Tough at the top

11 Aug 2008

Christine Connelly would seem to know all about difficult IT projects. When she joined Cadbury Schweppes as chief information officer in May 2004, the company was struggling with the biggest IT programme in its history.

Probe – standing for “project to realise the opportunities and benefits from ERP (enterprise resource planning)” – had started around 2000 and was meant to be complete by 2005.

However, as an official case study produced by consultants Capgemini and the company later admitted, “roll-out proved to be difficult and risky.”

Profits were hit in the regions where it was tried, including the UK. The system left Cadbury Trebor Bassett with a glut of chocolate bars at the end of 2005 that it had to discount the following spring; when people traditionally go on diets.

According to the case study, Connelly brought in Capgemini to create an IT infrastructure that would allow Cadbury Schweppes businesses to deploy IT services that met their business needs in a more gradual way. “The time had come for the IT function to stop playing extreme sport at the expense of the business,” she was quoted as saying.

A major project to impose a centralised IT system on a number of businesses operating under a single corporate banner. A project that over-runs, disrupts the business and eventually has to be re-thought.

On the face of it, at least, Connelly should find some similarities between her last job and her new one as the first chief information officer for health, which she starts on 22 September.

Nobody is underestimating the challenge ahead of her. NHS IT experts attach terms like “poisoned chalice” and “mega-difficult, mega-tough” to the new job, which the Department of Health says is about “delivering on the DH’s overall information strategy and integrating leadership across the NHS and associated bodies.”

Glyn Hayes for the British Computer Society and UK CHIP says one of her challenges will be to persuade the DH itself to take much more notice of information and IT requirements when formulating policy.

But the big issue will be to continue to move away from the National Programme for IT in the NHS’ model of deploying “strategic” solutions through local service providers. This is, officially, the “vision” towards which the NHS is working, even though the Health Informatics Review identified a need for more “interim” solutions.

At the same time, Connelly will need to get NHS organisations to invest in IT to deliver on business and clinical objectives. This may not be easy. In its formal response to the Health Informatics Review, the BCS argued that informatics had been “impeded” by a basic lack of commitment from NHS management.

However, Frances Blunden, who is scoping an informatics workstream for the NHS Confederation, argues that managers did want to invest in IT but had been prevented from doing so by “the well-known problems associated with the national programme.”

“One of the things we welcome from the Health Informatics Review is a more pragmatic approach because what we hear from trusts is that they need to be replacing systems and the programme has not done that.”

Blunden also argued that the DH’s decision to appoint a CIO “is a signal that this needs to be on board’s agendas.” Meanwhile, Connelly will also need to deliver on the Review’s recommendations to deliver better careers for informatics staff and information skills to other NHS workers.

“We wish her the best of luck,” says Dr Hayes. “We hope that she will want to work closely with those who have been involved in NHS IT for a long time. We are certainly here to help.”

Working alongside Connelly will be Martin Bellamy, who has been announced as the new director of programme and service delivery and head of NHS Connecting for Health. The DH says Bellamy will lead the agency and focus on “enhancing partnerships with and within the NHS.”

Where Connelly is an unknown quantity, Bellamy has a more familiar background; since 2003, he has worked for the Department for Work and Pensions, where his main role was chief information officer for the Pension Service.

He has also been involved with the DWP’s change management programme; another plan to introduce continuous improvement using Lean techniques and to drive up efficiency by providing people with information.

Bellamy’s DWP background will be shared by Gordon Hextall, who remains chief operating officer for NHS CFH. However, there has been some surprise that both jobs have gone to external candidates.

Indeed, one E-Health-Insider source was “really pissed off” that both appointees had come from outside the NHS, when a knowledge of the health service was one of the requirements in the job description.

A number of EHI posters have argued that one problem with Richard Granger, the director general of NHS IT appointed when the national programme was created, was that he did not understand the NHS “and now [the DH] are making the same mistake again.”

On the other hand, Blunden argues that “what is important is that [they] get familiarity with the reality of what it is like in the NHS, and the variety of it. Also, that with the increasing diversity of providers, [they] focus on standards and getting good standards for information governance in place.”

And Melissa Frewin, Intellect’s healthcare programme manager says: “NHS IT has faced some major challenges in recent years and we are pleased that Christine will bring experience from world-class organisations that have successfully used technology to support their business strategies.

“Martin brings a wealth of experience from the DWP which is widely recognised as a major innovator in delivering Transformational Government."

There is also relief that the two top jobs in NHS IT have finally been filled. Granger started to “transition” out of his post almost a year ago and finished work in January. Since then, health informatics and the national programme have been reviewed and an implementation plan is due in “the autumn.”

According to the calendar, late September is early autumn; so another question will be whether Connelly and Bellamy work with the timetable set for them, or have the implementation plans delayed so they can have more input.

On her profile on the LinkedIn networking site, Connelly, who worked for BP before going to Cadbury Schweppes, says she has “particular experience in a highly complex, adaptive environment, where the management of large scale change is seen as a foundation skill.” She will need to draw on all of it.

Lyn Whitfield

Reader's Comments

Bon courage!

14 Aug 08 22:24

I do wish our new uber-information-fuhrer the very best of luck.

Her personal challenge will arise, I suspect, from adapting quickly from an environment where standard solutions were to be applied universally to a single global business entity (I know it's not realy like that but at least the governance structures pretend it is and back you when necessary) to one where standard-ish solutions are to be applied to a heterogenous environment where the governance structures are against you. Fundamentally, the NHS has Trusts and Authorities with statutory remits to ensure local resources are deployed to best local benefit and value; they have an obligation to ensure that local interests override national interests if push comes to shove, even if individually they can see the "greater good" which may be served by the latter. Don't they?

Would I have preferred to see an insider appointed? No. It's difficult for anyone who has been around in the health or health information/IT world for a decent period to avoid becoming tribal, whether at the local, regional, national or even international level, and as a result thinking that if only all the other buggers would see the world like they do then all would be rosy. Being an outsider doesn't bring automatic immunity from this condition (ref. RG) but it at least offers the prospect of a degree of immunity.

We need leadership which recognises and embraces the essential diversity of the NHS whilst challenging robustly the non-essential diversity - cancer care is not diabetes management is not A&E, of course, but some of what passes for "clinical judgement" is little more than personal preference and local custom.

It would have been better to see someone coming in from an environment where diversity vs uniformity is a more deeply ingrained leadership and cultural struggle. But the biggest challenge lies in overlaying national/regional solutions onto an essentially federal organisation, and anyone who can crack this one will be my hero for life. I would bet as much on this person coming from a fast-moving-consumer-goods company as on a doctor or trust IT director. It's a big picture leadership and engagement thing, not whether someone understands HL7 or how the kidney works.

Yet another DWP appointee? What's in a name?

21 Aug 08 00:10

Lest we forget - Granger surrounded himself with ex DWP managers.

Installing IT infrastructure across Cadbury's Scweppes is a different kettle of fish entirely. The NHS is a loose confederation of increasingly independent franchises under one corporate logo. After all's said and done NPfIT, even post-Swindell, should be about business transformation ie change management not IT infrastructure.

IMHO the solution to the NHS's ills isn't a technical one it is a managerial one, we somehow need to make the massive investments in the NHS deliver improvements in patient outcomes. IT can support this process, but it can't deliver it.

Finally, what's in a name? What practical difference could giving Granger's replacement the job title of CIO instead of DG make (apart from, hopefully, reducing pay costs for the post by 50%)?

Don't forget the bottom of the pyramid..

21 Aug 08 09:40

Until they actually start - after the implementation plan has been developed? - it is hard to tell whether they will manage to make a success - whatever that means in this context - of the amended version of NPfIT. I, too, wish them luck and good fortune - which will be needed. It would be nice if they managed to evade the higher echelons and realise - as RG never did - that general practice IT is present, pervasive, mission critical - and at grave risk of destruction in two-thirds of England from the NCRS demand for single records in the form of the Detailed Care Record. Even application of logic would help - who *is* responsible for prescribing in this situation?