EHI CCIO interview: Matthew Swindells

The case for all NHS trusts to employ a chief clinical information officer is “unanswerable”, says Matthew Swindells, the current chair of BCS Health. The problem is that it has not been made to the people who need to hear it.

“The NHS has not heard the case yet and getting the airtime is important,” he says. “That’s why we need EHI’s campaign.”

Meeting the Nicholson challenge

EHealth Insider is running a campaign to encourage every NHS provider organisation to consider appointing a chief clinical information officer to lead on IT projects and using information to improve patient care.

The case for this kind of role was made by both BCS Health and Cerner (of which Swindells is senior vice president and managing director for global consulting) in their respective responses to the government’s ‘Information Revolution’ consultation on a new NHS information strategy last year.

The information strategy never emerged, although it is now vaguely promised for “winter.” Even so, the case for CCIOs needs to be made now more than ever, Swindells argues from the vantage point of his sixth floor office at Cerner’s building in Paddington.

The NHS is starting to get into the business of delivering the £20 billion of efficiency savings that it needs to make over the next four years to bridge the gap between flat funding and rising demand and costs.

And it needs to make good use of IT if it is to meet the so-called ‘Nicholson challenge’ of delivering those savings through quality, innovation, productivity and prevention initiatives, rather than old fashioned “slash and burn.”

“The Nicholson challenge has divided the NHS,” he says. “One part says that information is the key to addressing that challenge; the other says it is a distraction from the key task of saving money. I believe very firmly that the former is right.

“When you look at organisations that have made huge productivity gains, there are two tracks. The first is to move your workforce to somewhere cheaper. From where I sit” - and he waves an arm towards his aerial view of ambulances arriving at St Mary’s Hospital in Paddington - “moving the workforce overseas is not an option.”

The alternative is using information, IT and process automation to make the workforce more productive where it is. “I think the NHS will undertake Herculean efforts to save money by doing what it does better,” says Swindells.

“But to deliver sustainable improvements over five years or ten to 15 years – because let’s face it, we are not suddenly going to get to a time when a government says ‘here is an endless supply of money’ – then it’s going to have to be using information technology and process improvement.

“All the evidence says that if you want to do that, you have to start with clinical processes and it has to be clinically led. One of the key strategic decisions that an organisation needs to take in order to get clinical ownership of this kind of transformation is to appoint a chief clinical information officer.”

Learning from the US

Healthcare systems in Europe and the US have succeeded in using IT, information and process automation to achieve astonishing turnaround; without alienating their clinicians and, indeed, by making their working lives better.

Swindells cites Kansas Memorial Hospital, which treats patients on state-funded programmes, as an example. “The chief executive runs the hospital on a financial knife edge, yet the hospital has made a significant investment in clinical systems.

“I asked him recently how he could afford it; he told me: ‘how could I afford to run the hospital without the technology to help me?’.”

Yet Swindells has made this case since he was chief information officer at the Department of Health in 2007-08. So why has it still not got through?

“I think there is a certain amount of cynicism in the NHS about IT being part of the solution,” he admits. “And I would say there is a certain amount of reason for that. Not enough has been delivered and it’s not been delivered fast enough.”

Yes, technology has transformed services and clinical practice (think robotics in surgery); but information technology has not. It has been perceived as too hard, something the NHS does not do well.

Swindells lays the blame for this at the doors of the National Programme for IT in the NHS’ emphasis on patient administration systems over clinical functionality. In his time as DH CIO, he suggested shifting the focus to ‘Clinical 5’ functionality, on the grounds that this would make information systems clinically meaningful and change patient experience.

He also admits to a failing by healthcare IT companies. Going back to his recent experience in Kansas he says: “Talk to the staff about e-prescribing and other systems and they say it’s brilliant and improves quality and safety. Ask them how it was to implement and they say that the first six months was an absolute nightmare.”

But then, implementing new systems is really hard, he adds. “The change involved is enormous and we have forgotten to tell that to the NHS. The idea that anyone has a system that is flawless, that you can plug in like a TV and it will work is nonsense.

“It is up to people to understand and improve and computerise their processes. If you computerise poor process, you get more poor process and more expensive poor process.” Hence the need, once again, for clinical leadership to ensure that processes and pathways are improved as they are automated.

Getting a job description in place

Swindells argues that when clinicians see the case for using information systems to improve the quality and safety of care, transform the patient experience and make their working lives better, they get involved. And this requires a CCIO who is clinically credible, has resource to do the job and feeds into the medical director at board level.

“I think doctors in the NHS would be up for this role,” says Swindells. “But only if they are empowered to make changes and are not just the front man.”

Such roles are emerging in the NHS in England, albeit in a nascent form. Swindells cites Oxford Radcliffe Hospitals NHS Trust and Imperial College NHS Healthcare NHS Trust as organisations that have appointed people to jobs that look like prototype CCIO roles and that are, significantly, paying attention to the need for clinical leadership as they prepare to implement big EPR systems.

But for the wider NHS to adopt the model, there are some pieces of the jigsaw missing. And this is where BCS Health comes into the campaign. Deputy chair Dr Justin Whatling is leading some work to develop a job description and person specification that should help trusts and prospective CCIOs thrash out new roles.

“My belief is that [CCIOs] have to be under the medical director not the IT department,” says Swindells. “They need to have proper responsibilities and the information to do the job well. They need to remain in a clinical role to have credibility but equally they need the time to do the information role.”

He adds: “Hospitals find time for doctors to lead on junior doctor training and they need to find time for them to lead on IT too.”

Not just for geeks

So if every trust were to appoint a CCIO, would there be enough doctors with the skill to do the jobs? “These jobs are often done by doctors who are fascinated by technology and keep up to date, and they are often seen a geeks,” admits Swindells. “We cannot – and should not – rely on every organisation having such an individual.”

Instead, we need people who are “proper, practicing doctors and nurses with a good idea about how technology can help them,” he says. There is a role for the BCS in developing training to support such people, he adds. “We need to get away from the idea that this is a job for geeks.”