A time for reflection

I didn’t manage to write my 2021 Year in Review as life was just a bit too hectic, but with NHSX officially becoming part of the NHS England transformation directorate and retiring it’s brand yesterday, it feels like a good time to share some reflections that have been buzzing around in my head.

Organisational memory

I was very involved in the early conversations about establishing NHSX and why it was needed. I’d led the work to write the tech vision and had been involved in reviewing the operating model that was in place at the time. There aren’t many of the same people who were in those discussions still around in the leadership of NHSX, NHS Digital or NHS England so it’s easy — with all the challenges of the past two years — to forget some of the challenges that we faced at the time, and also to overlook quite how far things have moved forward.

We’ve learnt a lot of lessons during covid, but we can’t forget the lessons from the less recent past — from care.data, from the National Programme for IT, as well as from many programmes and initiatives that have been hugely successful. Designing our organisational future will require us to take a long hard look at what’s come before us because we can’t truly influence what we don’t understand. While we don’t want to be constrained by the past we do need to be prepared to listen to some uncomfortable truths from the people with the scars on their backs. Where we don’t, our critics will quickly and loudly set us straight.

Culture over structure

I’ve been in the health technology space for 10 years now, all of them employed by DHSC but with stints working in a joint team with NHSE and also embedded within HSCIC, now NHS Digital. In that time I have watched a lot of people get chewed up and spat out, some at quite close quarters. The time I spent establishing and delivering the NHS alpha and the programme for what is now the NHS website gave me a pretty good mauling of my own. The results achieved by the people that followed me — and that original, superb, team — have been rewarding to see but I won’t forget some of the painful lessons I learnt along the way.

Organisational structures and accountabilities are important to get right but they are never the whole problem and they will never be the whole solution. The culture of the leadership team(s) will have a significantly greater impact than any reorganisation or merger could ever achieve. It’s been with the announcement of NHSX’s future that I’ve really heard people talking about the culture that they want to keep and build on — one that is unhierarchical and open. NHSX has had its flaws but another thing I‘ve observed in recent months is an increase in humility, of acknowledgement that we need to deliver with and through others. We can not underestimate how much this culture means to people — there’s no going back to where we were.

A common purpose

The thing that makes me most optimistic for the next phase of this journey is that there’s a critical mass of people joining together from NHSX and NHSD, who are passionate, determined and experienced in why our work needs to be led by a deep understanding of people’s needs and that recognise it’s not really about the tech — it’s about service transformation, enabled by technology.

Most of the people working within our organisations are committed public servants, lots of whom have invested years or even decades into trying to make things better for staff, for patients, for carers — for all the people in this country who touch the health and care system. When you bring together the skills, knowledge, experience and networks of the thousands of people in NHSX, NHS Digital and NHS England and Improvement working on this agenda you have a force to reckon with.

We have a common purpose, and that’s why we’re here. Any organisational restructure needs to clear the way for us to better achieve this. It needs to be designed around removing the barriers. If we can keep our eyes focused clearly on the ‘what’ and the ‘why’ it will help us come up with better answers on the ‘how’.

Change is exhausting

I wasn’t actually around for the first year of NHSX because I was on maternity leave with my second child, and I’d thankfully managed to time my first baby to avoid the implementation of the last big restructure in DHSC in 2016/17. So I haven’t been as directly impacted by recent reorgs, and I’m sure one of the reasons I’ve stayed around as long as I have is because I’ve had those breaks to get fresh perspective.

I’m apprehensive about people leaving in the coming months, people who have just put in two backbreaking years responding to covid and who can’t quite face the merger process. I’ll do my level best to keep my own teams protected from the inevitable disruption and focussed on the huge opportunities that lie ahead. And I’m going to need to really actively think about how I build up and maintain my own resilience.

Embedding social care

One thing I’m extremely proud of achieving within my time in NHSX, and that really drives me, is the ever increasing focus on digitally transforming social care. I pitched to Matthew Gould, before the organisation existed, that NHSX’s scope should include social care, and he’s been a champion of this from the get-go. The commitment to continue pushing this agenda forward within the transformation directorate has been made loud and clear.

Because if we’re serious about joining up care, with the person at the centre, we can’t not do this.