The “end” of NHS England is being interpreted as a problem or as a solution from various perspectives. That discussion certainly has its place, but the current situation should be also a moment of serious enquiry into the problems our organisation has.
Financial/budgetary considerations and wider policy directions led the UK Government to decide this enormous change, but these are not the only causes. We need to add to it both the perception and the evidence of NHS England shortcomings.
In that sense, it is good to review the organisational and strategy problems we experienced. Without diminishing the value of what has been achieved, we should not get trapped in debates around “public” versus “private” or “centralised” versus “decentralised” health services!
First, because the NHS was always a layered and complex combination of public and private services. And the organisation was never “separated” or autonomous in relation to the government bodies and initiatives. If we focus on the oppositions of “central” vs “decentralised” or “public” vs “private” we will obscure other problems that exist under all of those categories.
We would miss in particular issues related to the way we think and implement Technology. And it is the case that one of the crucial factors in long-standing problems of productivity and enablement of front-line staff has been the entrenched ways in which we introduce and adopt information technology.
Let me highlight one aspect to start: For decades, the NHS organisations (not only NHS England) have implemented technology in a modality that can be described as “Product-Centric Architecture.” The characteristics of the same are evident across our estate: we repeatedly implement “solutions” around “products” (around specific branded and packaged software and hardware). We install “silos” with low or zero interoperability. And we do that repeatedly, multiplying the costs and extending the time to delivery.
The table attached illustrates the issue, comparing Product-Centric with Requirements-Centric Architecture.
This tendency is prevalent at all levels of the organisation. It affects all types of technology, from clinical applications to national databases and systems. Among these, Identity and Access Management services are particularly affected by overspending and multiplication of services which overlap with each other.
A sincere and thorough analysis has to be done. And the result will show that it *does not matter* what path we take (centralised or decentralised, public or private, or a mixture of those) if we don’t fundamentally change how we select and adopt technologies. That is the mission of Enterprise Architecture.