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.
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