The NHS has been hit by a spate of high-profile digital departures in recent months. It began in 2018 when CIO Joanna Smith left Royal Brompton & Harefield for Qatari hospital Sidra Medicine and Cleveland Henry ended a six-year stint at NHS Digital to take on a new role at UKCloud, and the rate of departures has sped up this year.
In January, Juliet Bauer left her role as Chief Digital Officer at NHS England to join KRY, an online GP consultation provider. In March South London and Maudsley NHS Foundation Trust CIO Stephen Docherty moved to Microsoft, and in April Richard Corbridge swapped Leeds Teaching Hospitals NHS Trust for Boots.
The higher salaries on offer in the private sector are an obvious attraction, but this incentive has always existed, so why is it only having such a strong impact now?
Corbridge blames the digital brain drain on a failure to adequately fund and prioritise IT.
"Hospital systems have yet to make the connection between poor IT capability - slow machines, bad WiFi and password multiplicity - and investment decisions at board level and beyond," he says.
"In my last NHS role, I had a trust chair who got it, an executive who could see the need, but when it came to prioritisation digital was an expense that could be deferred to another day. Unfortunately, expectation of capability didn't go hand in hand with this decision from all parts of the executive team.
"The mantra 'IT is not free' needs to be still reiterated to every board in the NHS, digital ambition requires prioritisation and funding."
Corbridge believes that the damage done by chronic underfunding and a growing staffing crisis has led many NHS digital leaders feeling that remaining would make them complicit.
He argues that the government has overlooked the argument for a sustained programme of increased NHS funding made in the reports of both Sir Derek Wanless and Professor Robert Wachter, making the continuous drive to do more with less a growing risk to healthcare.
"We can't be complicit anymore," he says. "Maybe digital healthcare from outside of the system will be better funded and therefore truly an investment in the system!"
Long term plans
Corbridge is also critical of the NHS Long Term Plan that was launched in January. The 10-year strategy to improve the quality of patient care and health outcomes has ambitious goals for technology that will not be met without proper funding and support.
"A plan is only a plan when it has funding identified," says Corbridge. "Without that element, it's an aspiration or a business case. One of the key barriers to achieving the digital aspirations of the Long Term Plan will be to remove the lone hero mentality that the NHS has. The leaders that are leaving were too lonely in the organisation they were in.
"One of the leaders still fighting the good fight is Andy Kinnear [Director of Digital Transformation at NHS South, Central and West] in Bristol. He has led the way nationally - perhaps even internationally - in the professionalisation of the digital leadership role as a way of trying to ensure that the numbers of leaders ready to step in continues to grow.
"The digital chapter of the Long Term Plan needs more than the known CIOs at the top of the tree to ensure it is implemented - it needs to have a resource capability defined akin to some of the recommendations in the Topol review and the desires of organisations like BCS and CHIME to assist in the creation of a truly modern workforce, not just for the provision of care but for the delivery of technology to the health system."
This will of course require investment, which Corbridge worries is unlikely to come. He recalls that at a recent CIO and CCIO leadership meeting in London, a large number of digital health leaders were unable to attend because the trusts were unwilling to fund their travel.
"Trusts unwilling to send staff to the single most useful meeting of the year because of funding seems like a very limiting decision to make and certainly shows where the priority for digital exists in those trusts," says Corbridge.
Pathway to success
Corbridge believes that an efficient NHS needs to enable standardisation while offering the capacity for innovation and entrepreneurial experimentation, a combination that is currently elusive.
Part of the problem is the power struggle that exists between local NHS organisations and the central bodies, illustrated by the reaction to the "Axe the Fax" campaign.
"A desire is clear to empower local to deliver, but when local does deliver - as Leeds did with the Axe the Fax campaign - it takes a mountain movement for the centre to then assist in delivering this as a blueprint that others can use," says Corbridge.
"The lack of empowered people networks for sharing - something the centre could be best placed to provide - ensures that solutions like Axe the Fax can only be delivered via word of mouth! As digital leaders start to consider roles elsewhere this will bring the unofficial networks that deliver for the NHS to breakdown, a very sad outcome of these changes that can only be combatted by the next generation recreating their own networks."
Corbridge had spent 20 years in the public sector before moving to Boots. He had initially intended to stay at Leeds Teaching Hospitals for three years but left after 18 months, in part because he believed that he could do more from outside the NHS than he could from within.
"I was quoted at a recent event saying 'we can't do this anymore. If we believe in a healthcare system powered by digital then, maybe, we, the digital leaders, need to collectively leave, go out and - hopefully - come back with a new set of skills and a new way of influencing people'," Corbridge recalls.
"I still believe in this, but I also hope that when we do come back the system will also have seen, understood and begun to place the right priority on digital."