Digital projects in the NHS rarely fail because the software does not work. They fail because nobody at board level owns the job of making sure staff use it. That was the case Bruno Botelho, Director of Digital Operations and Innovation at Chelsea and Westminster Hospital NHS Foundation Trust, made in a recent keynote titled “The NHS Needs Digital COOs”. It is a simple point, and it deserves more attention than it usually gets.

Trusts have become good at buying and installing technology. Contracts are signed, systems go live and project teams are stood down. What happens next is less certain. If a new tool never becomes part of the routine on a ward, in a clinic or in a booking office, the old ways of working carry on beside it and important tasks slip through. Staff end up keeping paper lists alongside electronic ones, or entering the same information twice, and the efficiency the system was bought to deliver never arrives. Botelho’s briefing paper gives an example that should concern any board. An urgent cancer follow-up was requested but never booked, because no single role owned the task from start to finish.

The cause lies in how NHS executive teams are built. The chief information officer is responsible for the technology itself: infrastructure, platforms, cyber security and architecture. The chief operating officer answers for performance, including access, patient flow and productivity. Chief clinical and nursing information officers make sure systems are safe and fit frontline practice. Each role is clearly defined. None of them is clearly accountable for whether a tool changes how work gets done. Adoption touches all of their portfolios and belongs fully to none.

The gap matters more now than it did five years ago. The Federated Data Platform, which NHS England is rolling out across trusts, depends on clinical and administrative staff adopting shared workflows and recording data consistently. Botelho knows this at first hand as programme director for the platform in North West London. The same holds for the single patient record and for the newer tools promised in the 10 Year Health Plan, from AI triage to ambient voice technology that drafts clinical notes during consultations. The efficiency gains attached to these products look convincing on paper. They will not show up in waiting list figures unless someone takes responsibility for redesigning the processes around them.

Botelho frames this as the question underneath every national digital priority. Can the organisation change how its work is actually done? Technical readiness is rarely the constraint. Most trusts can get a system live. Far fewer can show that it has shortened a pathway or freed up clinic capacity a year later.

Part of the difficulty is that adoption is slow, detailed work that does not fit neatly into a project plan. It means sitting with a booking team to understand why they still phone patients instead of using the new system, or working out which steps in a discharge process can be removed once information flows automatically. That work needs someone with the authority to change rotas, job descriptions and local procedures. A digital project manager rarely has that authority, and a chief operating officer managing daily pressures on beds and emergency care rarely has the time.

His proposal is modest. Trusts would give one executive explicit responsibility for adoption, either through a Digital COO post or by writing that mandate into an existing role. The person holding it would own process redesign with frontline teams and judge success by operational results such as shorter waits and better flow. Go-live dates would stop being treated as the finish line. None of this requires another layer of management, which makes it an easier case to put to boards at a time when trusts and ICBs are under pressure to cut running costs.

Botelho’s own career illustrates the argument. He trained as a nurse, moved into operational management and co-led Chelsea and Westminster’s electronic patient record rollout from the operations side of the organisation. That background gave the programme an owner who understood both the system and the work it was meant to change. Boards looking for someone to hold this mandate could do worse than search their own operations teams for people with a similar mix of clinical and managerial experience.

What is needed is a change in how boards think about digital investment. A new platform treated as an IT project leaves its success to chance once the implementation team moves on. Treated as a change to how the hospital operates, it gives someone clear responsibility for the outcome. The Federated Data Platform and the tools that follow it will deliver what has been promised only if trusts make that choice and name the person responsible.

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