronic health records. They give their full support to the charismatic Granger.

But the programme has reached a low point. Trusts are beset by uncertainty. Wirral, on which we report this week, is not the only health community which is forging ahead with a successful local health strategy.

GPs have voted not to engage with the programme until their concerns are addressed; and trust IT directors wonder where they will find the money to implement national systems, fund training and manage changes. The British Computer Society has warned that costs may be escalating.

Meanwhile, health officials continue to talk about the programme as if it has not a hair out of place.

Good leaders need opponents. Unquestioning supporters may push a project into disaster. Opponents show where the dangers are. If the national programme is to be saved, and hearts and minds won over, its leaders must be more open.

The programme is huge. Much will go wrong - inevitably. Officials should talk openly about these difficulties. They should not simply announce that the national programme has gone live. They should say where, what the issues are, how they are being overcome, and what lessons can be disseminated.

US president Theodore Roosevelt once described the difference between a leader and a boss. "The leader works in the open, and the boss in covert." If the national programme is to come through its credibility crisis, it needs now, more than ever, leaders to live up to Roosevelt's ideal.

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