This @stianwestlake thread, on how all countries think they're uniquely bad at commercialising inventions, is heroic. People clearly overestimate their invention's contribution to overall progress. BUT in the case of the NHS's chaotic approach to innovation, the UK is guilty...
.. on two fronts. Firstly, the NHS approach to innovation is often "USE NEW STUFF". That's what the current govt are eagerly encouraging. But new stuff is often crap. It's only "innovation" if it works better than what we have. Otherwise its just a waste of money. Secondly...
..Secondly, the NHS's approach to IT is incompetent, and a spectacular missed opportunity for British industry. We have a near-unique opportunity: healthcare provided free at point of access, sure; but more than that, all through the same single administrative entity, t'NHS...
... We could be using this to light a fire under health IT that lights up the world. We could have dashboards, live interactive feedback, decision support tools, linked records, a machine for producing new evidence and optimising care, and more. Instead we squander. Why?...
...the full answer would take an essay, but here are some thoughts.
Firsly, look at the boards. there is almost NOBODY in the senior ranks of NHS England, NHS RightCare, NHS Improvement (did I imagine that one?), or the rest, who understands tech, evidence, computers, data...
Firsly, look at the boards. there is almost NOBODY in the senior ranks of NHS England, NHS RightCare, NHS Improvement (did I imagine that one?), or the rest, who understands tech, evidence, computers, data...
.. Here, take a look: lots of great managers, and people with other skills. I'm sure they're all smart as hell, but there are no nerds. england.nhs.uk/about/board/me…
This means the NHS is crippled. Those people can't be creative and fluent around tech. They can't swiftly spot...
This means the NHS is crippled. Those people can't be creative and fluent around tech. They can't swiftly spot...
... quick wins, they can't instantly dismiss bogus promises. The NHS cannot use IT because it doesn't have nerds at the top. This runs all the way down btw. Among e.g. NHS Trust "Chief Clinical Information Officers" there are some smart nerds (vastly moreso than NHS E board)...
.. but many CCIO's are just good smart clinicians with management skills / ambitions. What does this mean? It sets up a vicious spiral. The NHS outsources its tech. But omg chaotically. Patrician well-meaning old men spend huge sums on external tools, with one thought...
... "Nobody ever got the sack for purchasing IBM, Brian..." So we see billions on NPfIT going to Fujitsu-Siemens (the personal character story to this saga must one day be told publicly btw). And worse today. While all this happens, the NHS loses all it internal nerd skills...
... because the old men with grey hair, and their political overlords, have no way to judge quality, they think that shiny external organisations with brochures ("just look at those glorious brochures, Martin!") are better...
.. Now why is this shortsighted? Because the way you do IT today is by collaborative co-development. Agile development. Engineers who know your world backwards, working with people who know the problems you want solving (in the NHS: doctors, nurses, academics) but who ALSO know..
...how software tools get built, what is fast and what is impossible, how to have a productive conversation as part of a team that includes engineers, designers, UX wonks, end users, and more. We don't have that. Instead we have incompetent, chaotic "procurement". We have an...
.. academic "digital health" community who, when given tens of millions of pounds for "new stuff" spend it immediately on bigger datasets to do the same old-fashioned cookbook epidemiology and RCTs as before. We have a SoS in the form of @Jeremy_Hunt who, I believe, really..
.. does want to do something new and powerful with computers in the NHS but is so at sea, so badly advised, all the way down, that all he can point at is silly AI gimmicks, because there is nobody pointing out the obvious, which is... WHICH IS...
... it's a bit late. Should I go on? If this is boring I can go away and write it all in one place.
.. ok, I'm offline tomorrow so this is not the time. In short: we need an NHS Digital Service built on the model of the original GDS. We need an entryist cohort of nerd vikings to storm the NHS. We need exemplar digital projects using proper methods, to light the way. We need...
... pitiless but *constructively informative* takedowns of crap tools and procurement that show how things can be done better. All this will take time and salaries, which will be hard to find under the monopoly of the Brians, but we can do it, not just in spite of them...
... in fact many of them will join us. Anyway, I'm slowly pulling together some friends, and I know there are already groupings of sensible people elsewhere. Do email me if u want to chat, and if u can't find my email address on Google in seconds then we can't be friends.
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To recap and link back to the @stianwestlake thread: the NHS gets terrible IT because we have too few internal senior nerds, use bad methods, and fail to pick winners. Pick winners, and we'll create a fertile UK health IT ecosystem and industry that will change the world forever.
@stianwestlake .. But only if we reward effective innovation, rather than glossy brochures designed to impress men called Brian.
