The last month has seen the impending departures of NHSE’s transformation director Tim Ferris, chief operating officer, Sir David Sloman and chief nursing information officer, Natasha Phillips. Rachel Murphy summarises a frank and honest discussion with the Silver Buccaneers advisory board to discuss the impending implications for health tech.

Tim Ferris’ focus on the convergence of clinical systems left some perplexed, and there’ll be a collective sigh of relief from many as they avoided entangling themselves in his enthusiasm for Epic. In times of upheaval, we want the centre to demonstrate leadership through simple action that avoids confusion. In recent months, it was said that this had been in short supply.

If the vacant director of transformation role is to be filled permanently, it is unclear who will step in. Ideally, it would be someone with an inside understanding of the issues at play. It will not be easy; there are poisoned chalices, and then there’s this gig!

Power vacuum looms

The centre must take swift, decisive action on priorities and ensure that the funding materialises. While Tim works his notice, Vin Diwakar steps in as interim. Vin is known for being a reliable pair of hands and will no doubt look to keep things on an even keel.

However, the power vacuum over the coming months is concerning – symptomatic of a tendency towards ‘interimitis’ within the NHS, where decisions are scarcely made, and responsibility is rarely taken. We can ill afford to lose the momentum for digital health that flourished during the pandemic.

The forthcoming general election renders such decisive action less likely, as both main parties battle to appear the least offensive to the electorate. Labour’s plan for building an NHS fit for the future came after our discussion, but it was clear Sir Keir Starmer’s plan is to be reassuring rather than revolutionary.

David’s departure is a tremendous loss. He possessed intelligence, competence, and a wealth of institutional memory that is increasingly rare. He follows Tara Donnelly and Natasha Phillips on the way out, and undoubtedly, many more will follow suit. This includes the 9,000 individuals set to be lost by NHS England and those in integrated care boards which fall victim to demoralising budget cuts of 6%.

The brain drain could delay progress

In struggling organisations, talented individuals find it easy to depart – particularly when asked to make substantial cuts to existing programs within an atmosphere of mismanaged decline.

Consequently, we face the possibility of an uncertain future with diminishing institutional memory and the looming possibility of having fewer people in the system with the power to effectively deliver.

The perils of this line of thinking become evident when discussions turn to the NHS App, something personally close to my heart. Health leaders now contemplate adopting a native app approach without the valuable insights gleaned from conversations held since 2016 examining the app’s architecture and design. We decided against this route for valid reasons.

When people fail to grasp this historical context, combined with the ongoing brain drain from the centre, there is a significant risk of reinventing the wheel, experiencing the same failures, and squandering another £4 billion in the process.

Technical knowledge essential

As has been astutely observed, there is unfortunately a deficiency in technical understanding within the NHS. Retaining individuals who can deliver is imperative, and technical insight is gold dust that the NHS cannot afford to let slip through its fingers. Otherwise, ill-advised decisions from well-meaning generalists will result in impulsive investments that repeat past mistakes.

On a positive note, health minister, Lord Markham demonstrates a solid commitment to establishing priorities, regardless of who occupies the digital driving seat. He advocates for increased system leadership and holds more meaningful conversations with the industry. This is an encouraging signal that the voices of those operating within the system will be heard.

Direct engagement of this nature is indispensable; otherwise, the NHS will continue to haemorrhage talent and undo the progress achieved in recent years.

Find out more about our Silver Bucanners.