Interview: Sarah Wilkinson, former CEO, NHS Digital

The bureaucracy burden

Like most public sector organisations, you can’t get away from bureaucracy in the NHS. The public sector, but especially the NHS, is a complicated beast with countless organisations, each with their own budgets, priorities and responsibilities.

This has been strongly felt at NHS Digital. Originally created as the Health and Social Care Information Centre (HSCIC) in 2013, the organisation was set up following former health secretary Andrew Lansley’s reform of the NHS, separating policy, delivery and commissioning.

“People have worked really, really hard to make progress in the last few years...but many of the day-to-day challenges that hamper productivity arise from structural complexity”

Initially, it was responsible for infrastructure and contracts around data collection and analysis, but as the organisation continued to develop, it was renamed NHS Digital in 2016 to better reflect its status as the NHS’s technology organisation.

However, its exact role has been confusing, both for those inside the organisation and those outside it. It did not improve when the, now former, health and social care secretary Matt Hancock launched a new technology organisation, NHSX, to lead on NHS technology strategy.

While the digital agenda has been at the forefront of the NHS transformation in recent years, with ministerial backing, what hasn’t changed, Wilkinson says, is “the structural confusion, the organisational complexity, the weakening of responsibility and the lack of strategic consistency at the centre over the past few years, which has been exacerbated by the existence of too many organisations with unclear and sometimes overlapping responsibilities and occasionally even different agendas”.

“The NHS is full of amazing people who will wizard navigating organisational complexity, and they get things done for the benefit of patients, despite the complexity of the system,” she says.

“It’s certainly been the case in the digital part of the system that lots of people have worked really, really hard to make progress in the last few years and have kind of tried to look through and look beyond the structural complexity to do that. But there is no doubt that many of the day-to-day challenges that hamper productivity arise from structural complexity.”

Coping with a pandemic

While NHS Digital has always had a huge workload, nothing could prepare Wilkinson or any of her staff for the Covid-19 coronavirus pandemic.

One of the positives the pandemic brought was that those structural complexities became less important. “During the pandemic, so much of that structural complexity and bureaucracy simply fell away. It just didn’t really matter. It was more about getting things done. In a way the raw potential of the system was revealed and all its riches,” says Wilkinson.

“I’ve been so blessed with the team at the top of NHS Digital. They’re not just competent, capable and extraordinarily hardworking. They’re also a fantastic group of people. We’ve got on brilliantly and we’ve got on with the job brilliantly. I’ll really miss them”

Sarah Wilkinson, former NHS Digital CEO

With an NHS stretched to the limit, NHS Digital felt the pressure, particularly as technology was suddenly seen as the holy grail, even by previous sceptics. In a matter of hours, days, or weeks, teams at the organisation spun up new services and products that would normally take months, if not years, to complete.

When the pandemic first hit and the UK faced its first lockdown and wave of Covid-19 positive cases, NHS Digital had to quickly scale up its NHS 111 non-emergency helpline and online service. Another big project was creating the risk stratification system, which enabled the NHS to identify individuals who were clinically “extremely vulnerable to Covid”, namely the shielded patients list.

These are only some examples of the work the teams had to complete. With Wilkinson at the helm, it was mainly a success. The work, alongside her other accomplishments, led to Wilkinson emerging as the winner of the UKtech50 2021.

“Our biggest success in the past four years, undoubtedly, was the way we responded to the pandemic,” she says. “But the reason we were able to do that is because the organisation’s core capabilities had risen to a level where we could step up to those things, and so much of what we were able to do was as a result of the work we put in place in the years prior to the pandemic.”

What Wilkinson is most proud of is the impact the organisation has had. There were some difficult moments, she says, but by taking a completely different risk appetite, NHS Digital was able to transform the services it was able to deliver.

This new approach highlighted some hidden talent across the organisation, which she describes as one of her biggest lessons and important moments. “You see individuals, who are not sort of big noisy superstars, but are just brilliantly slicing away at problems and having this extraordinary impact. And they’re able to blossom because we, as an organisation, put them in a position where they’re empowered to work,” she says.

The digital future of the NHS

Moving on to her new role at Thomson Reuters is bittersweet for Wilkinson.

“It’s an extraordinary experience coming into the public sector,” she says, adding that she wants to tell people who work as CIOs in the private sector to take the incredible opportunities that come up in the public sector, even if just for a few years.

“What you will take away is so much more than what you bring. It teaches you so much and I feel extraordinarily grateful that I was given the opportunity,” she says. “When you come in, it’s like another planet. But then you’re hit with the fact that it’s stuffed to the gills with the most extraordinarily talented people in the country. It’s amazing to have the opportunity to work with them for a few years of your career.”

Wilkinson hopes that the NHS Digital of the future will continue to deliver and help increase the digitisation of the healthcare system.

“I’d really like to see NHS England become increasingly ambitious and show increasingly strong leadership in digital transformation, because that’s what we need”

“I would like to see NHS Digital play an ever-increasing, strong role in that because it has the skills and capabilities that are needed to do that. I would like to see a much more streamlined organisational model for data and digital services at the national centre,” she says.

“There’s a big opportunity to do that with a change of leadership, to kind of look at that afresh, but I’d really like to see NHS England become increasingly ambitious and show increasingly strong leadership in digital transformation, because that’s what we need. We need a bold layer strategy, we need a multi-year perspective.

“Many of the huge transformation programmes that we need to deliver now, such as the transformation in cancer screening systems, will take a number of years to deploy system-wide, so we need the strategy to be persistent, unwavering, tenacious and apolitical.”

Although many things have gone well in the past few years, and solid progress has been made, Wilkinson says she “can’t help thinking we could have made greater progress”.

“What I really hope now is that opportunity is made of change in the leadership structure to really think through how we can have a set of organisational structures at the centre, which really enhances the work of digital transformation,” she says.

Wilkinson says the good thing is that across all the different NHS organisations there are great, motivated, highly capable people who are “unbelievably tenacious and get on every day and do great things”.

“But at the moment, the reality is also that we have a set of organisational structures at the centre, which in truth impairs, rather than enhances, the work that needs to be done,” she adds.

Having spent the past four years dealing with the complexities of the NHS, a pandemic and attempting to bust bureaucracy, while recognising the great talent in her organisation, as she settles into her new role, Wilkinson will take with her the challenges and wins she has accomplished at NHS Digital and says the NHS will never leave her.

“It’s the most extraordinary system and it makes you so proud to be British,” she says.