Where are all the NHS Trust CIOs?

Over the course of a couple of months I’ve been researching the state of the NHS Trust CIO community and their representation on Boards. It is a concerning picture. If we are the body that represents the use of technology in the NHS, then collectively we are failing.

Photo of cat hiding (source: https://pxhere.com/en/photo/1216476)

TL;DR: Executive Summary

This has turned into a long piece as I’ve drilled into more data, so deserves a high level summary.

• Trust Boards are lacking technical representation. Only 22% of 226 Trusts have a CIO on the Board. Are Boards being made aware of the 2019 Topol review, which states that 90% of NHS roles will require digital skills in 20 years? So much will change through technology over the next 20 years, impacting on clinicians, operations, finance and strategy, so it is worrying that 78% of Boards are not preparing. It would seem that technical leaders in NHS Trusts are failing to publicly advocate why they deserve a role on the Board to support the organisation of the future.
• Having a CIO on the Board does not correlate to HIMMS levels. So far there is too little data to conclude if having a CIO on the Board is a higher indicator of achieving HIMSS EMRAM Level 6 or 7.
• Openess is poor. It is really hard to find out who the most senior person is in a NHS Trust, or what the reporting line is for them, save submitting an FOI. Of the 226 Trusts, it was not possible to find the name of the CIO at 45 (20%). Of the 173 Trusts without a CIO on the Board, it was only possible to find the reporting lines for 38 of them. How can this be right? CIOs, regardless of presence on the Board need to have public visibility, to be banging the drum for the opportunities presented by technology to solve problems, to be open to connections from other CIOs or suppliers. As my research into NHS Trust Cloud-First policies in 2020 showed, lack of being openess extends to strategies and policies too.
• General Digital Presence is lacking. Much of the NHS Trust CIO community are not shaping themselves or their organisation to work in a way appropriate for the internet era. Of the 169 names that I could find, 90% have a present on LinkedIn, 47% are on Twitter and 1.2% have personal/hosted blogs. Whilst this looks ok on first inspection, many of the LinkedIn accounts have minimal profiles, including lack of a photo. Things aren’t much better when you look into more detail on Twitter — there are only 22 CIOs with any notable Twitter volume. And as for blogging, there are only two of us. Shouldn’t it be expected that those charged with leading the digital transformation of the NHS are embracing the tools available and role modelling their use?

Conclusion: NHS Trust CIOs don’t have the public presence that starts to creates a compelling argument for Board representation. They are hidden on many fronts. The depth and pace of technological change that is coming to the NHS demands appropriate leadership representation. However, changing this is relatively simple. Just takes a bit of time and a modicum of bravery. Committing to sharing things Trusts are doing and spending time to open eyes to what other are doing is the first step. There are some good role models to follow and what a great start to 2021 this would be.

Who are the NHS Trust CIOs?

Introduction

This started off as a simple check on how many CIOs were on Trust Boards, but it developed over the course of a couple of weeks. My research methodology is shown at the foot of this article along with a link to the source data.

Image of coin operated binoculars (source: Wikimedia)

CIO Representation on Boards

Of the 226 Trusts checked, 22% (49) have a CIO or equivalent role on the Board. On the face of it, this is a pretty decent start, but if every organisation is indeed a technology organisation [paraphrased from the well-known Forbes article which originated from 2011], then this is surely a massive failure in two very much interrelated parts.

Firstly it would seem to indicate a widespread failure of technology leaders to articulate in understandable terms why technology is a vital component in building a better NHS. If this is the case then we have no excuse to moan about the lack of CIO representation on Trust Boards. The research that follows tells me that the primary band of people who should be making this case are in the majority, failing to do so by not being out there banging the drum for digitial transformation.

Secondly, Boards needs to move from leaving tech outside of the Boardroom, to becoming “tech-curious”. Not because it’s a nice-to-have, but because that train is coming and Trusts who are not prepared will slip further behind, in failing their patients and their staff. Are Boards unaware of the 2019 Topol review, which states that 90% of NHS roles will require digital skills in 20 years? So much will change through technology over the next 20 years, impacting on clinicians, operations, finance and strategy, so it is worrying that 78% of Boards are not preparing.

There’s a valid argument to say that Trusts won’t need a CIO on the Board in the future or that following in the vein of every organisation is a technology organisation and that There’s No Such Thing As a Digital Strategy, Just a Strategy in a Digital World. So I can see a time when technology is so deeply embedded in all we do that the role of CIO merges with Strategy or Operations, but there’s too much to catch up with and too much change coming in the next few years that my view is that it requires proper expertise at Board level to steer it.

CIOs not on the Board

There are 173 (78%) Trusts without a CIO on the Board. In trying to find out more, I was only able to find out the reporting lines for 38 of them, mainly through the information in FOI requests. Of those I could find, 61% report through the Finance line. There’s not enough data to determine if this is a wider trend, but I wouldn’t be surprised if it was.

So the first question at this point is why is it so hard to find the most senior tech lead in an organisation, and what their reporting lines are. Isn’t this the sort of thing that would be useful, to suppliers, to prospective employees joining the Trust and to internal teams? Of the 226 Trusts, it was not possible to find the name of the CIO at 45 (20%).

The second question is why finance? If digital transformation is route to build a better NHS, then having technology under strategy or transformation would surely be a better fit. Who is making those arguments in Trusts or is it all about shaving another few quid off an already underfunded IT budget?

Does a CIO on the Board correlate with Digital Maturity?

Does having a CIO on the Board make a difference to the achievement of the HIMSS Electronic Medical Record Adoption Model levels 6 or 7?

Only 7 Trusts have achieved level 6 or 7 in England². Whilst not all Trusts are interested in this method of assessment, it is an known and credible indicator of digital maturity.

• 3 of the Trusts achieving level 6 or 7 have a CIO on the Board.
• Of the other four, two don’t seem to have a CIO in place currently, one is an interim CIO.

So hard to draw conclusions from such small numbers. It could tell us that acheiving HIMSS Levels 6 or 7 can be achieved even if you have no CIO — but I suspect that those Trusts achieving the level have their CIO attracted away to other roles very quickly in that moment of high currency. What will be interesting to see if the progress can be maintained by those Trusts without leadership in place.

Spreadsheet of 7 Trusts achieving HIMSS EMRAM Level 6 and 7

Wot no Digital Presence?

Gif of someone searching with binoculars

Regardless of being on the Board or not, shouldn’t the most senior tech lead in any Trust be one of the most progressive in terms of a digital presence? Of the 169 CIOs whose names I could associate with a Trust, I looked for three public indicators:

• Present on LinkedIn — 90%
• Present on Twitter — 47%
• Personal/Hosted Blogs — 1.2%

Although the LinkedIn situation initially looks reasonable, too many of the profiles are without a profile picture, any network or any meaningful history. I didn’t note how many of the accounts had this kind of empty profile, but it was plenty. Yes LinkedIn is annoying and you get loads of sales people on there who fail to spend any time trying to understand what problems you are trying to solve BUT it is also a great way to network within the tech community. My view is that the CIO cohort should be one of the professions who are using LinkedIn to the fullest — making connections within and without the NHS, learning from each other and boosting our profession’s profile.

Image of a typically blank NHS CIO LinkedIn profile

The decline continues if you head to Twitter, with 47% (79) of CIOs with an account. However, many of these are rarely used:

• 9 people have not tweeted in 2020
• 48 have tweeted less than 500 times
• 4 are protected (private) accounts

However, there are 22 big hitters, with Ade Byrne smashing everyone with 17k2 tweets. But once again, of the 226 Trusts, if only about 10% of the senior tech folk are engaging with Twitter, it does not speak of a group seeking to exchange ideas and enter into debates.

CIO Top Tweeters Table

Finally onto blogging. Of course blogging isn’t for everyone, but for there two be only 2 of us in the 226 Trusts who blog about our work should be one of the most worrying indications of this research. Beth hasn’t posted anything since 2019 on her eponymous site, and nothing since 2017 on her other site http://www.howtochange.org.uk/.

CIOs who blog

It’s not like you need to install anything these days, and starting by posting a few LinkedIn articles would be a great step forward.

There are some CIOs are doing interviews in HTN or Digital Health, which is a good start, but I fear that too much of this is linked to marketing via supplier relationships and I suspect is not being drafted by the CIO in many cases. My view is that the primary source for people to find out what you think and what you stand for will not be via one of those articles.

Conclusions

NHS Trust CIOs don’t have the public presence that starts to create a compelling argument for Board representation. They are hidden on many fronts. There are not enough signs of striving to apply the culture, processes, business models & technologies of the internet era to respond to people’s raised expectations. Shouldn’t the most senior tech person in a Trust be continually pushing and agitating for applying new technology and developments to solve people’s problems?

Trust CIOs will clearly be doing a lot of internal communication and interaction, but relying on formal meetings is missing a trick. Shouldn’t Trust CIOs be using the tools of the internet era to communicate? Where is the Chair, the CEO, Non-Executive Directors or other members of the Board seeing evidence of the voice of the Trust CIO beyond formal interactions? When will Boards start to agitate for CIO membership unless they start to see the value it can add?

So where can you start?

Creating a vibrant professional network is a brilliant source of inspiration, knowledge and short-cuts to achieving the things our Trusts need. Committing to sharing things your Trust are doing and spending time to open your eyes to what other are doing is the first step. If you think you don’t have time to invest in your network, I’d challenge by asking do you have time to reinvent the wheel? Furthermore, having a good network will also allow you to have a triangulation point to reference against that amazing claim from one of your suppliers.

I’d encourage CIOs to:

• Update LinkedIn profiles fully, adding a photo and description of current role.
• Sign up Digital Health networks.
• Start engaging with Twitter, add a profile picture and include the name of host Trust in profiles. Follow the top 22 NHS CIOs Tweeters listed here. Start by committing to tweeting one personal opinion per 10 re-tweets or likes. It is personal opinion that makes the difference and adds interest and colour. Create an account with a [@[Name]CIO type handle if you feel the need to separate out your public and private life, but that’s not quite how the world works these days.
• Put a page on the Trust website that has the tech structure and reporting line to the Board clearly defined. This will save a lot of FOI responses, it might get you a few more sales approaches, but it may also get you some great new connections.
• Start blogging — some people create the articles using LinkedIn posts, which is a really simple way to get going. Others use services such as Blogger, Wordpress or Medium, there are loads to choose from. You are the expect on the things going on in your Trust — tell people about it, promote the article on Twitter and LinkedIn and enjoy the conversations that follow.
• Keep up the blogging. A site with a few ancient articles doesn’t give a great impression. Some people use Weeknotes as a discipline to blog regularly. I like this article by Steve Messer on why he uses Weeknoting. This article from Jenny Vass gives plenty of encouragement and this one from Sam Villis gives you some pointers on different styles to use.
• Start to make the argument with your Trust senior team that representation of the CIO on the Board is important for building a better NHS. And match that by upping your professionalism. Doing the same but for a bit less is not a model for the future, so you need to be ready to steer your Trust thought this change or prepare to report to someone who will.
• And finally, comment on this research. My methodology is open, the source data is open, but my conclusions may be wrong. It would be great to hear your opinion, especially if you have different interpretations.

Research Methodology

The data used is recorded on this spreadsheet. Please flag any errors.

CIO on the Board

1. Visit the Trust website¹, open the “About Us” or similar pages and find the list of Board of Directors
2. Review if any of the Executive Directors are Digital/CIO type roles.
3. I didn’t differentiate between voting and not voting members, but I did exclude those that attended Board, but were not Board members.

Name of CIO/Profile on LinkedIn/Who they report to

1. If the CIO on the Board search has not revealed the name, then Google [Trust Name] + CIO and [Trust Name] + IT Director.
2. This may reveal the name (search limited to page 1 of Google results). Check up on LinkedIn if available.
3. If there was an FOI linked to CIO names/structures, I took the name and reporting line from this — most Trust FOIs seem to come from someone called Kyle Preston who made FOI requests to pretty much all Trusts during 2018 and into early 2019. I can’t find anyone called Kyle Preston who seems to match the profile of someone who would be asking for this info.

Twitter Account Check

1. Google [Trust Name] + [CIO Name] + “Twitter” (search limited to page 1 of Google results)
2. View Twitter page if shown.

Blog Check

1. Google [Trust Name] + [CIO Name]
2. Scroll down page 1 of Google results for obvious blog site. Ignored articles on Digital Health and HTN etc.

Sources

¹ https://www.nhs.uk/servicedirectories/pages/nhstrustlisting.aspx (Downloaded 1 Nov 2020)

² https://www.himssanalytics.org/europe/stage-6-7-achievement (accessed 1 Jan 2021)