Why you need a CIO on your NHS Trust Board

TL;DR: Every organisation is a technology organisation including NHS Trusts. 78% of NHS Trusts have no Board CIO and that needs to change.

Introduction to the Series

This is part one of a two-part set. The first part is setting out why you need a Chief Information Officer¹ on your Board and the second part is tips on recruitment, job descriptions etc.

This article is aimed at NHS Trust Boards, but I after finishing the first draft of this blog, I came across an article in Forbes which gives reasons Why CIOs Make The Perfect Corporate Board Members.

Photo of people sat round a meeting room table playing with lego
Photo of people sat round a meeting room table playing with lego

Why Bother?

In introduction to the University Hospitals of Northamptonshire Group Digital Strategy, I paraphrase Satya Nadella, the CEO of Microsoft, saying “Every organisation is a technology organisation” and I feel the health system is no different and as such requires senior technical leadership. I believe that to build a better, sustainable NHS will require digital and if you’re going to bet that big on digital in your Trust, then you’re going to need Board presence.

But if a Trust takes this decision, then the person on the Board can’t be sitting in a rebadged IT Director role. This needs to be different. I’m not going to be popular saying this, but I’d argue that one of the reasons only 22% of Boards have a CIO presence is that the majority of Boards have not had any exposure to anything other than that old school IT Director role, and don’t know they need any different. So this is a problem that needs tackling in two ways; 1) learning the difference between digital and IT and 2) expanding your horizons beyond NHS experience.

What is Digital?

You can’t do much better than using Tom Loosemore’s Definition of Digital:

Applying the culture, processes, business models and technologies of the internet era to respond to people’s raised expectations.

And this from Defra’s Myra Hunt and Harriet Green deconstructs Tom’s definition:

He lists 4 things: culture, practices, processes and technologies.

The first 3 of those are about how we do things. About the ways that people work.

Digital transformation means changing those working methods. It means: being more agile; putting users first; starting small and iterating from there, based on user research.

Expanding Horizons Beyond the NHS

This blog isn’t going to win me any popularity contests, but it needs to be said. If your only experience of technology professionals is existing NHS IT professionals then I’d wager that there’s a high chance that you’re less than enthused and don’t see many of them as potential Board material, or doing anything transformational. In the public sector, I’d say other parts of the public sector are doing this a lot better than the bulk of the NHS. There are some great examples of Good Services done by local government colleagues² that I don’t see as much in the NHS. Seeking to inject energy and passion for change, built on experience hard earned from elsewhere should be considered carefully and in some cases previous NHS experience may actually be a disadvantage.

What you’re missing by not having a CIO on the Board

Some people will say that reporting into a Board Director is sufficient. My research back in Jan 2021 showed that where I could find the reporting lines, the majority of senior technical folk in NHS Trusts report into the Director of Finance. There are a lot of enlightened Directors of Finance, but for the most part I’m convinced that to have technology reporting in through this route means that it will more than often be seen as an overhead and a cost to be managed down. I’d also suggest that through this route, the approach will be about IT, about boxes and wires and if you’re lucky cyber security.

Going back to my assertion at the beginning; if each organisation really is a technology organisation, who is there helping the whole board to become more tech savvy? Who is agitating that in order to respond to the opportunities of the future (for example see the Topol review), the culture, processes and business models will need to change. I’d argue that your average Director of Finance won’t be making that as their primary pitch — they’ve got too much on their plate already.

By not having a CIO on the Board, you’re missing out on attracting the best talent. Existing Board CIOs are not going to move to a non-Board position, so you’re immediately restricting your market. It is a strong message to the existing staff that there is a career progression from, for example the servicedesk to the Board room. Despite what I said earlier about attracting experience from outside of the NHS, there are some great people within. Sadly this year, there has been a notable exit of good technology leaders leaving the NHS (I could write a list), fed up of being denied the Board position they’re capable, denied through lack of vision and recognition about what the future NHS needs to look like.

Photo of a blocked road with a Road Closed sign
Photo of a blocked road with a Road Closed sign

Finally, there’s something important about having Digital at an equal heirarchy in the organisation. There’s a lot to do to challenge the rigid hierarchy of the NHS (and it’s rich coming from someone in a position like me), but I observe that to have a equal voice around the Boardroom, you need to be an Executive Director. So by not having that equality, we have to face up to the fact that Digital will not be given sufficient air time, budget or recognition, regardless of the quality of the delivery team.

So what next?

So at this point I’m hoping you’re at least warming to the idea that your Trust should move out of the gang of 78% and recruit to a board level position for a CIO/CDIO. If so, read on for part 2 — How to recruit your NHS Trust Board CIO.


¹ Or a Chief DIGITAL Information Officer or Chief Digital Officer. Just make sure it’s not an old school NHS IT Director.

² There are many examples of excellent Local Government Digital Services — notable are Croydon, Hounslow and Dorset.

Husband. Dad to 3 smashing lads. Cub Leader. MAMIL. Group CDIO for Northampton and Kettering Hospitals. Ex NHS Digital. Views own. Always learning.