This post is an open letter to whoever will become the new chief digital officer for health and care in Wales, prompted by this exciting announcement by the Health and Social Services Minister on 30th September 2019.

£50 million and new body to transform digital health and care services in Wales The plans include creating the role of Chief Digital Officer for Health and Care and a new NHS Wales organisation to deliver national digital services, supported by £50 million new funding.

The Chief Digital Officer for Health and Care will define national standards for digital software and services, as part of moving to an open digital architecture, across all digital systems. The CDO will also advise Welsh Government on digital strategy, lead the digital profession, and be a champion for digital health and care in Wales.

Vaughan Gething, Health and Social Services Minister,

Dear Sir / Madam,

Congratulations on being successfully appointed as the new Chief Digital Officer for Health and Care in Wales. This is an exciting time and I thought I’d take the opportunity to help you get started with your work; I want to highlight some opportunities, some challenges and suggest some priorities:

1. People

We have some amazing people, projects and products in Wales. You will need to understand that somehow, at the moment, the total is currently less than the sum of the parts. However, there aren’t too many changes you’ll need to make to fix this paradox: I would say the two most important issues are trust and collaboration. Ask: what can we do to help people achieve what they want to achieve, and what should be provided at a national scale to most support those efforts?

2. Data

We have historically not prioritised meaningful, interpretable data as the core foundation of our services - you need to understand that data underpins what we want to achieve - whether for direct care, service management, quality improvement or clinical research. Please understand how arbitrary boundaries between these different uses are a risk to building a truly learning health and care system. You must change this while taking into account the legal and regulatory constraints defined by the purpose for which those data are used. Carefully question proponents of an application-centred strategy.

3. Transparency

As a digital leader, you will already know that there is often no clear right choice or single solution, but instead decisions need a fine balance between the advantages and disadvantages of any specific solution, sprinkled with a healthy dose of pragmatism, and a need to consider the future roadmap. An easy way to address this challenge is to be open and transparent.

4. Collaboration

Set broad principles and empower, don’t control.

You need to be dogmatic in setting the broad principles and defining the ‘guard-rails’ that will define how we will use digital technology to support solving the problems in health and care that we need to solve. In keeping with our need for transparency, it should be straightforward to understand what approach should be used and what kind of work should be funded, because the rules we work by are explicit. But that doesn’t mean centralised command-and-control or mandating a specific application. What we do need is an approach predicated upon adoption of pragmatic open standards and the creation of a toolbox of software code and data services that can be used to solve our day-to-day problems in a collaborative manner.

5. Agility

Agility means recognising the benefits of adaptability, flexibility and fast feedback. We must learn from other industries who are adopting these practices with pace, and improving the safety and reliability of their software delivery pipeline. We must build systems that can adapt and evolve to change.

You will already know about the benefits of modularisation of software and data services and particularly how the unbundling of services means that they can be developed independently, in parallel, with agreed technical standards defining their interactions.

But just because we have multiple modules all being built, deployed and continuously improved independently, it doesn’t mean that each doesn’t form a cog in the wider single system. By single system, we should mean a credible, coherent, overall high-level strategic approach means that there are clear principles that guide all of our work, with definite and explicit direction-of-travel, but empowered teams delivering the incremental steps on that, truly collaborative, journey. That means a shared vision, but small steps, and that doesn’t mean only for our technology products but in our overall approach to management and leadership. Our work will never be complete.

6. Technical expertise

Our work in health and care in Wales needs to be built on a solid foundation of technical skills. You will need to consider whether you need the support of a Chief Technical Officer, and emulate the highest performing technology companies of the world by fostering developer productivity and adopting a ‘products not projects’ approach. Our efforts to make the right information available at the right time, for both patients and professionals, will succeed or fail based on our ability to make use of the very best technology.

7. Standards, ecosystems and driving the commercial market

You will need to understand how we need to reboot our relationship with commercial and academic partners, and see how this can be fostered by building a truly open platform in which software and data services are made available for both internal and external users. You need to understand the meaning of “dogfooding”. You will need to see how programmes like the Digital Health Ecosystem cannot remain as a separate or external programme but in fact are central in achieving what we want to deliver.

8. Think outside of health

You should seek to work across Welsh Government to share the same design patterns and user-centred approaches, understand how health and care can fit into the wider strategic government-as-a-platform approach, and shape the way we design services using data. You will need to look for common ground and shared learning across health and care as well as other departments, particularly in relation to user-centred design and the adoption of standards.

9. Be humble

Recognising that we don’t have all of the answers is absolutely essential, but that doesn’t stop us taking responsibility for the broad over-arching principles and guard-rails that define our overall mission. I’m pretty sure that you will have to adapt and modify our plans as we go along, and be open and transparent about how we discover hitherto unconsidered challenges and how we will learn to overcome them.

10. Have fun

Wales could be the very best place in the world to deliver digital health and care; we are small, we pretty much all know one another and we have a health system that in theory lacks many of the arbitrary boundaries between organisations and services. There has been some very good work already that has delivered benefit for both patients and professionals. Your job will be to see the common thread that runs through our systems, our services and our nation and help us to use digital technology to create a truly learning, data-driven and person-centric health and care system.

You’ll quickly see that there are some basics to get right - user login, single sign-on - but you will also need to have the clarity of vision to see how getting those fundamentals solved in the right way forms the foundation to deliver, iteratively and with pace, ever more sophisticated technology to support our health and care services.

We need to do this together to succeed.

Mark Wardle

Further reading

On health technology and digital transformation

On “Once for Wales”

On trust and innovation

On platforms:

On focus:

On data:

On development standards and ecosystems