Series: From Bedside to Build · Episode 18 · Pillar 3: Expertise and Opportunity
By Rod Gamble | Week 45, 2026 | Pillar 3: Expertise and Opportunity
The information was there. It just never arrived where the clinician was working, and that distance is too often nobody’s job.
I have spent twenty-five years in the gap between the ward and the system, so I read the first days of October with recognition. All of it was the same gap.
A Gap Nobody Owned
On 28 September a coroner’s Prevention of Future Deaths report was published, and the Pharmaceutical Journal reported it on 2 October. It described a referral at Darent Valley Hospital that took more than 24 hours to be acted on. The coroner suggested that paper notes had been printed out and left in a tray, and that staff had no access to previous clinical notes from other organisations. The local integrated care board’s reply was careful and honest: information “may be available through more than one system, but it may not always appear automatically in the clinician’s usual workflow.”
The coroner was equally careful. She found these issues “did not more than minimally or trivially contribute to the death”, and still said they posed “a risk of future deaths for others”. NHS England has said the trust is not yet meeting the core electronic patient record standards and is expected to submit a business case. Nobody in this story is a villain.
Put it beside the rest of the week. An NHS England board committee was reported as calling national digital programmes “disjointed” (HSJ, 1 October). Guernsey announced it is moving its EPR programme towards closure after spending £22 million of a £23.711 million budget, with critical care, acute e-prescribing and a safeguarding update passing to a rolling improvement programme. Its health committee president said: “We don’t want to pursue ‘big bang’ programmes with a wide array of elements.” That reads to me as a deliberate change of approach, not a failure. And Epic paused most product development, likely for about six weeks, after security flaws were found; its chief security officer told the New York Times that some customer configurations could allow outsiders to reach records without the intrusion appearing in the logs.
None of that is a technology gap. Each one sits between clinical reality, patient safety, information governance and delivery. But those four rarely share a room, and few job titles join them. Therefore: who does?
Who Is Doing That Job Today
Take safety, one of the four. A survey reported by EMJ on 1 September, from Roy-Highley and colleagues in BMJ Innovations, heard from 211 of 239 NHS trusts and integrated care boards. It found 70.1% of digital health technology deployments lacked documented assurance against the statutory clinical safety standards. The mean Clinical Safety Officer capacity was 1.1 whole-time equivalents per organisation, and the authors noted that safety work was commonly done alongside existing clinical duties. It is a survey, not a census, but the shape is clear: roughly one part-time clinician, on top of a day job.
Adoption is the same story: at Barts, with over 2,000 clinicians given ambient voice access, some “asked for more time to transition”. That is change work, not a software install.
Prabha Vijayakumar, an occupational therapist and NHS England’s first Chief Allied Health Professions Information Officer, put it better than I can. Her mission is to “connect frontline insight with digital strategy so technology serves care, not the other way round”, and she wrote in January that “Digital transformation is rarely held back by technology; it’s held back by how we lead.”
You Already Hold the Hard Part
Here is the turn. Most clinicians I talk to assume the scarce thing is technical skill, so they ask whether they can learn it. But the system is not short of people who can configure software. It is short of people the ward already trusts.
A nurse on a public forum wrote in February 2023 about an analyst vacancy: “The final 5, 3 had a master in informatics, 1 was a floor nurse, 1 was an informatics trainer. Guess who got hired? The floor nurse.” A doctor who completed a US informatics fellowship wrote in May 2023 that reaching a chief medical information officer role “takes years of building relationships to be able to affect the change needed to be trusted in that role.” The credential is trust. And a doctor on a public forum in May 2025, listing reasons for wanting to leave, wrote: “Nobody is interested in your ideas to improve workflow, even if they are good ideas.” The gap the NHS cannot fill is the exact gap that doctor describes.
The role is advertised, too. In October Black Country Healthcare NHS Foundation Trust advertised a Chief Nursing Information Officer, asking for a leader who “understands both the realities of frontline care and the potential of digital technology” and for digital change that is “clinically led, safe, inclusive”. I offer it as an example of wording, not a job tip.
Two fears come up more than any other, and neither is “can I do it?” The first is “will I stop being a real nurse or doctor?” You will not. The nurse in me hadn’t gone anywhere. He was working at a different magnification. The second is “what happens to me after go-live?” A nurse weighing a move into informatics asked exactly that on a public forum in 2012, and a reply came two days later: post go-live, everything rarely is perfect. Guernsey’s rolling improvement programme says the same thing in public. The work does not end at go-live.
I know what the translator job looks like because I did it. From 2015 to 2017 I led a green-field Cerner programme putting two culturally different NHS Trusts onto one shared system, about £100 million, with roughly 30 leaders, 150 staff and 1,600 super-users. The hardest part was not the technology. It was the change management between two organisations that did things differently. External assurance rated the first Trust ready for go-live two months early. That was clinical reality, safety, governance and delivery in one conversation, and the person holding it together had to understand all four.
Steps You Can Take Now
1. Write down one place in your own working day where the information exists but doesn’t arrive. A tray, a second login, a referral nobody sees. Be specific enough that a colleague would recognise it.
2. Name who owns fixing it, across all four: the safety question, the information governance question, the workflow question, and the programme that could change it. If the honest answer is “nobody”, you have found the gap.
3. Keep that paragraph. It is the start of your case for this kind of role, and it rests on experience you already have, not on a new qualification.
4. Notice who asks these questions publicly. The National Data Guardian’s Single Patient Record survey, which closed on 9 October, asked health and care staff about difficulty accessing information, responsibility for what goes into the record, and safeguards. That is translator work in miniature.
Registration, indemnity, employment terms and pensions are all worth checking before any change of role, and I am not the person to advise on them. Treat them as considerations, not obstacles.
The note was there. What was missing was someone whose job it was to make sure it arrived, and more often than not that someone is a clinician who decided it was theirs.
When you’re ready to talk, rodgamble.com is where to find me.
#CoachRod #digitalhealth #clinicalinformatics #healthinformatics #digitalhealthjobs #HealthcareTransformation #healthtech #digitaltransformation
References
1. Pharmaceutical Journal. Coroner’s Prevention of Future Deaths report, Darent Valley Hospital (2 October 2026). https://pharmaceutical-journal.com/article/news/trust-linked-to-sickle-cell-death-had-failed-electronic-patient-record-standards
2. Health Tech News (HTN). “Government of Guernsey updates on progress and closure of EPR programme” (2 October 2026). https://htn.co.uk/2026/10/02/government-of-guernsey-updates-on-progress-and-closure-of-epr-programme/
3. EMJ Reviews. “Digital clinical safety gaps threaten NHS transformation” (1 September 2026), reporting Roy-Highley E et al., BMJ Innovations 2026. https://www.emjreviews.com/innovations/news/digital-clinical-safety-gaps-threaten-nhs-transformation/
4. TechCrunch. “Medical records giant Epic pauses product development to fix security bugs that risk patients’ data” (2 October 2026). https://techcrunch.com/2026/10/02/medical-records-giant-epic-pauses-product-development-to-fix-security-bugs-that-risk-patients-data/
5. Health Tech News (HTN). “Barts Health continues to roll out ambient voice technology” (2 October 2026). https://htn.co.uk/2026/10/02/barts-health-continues-to-roll-out-ambient-voice-technology/
6. BMJ Careers. Chief Nursing Information Officer (CNIO, Deputy CCIO), Black Country Healthcare NHS Foundation Trust (advert, October 2026). https://www.bmj.com/healthcareers/job/853353/chief-nursing-information-officer-cnio-deputy-ccio-/
7. Vijayakumar P. “From analogue to digital: an AHP-informed journey to national informatics leadership.” BMJ Leader blog (12 January 2026). https://blogs.bmj.com/bmjleader/2026/01/12/from-analogue-to-digital-an-ahp-informed-journey-to-national-informatics-leadership-by-prabha-vijayakumar/
8. Public forum threads: allnurses, “Getting my foot in the door” (Feb 2023) https://allnurses.com/getting-foot-door-t749592/ · allnurses, “Am I making the right decision? ICU to RN informatics” (Feb 2012) https://allnurses.com/am-i-making-right-decision-t419331/ · Student Doctor Network, “Clinical Informatics Fellowship” (May 2023) https://forums.studentdoctor.net/threads/clinical-informatics-fellowship.1479521/ · Student Doctor Network, “What are the options as an MD, if you get stuck in a specialty you hate” (May 2025) https://forums.studentdoctor.net/threads/what-are-the-options-as-an-md-if-you-get-stuck-in-a-specialty-you-hate-and-you-want-to-leave.1508745/
9. HSJ (1 October 2026), headline “Disjointed tech projects must be accelerated, says NHSE board” (paywalled). https://www.hsj.co.uk/technology-and-innovation/disjointed-tech-projects-must-be-accelerated-says-nhse-board/8124465.article · HTN (30 September 2026), National Data Guardian seeks views on the single patient record. https://htn.co.uk/2026/09/30/national-data-guardian-seeks-views-on-single-patient-record/
