The idea for the Clinical Digital Manifesto came from conversations between @TomStocker and @marcusbaw in late 2023, in which they shared frustrations with the low levels of usability, user responsiveness, and overall quality in NHS IT systems.
The pain caused by having to use such systems is a daily experience for most of the NHS’ clinical staff, and it results in worse clinical outcomes for patients, delays, errors, and even serious harm. For staff it causes fatigue, burnout, and detracts from the potential to find their work rewarding.
They knew it absolutely could be solved, but also knew it couldn’t be solved by using the same thinking which had created the problem in the first place. They decided they needed a more radical way to bring these ideas forward and collaborated to put together the first draft of the Manifesto.
Not much of what is in the Manifesto is new, instead it draws on some of the lessons of the past, both good - such as the way the Government Digital Service Team brought the burgeoning number of GOV.UK sites under rational control and their feature set and quality into the 21st Century - and bad - thinking of IT disasters like the NHS’s disastrous National Programme for IT (NPfIT) and the Post Office’s Horizon software.
The aim of the Manifesto is to serve as a common banner under which we can unite clinicians, NHS technologists, managers, and politicians. It’s a minimal, commonly-agreeable set of principles around which we can drive change. It is intentionally high-level and doesn’t attempt to dictate too much of the detail, this is intentional.
The most important concept within the Manifesto is that it has to call for radical change in how we approach NHS IT. ‘Supplier’, ‘Market’, and ‘Procurement’ have all had a role to play in bringing us to the dire situation in which we find ourselves now. So we have to turn away from these broken approaches and do things open, in-house, and owned by the NHS.