The NHS is going through another seismic reorganisation and the future of the IT agency, NHS Connecting for Health (CFH), is under question. Nobody seems to know where it will fit in the ‘future state’ or even whether it has any kind of role at all. Setting aside the half-arsed way that the government has gone about this reorganisation and the woolly-minded thinking that underpins it (I know, that’s setting a lot aside), a question has arisen about the re-branding of the organisation in order to ditch what is perceived to have become a discredited brand.
This is not new. Part of the legacy of Christine Connelly’s time as Department of Health CIO is that of brand confusion. CC was keen to incorporate NHS CFH into what she termed the DH Informatics Directorate, but found that she couldn’t because the lion’s share of the organisation’s staff are NHS employees. Although CFH is an ‘executive agency’ of the DH, in practice it operates as an NHS body and not as part of DH. So when it came down to it, the Technology Office happily rebranded itself as DHID, but the rest of the organisation remained as CFH in the absence of a clear steer from above.
A large part of wanting to subsume CFH into DHID was connected to the perception that the CFH brand had become contaminated, and on this score, there is considerable ‘form’. Historically, the Information Management Group (IMG) brand had been ditched for similar reasons and the NHS Information Authority (NHSIA) set up to replace some of its functions. The bolt-gun was applied to the metaphorical head of the IA for similar reasons as what was then NPfIT (National Programme for IT) came into being. Even CFH was cooked up in part because the NPfIT brand was starting to look rather tatty after only a couple of years in existence.
Now I want to make it very clear, I hate the name NHS Connecting for Health. Part of that hatred stems from the supposed origin of the name in a competition run at the time which supposedly evaluated a number of options. I don’t believe there was ever a real competition, and this was just a smoke-screen to make CFH employees feel they were all contributing to naming the new baby. I think the name was actually concocted at the highest levels with the very political intention of 1) avoiding any overt reference to information or IT lest it turn off NHS managers and clinicians; 2) get over the idea that we’re working to connect the NHS and what a jolly good idea that is. Frankly this is patronising tosh and anybody with half a brain in the wider service will see it for what it is, and very soon make the connection that CFH is about IT.
On top of that, it’s very true that the brand has become contaminated and that CFH has a very poor reputation across the NHS and with the national media – both specialist and generalist.
So why wouldn’t a rebranding help? Well for a start, the organisation does not have any kind of plan to address its manifold shortcomings, although the even bigger challenge is to carve out a viable niche for itself in the new NHS. So no idea what its role and purpose is, and no plan to tackle its shortcomings, which means no chance that this particular leopard will be changing its spots any time soon. That being the case, a rebranding right now would only serve to generate more cynicism in the service about the IT agency and lead to another contaminated brand that will need ditching in a year or two’s time. To bastardise Shakespeare: ‘a turd by any other name…’.
So what to do? I think the example to follow has to be Skoda. Not that long ago, this was a contaminated brand too – a national joke in this country and elsewhere, despite the firm’s enviable record in rallying and proud history of innovation and engineering skills from way back. So would it have helped to rename the company Adoks back in 1988, or would comedians have just tweaked the punch line to their crap car jokes? Probably the latter.
So instead, they set about changing the company: becoming part of the VW Group and rebuilding it around a couple of basic but well engineered products- the Fabia and Octavia – using VW technical platforms. It’s taken a long time, but twenty years later, nobody is telling Skoda jokes anymore unless they want to look out of date. And there are plenty of their cars on British and other European roads. Czech-mate I’d say.
So CFH should follow their lead – concentrating on a focused set of reliable products and services which it can use to build a new image based on a track record of successful delivery. Then in five years time, when perceptions of the organisation have been changed by actions rather than words, that is the time to consider changing the brand.
Friday 16 December 2011
Informatics - not so very NICE
In the HSJ a couple of weeks ago, Alistair McLellan wrote a very good article in praise of the leadership of NICE, rightly attributing a large slice of that organisation's success to the combined efforts of Andrew Dillon and Michael Rawlins.
The article got me thinking because many of the issues that McLellan raised as contributing to their successful tenure at the head of NICE are exactly those that have been absent from leadership in informatics. You could say the comparison is unfair because NICE was established on a very different footing to either the NHSIA or NHS CFH, but I tend to agree with McLellan that there are things we can learn from their approach.
Firstly, there has been continuity of leadership with both Dillon and Rawlins being in post for more than a decade. Not only that, but they appear to have a cast iron working relationship. We have had three informatics leaders in less than ten years, but each has adopted a different job title and sought a different working relationship with the DH and NHS. In all cases there has been a dislocation between informatics leadership (firmly on the DH side) and the delivery agency (less firmly, but in practice on the NHS side). This is still the case with Katie Davis, now the MD for Informatics.
Secondly, there has been little clarity of purpose, with even the initial four pillars of NPfIT being augmented with additional responsibilities and deliverables. As long as I've been involved there have been problems with basic portfolio management, with senior leadership failing to exert much authority over the organisation's business. The almost constant rounds of questionnaires and forms that programmes have been asked to complete documenting basic details like deliverables and costs seem to indicate not only a senior leadership with no handle on current activity, but also one with no organisational memory.
We have been through a couple of attempts to assert some basic ground rules with the DH, based on the (in my view) flawed assumption that the DH represents the 'head office' of the NHS and therefore the top of the business. It has also been assumed (again incorrectly) that DH officials understand that they need to formally commission the Informatics Directorate to deliver work and to back this up with business cases and funding streams.
I believe that a lot of the woolliness around the fundamental relationships with both the DH and NHS arise from the lack of direct NHS knowledge in the senior leadership team. It's no surprise that at NICE both Andrew Dillon and Michael Rawlins are both long-term NHS people. Informatics on the other hand has had the dubious benefit of 'expertise' from the private sector where the relationship between corporate head office and wider organisation is far more straightforward.
One of the keys to NICE's success and acceptance has been that its guidance is not mandatory, thus avoiding direct conflict with NHS organisation's own decision making processes and autonomy. Contrast that with the heavy-handed and ill informed imposition of IT systems on an NHS with widely varying levels of enthusiasm and commitment.
Finally, there is something to be said for the personal style of the individuals involved. Neither Dillon or Rawlins at NICE are bigger than the organisation itself. They never became the story. Yet both are highly competent media performers striking a calm, measured and precise note in interviews. Again, constrast this with Richard Granger's pugilistic style and infantile management speak, or even Christine Connelly's tortured Scottish accent and excessive control freakery. Katie Davis apprears upbeat, but it remains to be seen whether she can project a more clear-headed and rational voice than her predesessors.
So the bottom line is, yes, informatics could learn a hell of a lot from an organisation like NICE. Unfortunately, there's no indication that those in authority in the DH have recognised this.
The article got me thinking because many of the issues that McLellan raised as contributing to their successful tenure at the head of NICE are exactly those that have been absent from leadership in informatics. You could say the comparison is unfair because NICE was established on a very different footing to either the NHSIA or NHS CFH, but I tend to agree with McLellan that there are things we can learn from their approach.
Firstly, there has been continuity of leadership with both Dillon and Rawlins being in post for more than a decade. Not only that, but they appear to have a cast iron working relationship. We have had three informatics leaders in less than ten years, but each has adopted a different job title and sought a different working relationship with the DH and NHS. In all cases there has been a dislocation between informatics leadership (firmly on the DH side) and the delivery agency (less firmly, but in practice on the NHS side). This is still the case with Katie Davis, now the MD for Informatics.
Secondly, there has been little clarity of purpose, with even the initial four pillars of NPfIT being augmented with additional responsibilities and deliverables. As long as I've been involved there have been problems with basic portfolio management, with senior leadership failing to exert much authority over the organisation's business. The almost constant rounds of questionnaires and forms that programmes have been asked to complete documenting basic details like deliverables and costs seem to indicate not only a senior leadership with no handle on current activity, but also one with no organisational memory.
We have been through a couple of attempts to assert some basic ground rules with the DH, based on the (in my view) flawed assumption that the DH represents the 'head office' of the NHS and therefore the top of the business. It has also been assumed (again incorrectly) that DH officials understand that they need to formally commission the Informatics Directorate to deliver work and to back this up with business cases and funding streams.
I believe that a lot of the woolliness around the fundamental relationships with both the DH and NHS arise from the lack of direct NHS knowledge in the senior leadership team. It's no surprise that at NICE both Andrew Dillon and Michael Rawlins are both long-term NHS people. Informatics on the other hand has had the dubious benefit of 'expertise' from the private sector where the relationship between corporate head office and wider organisation is far more straightforward.
One of the keys to NICE's success and acceptance has been that its guidance is not mandatory, thus avoiding direct conflict with NHS organisation's own decision making processes and autonomy. Contrast that with the heavy-handed and ill informed imposition of IT systems on an NHS with widely varying levels of enthusiasm and commitment.
Finally, there is something to be said for the personal style of the individuals involved. Neither Dillon or Rawlins at NICE are bigger than the organisation itself. They never became the story. Yet both are highly competent media performers striking a calm, measured and precise note in interviews. Again, constrast this with Richard Granger's pugilistic style and infantile management speak, or even Christine Connelly's tortured Scottish accent and excessive control freakery. Katie Davis apprears upbeat, but it remains to be seen whether she can project a more clear-headed and rational voice than her predesessors.
So the bottom line is, yes, informatics could learn a hell of a lot from an organisation like NICE. Unfortunately, there's no indication that those in authority in the DH have recognised this.
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