My life is weird. Again.

Looking out over London from the top floor. The Eye is glittering and the Palace of Westminster is glowing.

Someone pours me a glass of (very expensive⁰) champagne, as the Secretary of State laughs at my witty bon mot.

Is this my life now? People of distinction and influence listening to what I have to say? It isn't an oak-panelled room, with deep armchairs, where cigar-smoking men carve up the world. It's a modest and plain office where men (and women!) have gathered for a bit of mutual backslapping. But I am here. I'm in the room and being thanked.

And why not! We've all worked hard on launching NHSX and are rewarded with a little audience. The chit-chat is awkward - despite the geniality, we're all aware that the boss is here.

Naturally, I believe someone is going to tap me on the shoulder and ask me what the hell I think I'm doing in a room full of proper grown-ups. But, no, people keep asking me questions and telling me their well-practiced anecdotes.

It is simultaneously amazing and banal. I've been at this work-party several times in my career, with dozens of companies, with a parade of CEOs. This feels different. A tiny glimmer of "I've made it a difference!"

I eat my fill of crisps - I am driving later - and slip out. I want to savour the moment, but know too well the perils of outstaying my welcome. I float all the way home.

Proximity to power is a powerful glamour. I understand why some are drawn to it, and some are seemingly addicted.

But I'll be different, I'm sure, as I bask in the experience.

My 4th day in a new job and I'm sat in a meeting with the Secretary of State.

I've been in rooms with CEOs. With celebrities. With politicians. But this is the first time I've faced someone this senior, discussing sensitive issues. It's a moment.

I'm in the room. I disassociate briefly. All of a sudden, I'm interrupting someone and making a surprisingly intelligent point. The SofS agrees with me and, seemingly, is impressed - carrying my point forward and referencing it towards the end of the meeting.

The poor chap next to me is getting eviscerated. He either doesn't know his brief - or is being deliberately evasive. The atmosphere is congenial - but there's an undercurrent of menace. The guy is floundering, and the SofS is... not exactly merciless, but lets the guy know he isn't falling for the patter.

I'm simultaneously glad I'm not in the firing line - and worried that I'll one day find myself out of my depth.

The meeting ends and I'm formally introduced. He seems pleased to have me on board - I'm just glad I didn't make a complete fool of myself. And mildly impressed that he actually knew what he was talking about when it came to the details of technology.

That evening, my Great Aunt Sonia dies - aged 90. She had been gently cared for by the NHS. And the work I'm doing suddenly feels a lot more viscerally real.

It has been a fun and challenging year. Some of the things I've tried have worked, others less so.

The Good

Helped kickstart NHSX. I think that counts for something! A bit of that was procedural stuff like obtaining the domain name and convincing Twitter to give us the @NHSX name. Some of it was sitting in rooms while senior people turned to me and said "Terence, what do you think?" Then I said my thinks.

Obviously success has a thousand parents, and I was part of a great big gang. But it feels pretty wonderful to have helped launch something which - hopefully - will make a difference.

I'm all of a sudden working with very senior civil servants and politicians. It's not enormously different from the environments I've worked in before, but it is fun walking the corridors of power.

Writing policy and seeing it published and implemented is amazing. We haven't even scratched the surface yet - but there's a definite feeling that we're on the verge of doing something great.

I'm part of a fun and friendly team. I don't just mean my immediate colleagues - I mean everyone in both London and Leeds. They're all so generous with their time and knowledge.

There's a sense of mission. Improve the technology experience for patients and staff in the NHS. Simple to articulate, impossible to argue with, and an achievable goal.

I have a long list of achievements from the last 12 months.

The Bad

It's hard to write about the things that don't go right. Especially when you're still working on something. So I'll try for a bit of candour.

It can't have escaped your attention that there's a lot of Politics about. The recent General Election meant putting a bunch of work on pause while we waited for the results. That was frustrating.

Similarly, because healthcare and healthtech is so high profile, we get a lot of mud slung our way. When we make an announcement of something genuinely good, it's disheartening to see it unjustly savaged.

I made an ill-judged remark at a conference while in front of a journalist. It split the audience and earned me a snitty write-up in the trade press. Obviously I need to be more careful how I word things. I'm used to being off-the-cuff, but that isn't always sensible in a high-profile organisation.

There is too much for me to do. We're rapidly hiring, but I'm conscious of the emails I've not replied to, the documents I've only half-read, and the opportunities I've missed due to time constraints.

The Ugly

I don't deal with bureaucratic things well. ID cards, logins to expenses systems, meeting room bookings. I get overly grumpy when people say "that's just the way we do things". It's not in my nature to go "OK, I'll submit to this daft system."

I've got to remember that's it's not my job to fix everything.

I'm squeamish. I can't watch medical dramas on TV because of the blood, guts, and general body-horror. It turns out that I feel that way when sat in an anodyne meeting room discussing cancer care in the abstract.

Because health is so visceral, it's hard to detach emotion from your work. That's doubly hard when friends express their frustrations about the NHS. When I worked for a phone company, I was always happy to forward a friend's grumble about crappy service. I don't know if I can or should escalate complaints with medical care.

Data standards in the health space seem to be dominated by academic thinkers, rather than practical thinkers. There's lots of "this is how the world should work" and not enough "this is what users need".

I'm not a doctor. Nor any sort of medical practitioner. This has me at a disadvantage because I can't talk authentically about their needs. I have to equip myself with anecdotes.

I miss some of the international work I used to do. This role is - necessarily - focussed on NHS England. But I don't know if that's just my ego because I like talking in front of large international audiences.

What's next?

This was meant to be a year-long secondment, but has been extended. I've gone from being Senior Technology Advisor, to Head of Open Technology.

Terence Eden is on Mastodon

@edent

Very happy to announce that I'm taking on a new role at #NHSX.

I'm now the Head of Open Technology

🖥 Open Source
📙 Open Standards
📊 Open Data
🔌 Open APIs

That's the future for technology in the NHS.

(NB can't answer many questions due to pre-election period guidance.)

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At some point this year, there'll be a new Director to report into. And NHSX will grow and grow. I need to grow as well.

We're not a funky start-up. And it's right that teams expand and evolve. But I do love the thrill of starting something up something new.

This role ends in one of two ways:

1. Everyone "gets" open. The value of open technology is embedded in the culture of the NHS. In which case, job done.
2. Not everyone is convinced. Which means endlessly having the same arguments internally and externally. That could be aggravating.

The question is, how close can I get to (1) before I'm exhausted by (2)?

Fun times ahead!

In my new job, I decided to keep an achievement journal. Well, a Trello list of tasks I've done well.

This has been most useful. I looked though my record of achievement and picked out the highlights. This isn't a new tip - but one I'm glad to have rediscovered.

In no particular order, with no SMART analysis, no Success Profiles, and with suitable redactions, this is what I've done over the last two months.

Advisory

• Edited several papers for █████
  • Reviewing subs for █████ and ensuring they were technically sound.
  • Feeding back to teams when the sub was imprecise or unclear.
• Provided technical input for █████ keynote speech
• Gave in-depth technical guidance on pager technology, 5G, encryption standards, open standards, and Project █████.
• Contributed to █████ architecture discussions.
• With █████ reviewed their work on NHS API access.
• Worked with ████ to draft email security standard advice.
• Created high-level slide deck on Open Standards for █████ and ████.

NHSX

• Contributed to drafting of founding principles
• Procured domain name
• Set up social media (Twitter, LinkedIn)
• Working with Twitter's public sector liaison to recover @nhsx from a dormant account and get the account verified.
• Set up Open Source repositories (GitHub, GitLab)
• Work on IT / Tools steering group with █████ and █████
• Made policy decisions on which tools to evaluate
• Set up trials of █████
• Conducted user research
• Setting up G-Suite with █████ / █████
• Worked with █████ and █████ to ensure their vision for NHSX was properly communicated.

Team

• Acted as a technical assessor for the GP IT Futures alpha assessment - identifying risks within the project.
• Visited Wolverhampton Hospital, learning about their cyber security, patient tracking, and technology difficulties. Conducted user research.
• Worked with e-Rostering team to ensure open standards are at the heart of any new development.
• Provided ad-hoc technical advice and guidance.
  • DHSC tech team - API standards, open source policy, working in the open.
• Team prioritisation and objective planning.
• Supporting managers where appropriate
• Pastoral support to some team members
• Promoted open standards and open source projects within the team.
• Support ALB tech meeting with expert advice.
• Work with new comms team
  • Ensure social media policy was robust
  • Created plans for website
• Edits and suggestions to press releases

Conferences and Outreach

• Welsh Interoperability Symposium
• HealthTech Oxford Community Event
• NCSC Digital Loft
• Emergency and Urgent Care Conference (upcoming)

Training

• Provided AI masterclass to GDS Academy
  • At the request of GDS, I provided a training package for colleagues celebrating the Digital Academy's anniversary.
  • Preparing to deliver internally
• Provided training on digital policy-making to Future Leaders Scheme
  • At the request of █████, I created a workshop and presentation on the challenges of NHSX and future policy making

Corporate Contribution

• Acted as a mentor to BAME colleague.
• Arranged LGBT+ ally lanyards to be delivered to the office.
• Worked with Canadian Open Source contacts during a fact-finding visit to the UK
• Created t-shirts bearing inspirational slogans.

I was wondering why I was feeling emotionally and intellectually exhausted. Looks like I've been working pretty hard. Might be time for a holiday soon.

Matt Hancock

@MattHancock

Big welcome to @NHSX - harnessing technology to deliver for patients

Transforming health and care

@NHSX

Hello, World!
gov.uk/government/new…

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BOOM!

With a fancy announcement in the House of Commons and everything!

It has been a lot of work - and I'm obviously not the only person involved - so I wanted to explain some of the lessons I learned along the way.

Working in the open sometimes sucks*

*When you don't have the answers

I'm a true-believer when it comes to working in the open and talking about our work. But that can cause frustration. If you're in a meeting and someone says "what does this mean for my job?" or "which exact things will it do?" or "when will this happen?" - you need an answer. We were sometimes in the unfortunate position of saying, genuinely, "we don't know."

Some people prefer certainty to ambiguity.

That's stressful for all concerned but, I believe, it is a price worth paying. Let people know what you do and don't know. Get them used to working in a changeable environment.

(Don't) ignore the haters

Whenever you launch something a little different, people will love telling you that your priorities are wrong, that the way you're doing things is stupid, and that you are literally evil. Most of these people will be wrong. But not all of them.

Check in with your moral compass as to whether you think you're behaving ethically. Talk to your colleagues to see whether you are being stupid. Ignore the people flinging nothing but abuse - their lack of humanity isn't yours to fix.

You can't do everything

Every five minutes before launch, I was asked if we could add "just one more thing."

Every five minutes after launch, I was asked if we could... well, you get the picture!

Sometimes you have to say no. Or, at least, "that's an interesting idea, let's pick it up later."

When seemingly everyone wants to hook on to your launch, you need to be selective. Even on ideas you really like. A launch has to be pretty lean. And that can piss off people.

Talk to people

I know it is pretty obvious. But stepping away from the Internet and chatting with real people is an excellent way to test your ideas.

You don't know everything. Well, I certainly don't know everything. Talk to people with more experience than you.

You can't do that

If the Ministry-of-No steps in, it is mostly OK to over-rule them - as long as you're prepared to take responsibility for any disasters.

Most people are interested in protecting themselves - that's only natural - so you have to calibrate your risk tolerance against theirs.

Have a drink when it's over

At the end of the beginning, it's OK to take a break, gather the team, have some drinks, chocolates, and generally toast your hard work.

Remember, you're not drinking to the work done, but for the journey yet to be taken. This is where the real work starts.

Onwards!

• I have a new job.
• I am a bit scared by my new job.

This week - WTF? OMG? BBQ???

I've been working for DHSC (Department of Health and Social Care) for two weeks. I've made a list of every single new acronym that I've heard. Here it is:

• AAC - Accelerated Access Collaborative
• AHP - Allied Health Professional
• BMA - British Medical Association
• CAMHS - children's and adolescent mental health
• CSU - Commissioning Support Unit
• DDC - Digital Delivery Centre
• DPS - Data Processing Services
• FHIR - Fast Healthcare Interoperability Resources
• FN4G - Future Networks for Government
• HUS - Hospital Use Statistics
• HIMSS - This eight-stage (0-7) model measures the adoption and utilization of electronic medical record (EMR) functions
• HSCIC - Old name for NHS Digital
• HSCN - Health and Social Care Network
• HSJ - Health Service Journal
• HSSF - Health Systems Support Framework
• ICS - Integrated Care Systems
• LHCR - Local Health and Care Record
• MHRA - Medicines & Healthcare products Regulatory Agency
• NPfIT - National Programme for IT
• OBC - Outline Business Case
• OLS - Office for Life Sciences
• PAS - Patient Administration System
• PHI - Population Health Intelligence
• PRSB - Professional Records Standards Body
• PS(H) - Parliamentary Undersecretary of State for Health
• RCN - Royal College of Nursing
• STP - Sustainability and Transformation Partnership

Around 3 new acronyms per day. My brain is full.

Why do we do this to ourselves?

There is some marginal gain to reducing polysyllabic phrases - both in speech and in text. But it does feel like it is mostly to provide a Shibboleth. Correct use of acronyms marks you out as part on the "in" group. You're a full member of society. Those who don't understand the code are outsiders.

I've had great fun calling it out. Stopping conference calls to say "Sorry, I'm new here. What does XYZ stand for?" is a perfectly sensible thing to do.

And, only twice has it resulted in people arguing over what the acronym means.

TIAB!