by Mark Dundon

From private sector board member to NHS CIO

Jul 09, 20148 mins

Making the transition from private to public sector has so far been a fascinating experience. I have been in position as CIO of the Yorkshire and Humber Commissioning Support Unit (YHCSU) for 12 weeks. My motives for considering and accepting this role were initially, and primarily, based on sentiment, after two of my children were saved by Sheffield Children’s Hospital many years ago, with a self-made promise that at some time in my career I would like to take a role to “make a difference and give something back”.

Years later, my career having progressed in to CIO leadership, I was headhunted in November 2013 to consider this new position. The letters “NHS” were the one thing that would catch my attention and consider a move away from a role that was very rewarding while leading technology transformation in an aggressively growing company like Plusnet. I started at the YHCSU in April 2014.

The Yorkshire and Humber Commissioning Support Unit (YHCSU) covers 16,000 square KMs in geography and has responsibility for a population of circa six million supporting 23 Clinical Commissioning Groups (CCGs). NHS England is undergoing massive transformation as an organisation. Simon Stevens has recently been appointed as the new CEO. In a difficult global economy, and austerity within the UK economy, a national health public service has its challenges with an annual budget of circa £120 billion which has remained flat in real terms while simultaneously having to absorb and accommodate an increase in demand; in short treating a greater number of patients in a growing population (birth rates and immigration) where people live longer and suffer from many different types of physical and mental illnesses.

As the NHS implements its reform commercialisation is high on the agenda; increase the quality of services whilst lowering prices through competition. Primary Care Trusts were previously responsible for both commissioning and providing services across all NHS entities. PCTs were consolidated and replaced by CCGs to commission and CSUs to provision. In April 2013 when CCGs and CSUs were formally created to replace PCTs there were around 100 CSUs attempting to formalise.

Some 25 were created as entities in April 2013 and since then there has been further consolidation through merger or alliance down to nine CSUs. CSU consolidation is representative of competition as CSU organisations look to strategically place themselves in positions of strength to provide services as demanded and needed by CCGs. Equally a CSU is not limited to providing services solely to its natural geographic region. The marketplace for a CSU is nationwide; a CSU can compete against other CSUs and tender for the provision of services anywhere outside of its natural habitat. A CSU has the freedom to specialise in particular service lines, or broadly provide all services. CCGs have the freedom to commission service lines for all of the entities that they are regionally responsible for (GP surgeries, hospitals, day and community centres, mental health etc) from any CSU, or indeed any private sector service provider, based on best value for money, or strategic relationships.

For a CSU to survive and flourish, the result is clear demand on leadership experienced in both the NHS with critical injections of commercial acumen from the private sector. The same is true for the demand on CIO leadership within a CSU. Incidentally understanding of a modern CIO role – disruptive, innovative technology leadership experienced with commercial acumen and business growth – within the NHS is limited. There are exceptions however. My own transition in to the CSU from the board of Plusnet is testament to the leadership of the CSU who sought headhunter assistance to recruit such a CIO.

I plan to share elements of my journey as I “make that difference” through technology leadership with commercial expertise, digitisation, transformation with Big Data in the field of BI, and innovation across technology, all of which will ultimately improve patient care, and assist the government’s agenda.

I also aim to provide insight in to my experience with a view to in many ways break down any barriers that restrict talent flow from private to public sector and indeed in reverse. For now I will share with you some of the more salient observations.

During transition I have been struck by the commitment of leadership and workforce within the CSU and within the CCGs. Motivation theory is a fascinating topic and it is one I enjoyed studying within organisational behaviour as I completed an executive MBA. On the whole those who I have met are genuinely motivated to make a difference and go above and beyond for that reason. There are no financial incentives such as bonuses. As I reflect on my own motives for moving I can understand. For the time that I am within the NHS my desire is to be positively disruptive with my own leadership across technology innovation and business growth to ultimately improve patient care.

There is a realistic and critical demand for a business intelligence service that adds real value to CCGs. CCGs have a real challenge with providing the best possible care across their health economy within a financial envelope being ever challenged. They need to understand how best to spend their money to make the biggest difference. The health needs of each local area covered by a CCG differ from the next. The opportunities for Big Data solutions pulling together many disparate sources of data across the health economy and then providing real intelligence to aid decision making are enormous, and actually, very critical.

Every CSU is under pressure to provide such capability. It is my view that it will be highly beneficial for the NHS nationally for a number of CSUs to innovate and come up with a viable product to service the needs for CCGs to ensure that there is competition. Where there is competition, customer value increases, price decreases. It will be difficult for private suppliers to break in to this market place alone as much is dependent on the local knowledge and expertise around the data, heavily controlled by information governance which private sector suppliers are restricted from.

It is this latter point that provides a CSU an opportunity. But the CSUs have to act, invest, and innovate. Due to such criticality this is one of the areas that I have spent a larger proportion of my time during the first three months in my new role. A CSU’s life span in my opinion will largely be determined dependent on its success or failure within BI. Business Intelligence cuts across every one of the other service lines provided by a CSU and needed by a CCG. If a CCG can’t obtain BI from a CSU, they are highly likely to commission other services lines from a CSU (or other entity) who can.

As there has generally been an absence of modern CIO leadership there is masses of potential to innovate.

I have seen evidence of advanced innovation and equally areas where modern technology have not yet been introduced. Desktop in the cloud provided across enterprise IT and in to doctor’s surgeries is an example of the former (fantastically quick to issue necessary software maintenance and updates remotely without the need for onsite engineers), while absence of unified communications capability is an example of the latter.

Immediately I have been able to make a difference through the introduction of unified communications, video conferencing and desktop collaboration tools. These are currently being trialled across our enterprise IT estate while also in trial to make a difference within multiple site GP practices. My vision is to push forward with further implementation to allow the whole estate across CSU, CCG, and front line surgeries and practices all able to communicate more efficiently on a common platform, whilst also looking for new channels to engage with patients (why couldn’t a patient video conference to a surgery from home?).

Already significant amounts of miles travelled (think mileage costs at on average 50p per mile with over 100,000 miles currently being travelled a month) and time on the road (think efficiency and productive time of expensive resources) have been saved around the 16,000 square miles of Yorkshire and Humber as this type of technology is being trialled.

The CSU market place is actually a very competitive one. CSU consolidation is testament to this. In 2016 there is an agenda for CSUs to “externalise” and formally move away from the NHS as a legal entity of their own ensuring that self-sustenance financially is critical.

There are actually some very bright and commercially aware NHS leaders contrary to general private sector opinion.

The NHS is undoubtedly a very complicated organisation, complicated in structure, complicated in governance, and from a technology point of view, containing many disparate systems which are currently prohibitive to Big Data initiatives restricting the ability of Business Intelligence to meet current demand.

While I spend time from my career within the NHS, it is my own goal and vision to positively disrupt and leave a trail of technology transformation that makes a real difference and I am genuinely excited about the opportunities to do so. The challenge will be to overcome organisational complexity, while delivering change and innovation to meet the immediate and future needs of CCGs and ultimately patients.