There has been some really good work in digital health and care in response to the COVID-19 crisis in Wales.

What have been the characteristics of these successes? They have:

  • focused on delivering solutions to immediate needs
  • broken down historic barriers
  • used commodity cloud services
  • leveraged commodity technologies such as video

And it’s really important to recognise this good work but we also need to see that most of this work has been, what are essentially, greenfield developments.

And that tells you something interesting, because if you enable a culture, and a technology platform, that allows things to be developed as independently as possible - decoupling, then it’s like giving a nitro-boost to your digital productivity.

Our next challenge is to see how we can use those same approaches for brownfield developments, paying down technical debt and re-focusing our technical architecture on data and standards.

There’s a paradox here. People who know little about technology and software think it makes sense to centralise and manage through command and control. It’s a seductive approach, but it doesn’t work. Let’s do it “once-for-Wales” they say, as if technology wasn’t a complex, multi-faceted intervention in a complex adaptive system. One size truly doesn’t fit all.

One Size Doesnt Fit All

by Simon Wardley, No One Size Fits All. Also see Wardley maps


But my biggest concern?

That while here in Wales we have an amazing mix of people, skills and capabilities, we’re not working as openly and transparently as we should, and we’re not fostering healthy discussion and debate.

We work for the public sector, and that means being open and transparent.

Wales can and should be the best place to do health and care technology. But late in 2018, at a national clinical informatics meeting, I was told that I could no longer work for the NHS Wales Informatics Service unless I took down this blog, because it was deemed critical of the status quo (*).

But we need to be critical because we need to keep on improving for the people of Wales, and having insight into when we’re doing well and when we’re not, is critical in order to improve.

So in light of that, while the NHS Wales Technical Standards Board has been furloughed, albeit temporarily, have a look at our project list and raise an issue, and start a debate. The website is open. Its source code is open. Anyone can contribute. Tell me, what should we be doing next?


(*) I no longer work for the NHS Wales Informatics Service. The “funding ran out”.