James Thomas has stepped down as CIO of University College London Hospitals (UCLH) and arguably as the most influential CIO in the NHS. But he is at pains to stress that he's staying with healthcare and his latest move is because healthcare matters so much to him.
I met up with Thomas in his last week at UCLH. The classic Mini pictures were still on the wall of his Warren Street, London office, and we looked back on his eight-year career in healthcare and the transformation opportunities available to NHS CIOs.
"Waiting targets are rising all over the place and three quarters of acute hospitals are in financial stress," he says of the deep pain the NHS is suffering. But Thomas and UCLH have demonstrated that despite bungling health policy from both major political parties over the past decade, strong leadership and innovative management can lead to improved health care.
"I can't believe it's been eight years. It has been a phenomenal journey. We have built two hospitals and a virtual training facility in that period," Thomas says of his three proudest achievements at UCLH. "It is an institute like this that gives you opportunities to stretch. Every year I have been here, we have grown by 10% as an organisation."
In the judging of the 2013 CIO 100, Richard Sykes, a former CIO, led a chorus of support from the panel. It applauded Thomas' attitude and influence on the vendor community and readiness to challenge, discuss and innovate with its suppliers.
An outsourcing strategy means that Thomas' IT staff consists of just 20, while 100 outsourced heads fill the Warren Street office and manage the technology essential to one of London's most important first responder hospitals.
Thomas delivered greater organisational flexibility, which allowed UCLH to move forwards and focus on innovations such as the Macmillan Cancer Centre. Opened in April 2012, the centre was a £100 million development between both the UCLH and, as the name suggests, the Macmillan cancer care charity. The building includes a hotel for patients and their partners, and a third floor ward devoted to teenagers, which has social areas, pool tables and computer games booths.
All of this has been made possible because of the collaborative nature of UCLH. Macmillan is not the only charity to commit to the centre; CLIC Sargent and the Teenage Cancer Trust also invested in the partnership.
UCLH and Thomas have a management ethos that is bold and prepared to embrace technology to improve the lives and processes of all involved, whether patient or carer.
"Patients receive a barcoded letter for their appointments," Thomas told CIO UK during a tour of the hospital.
"They present the barcode to the plinth computers on entering the centre. This is connected directly to the hospital administration system and the scheduling software is connected to the core patient records. When a doctor requests a patient's record this triggers the information screens in the building, which alert patients that their appointment is due and where." The system also reveals how to get to the room of your appointment. This is recognition of technology having a role in helping patients during a very stressful period of their lives.
UCLH collects information throughout this processes, too, so time stamps allow the analysis of how long doctors and patients need together, which will improve the scheduling and management of the centre.
All four intensive care units at UCLH went fully digital during Thomas' tenure. As the CIO, he was key to the expansion and improvement of the digital services and delivered through some outsourcing deals not seen in the NHS before. UCLH has a managed service telecommunications deal with Azzuri and an outsourcing agreement with CGI to operate its GE patient administration systems. The CIO 100 judging panel analysed Thomas' relationships and management of vendors and were impressed.
"I'm immensely proud of the team I've got," he says, looking back on his tenure. His successor, David Hill, has been head of business solutions at UCLH since 2012.
Thomas starts 2015 as for Atos, covering the UK and Ireland. Beverley Bryant, director of strategic systems and technology, NHS England recently told a major healthcare conference that there are over 200 major technology procurements going on across the NHS. "That is a challenge to the supplier market" Thomas says.
"I'm hoping that this role is an opportunity to talk to trusts across the country," he says of the role a vendor, led by a former CIO, can have in delivering real transformation to the NHS.
"Atos has done a lot of business change; it is the primary provider to the Olympics, which in Rio 2016 will be almost entirely operated from the cloud. That is a huge real-time challenge," he explains.
Real-time technology experience is something that Thomas sees as offering the NHS major opportunities.
"Atos did a lot of work for Gatwick Airport to mitigate against winter disruptions. That is completely relevant to health.
"Atos has significant managed services, outsourcing, security, infrastructure and analytics capabilities. Yet Atos has not brought its technology to bear at the Trust level. Its experience of information and infrastructure security in financial services is again compatible with healthcare. The cyber-security agenda in health is becoming very relevant. My biggest challenge will be to distil down all of this to a 'what we do list'," explains Thomas.
"One of the challenges of the health sector is the relationship with the vendors. The difficulty is that the vocabulary gets flushed down," he says of the mud-slinging that has gone on since the failure of the NHS National Programme for IT.
"For UCLH having a large provider is beneficial.
"We have to get intelligent policy statements," Thomas reveals, adding that it seems that there is an outbreak of common sense in Whitehall.
"NHS England says it needs a strong technology supplier base. The vendor community has been totally opportunistic," he admits. "It is now about the supplier market being involved in the professionalism of healthcare IT. That is all part of being a mature sustainable business," Thomas says.
"I'm convinced health as a service that will be totally agnostic of the facility will arise. That way the brand will be about the delivery and its analytics. The building will be insignificant; it will be like a Regus office. I think we are still stuck in a point where we prioritise mortar over clicks."
His vision is right on many levels, but sadly the parlous state of modern media and discourse means that constituencies expect to physically see a hospital, just as they do a Victorian fire station, and ignore the fact that the building could be repurposed and services improved.
Thomas has always had a passion for change, an excitement for what technology can do and a deep understanding of an organisation and its challenges. He sees service providers offering the Clinical Commissioning bodies distinct processes that could reduce costs and improve outcomes. As CIO Mark Dundun recently described to this title: "It is incredibly exciting, but it is not here today."
Thomas is also acutely aware that we face an election in 2015 and in his experience, even if a change from the current coalition is unlikely and largely unwanted, it will create a lag in policy and investment of between six and 12 months. But that doesn't mean there are not opportunities for major change across the country, according to Thomas.
"There are mid- to back-of-the-pack Trusts that could redefine health if they are brave and digital channels are the way to do that. I was in the USA in 2014 and I went to Long Island North Shores hospital. They serve a population of 11 million, but their digital and data assets outstrip their physical assets," he says of the juxtaposition with the UK's ties to its physical hospitals. "Doctors have moved to become informaticians and Long Island North Shores is offering a better health insurance to its population base. Health is all about data and resources, so it is a virtuous circle.
"When you look at the CEOs coming though, the CEO is a doctor and you are seeing a new age of CEO coming through that have grown up in a digital age and that is refreshing," Thomas explains.
"The amount of conversation, surprise and interest has been interesting," he says of the reaction by the healthcare technology leadership community to his decision to go vendor side.
"I love doing the CIO role and I'm not ruling out doing another CIO role, but there are not the CIO roles in health that give the opportunity I want to take up. I choose to be in health and that's a really big tie for me," he says of the sector he joined because of a family experience and his realisation that he could do more with his business technology leadership skills.
It is interesting that Thomas sees a greater opportunity to transform healthcare as a vendor than is available in the NHS. Willem Eelman, third in the CIO 100 the year Thomas was number one, also said as he exited the CIO world that boards are not giving CIOs the opportunity to deliver change. Eelman has returned to the CFO role, while Ian Cohen, also in the top three with Thomas has recently left the CIO role to become a non-executive director for the startup world.
"For the moment, I don't want to give up on health and I want one more crack at really pushing it forward," he says. Atos and the wider health leadership community want Thomas to remain involved in shaping the future of health informatics.
"I'm very proud of the knowledge sharing that has gone on. NHS England has requested that I remain part of it," he says. "I'm not leaving health, but I am leaving the NHS."