The titles give the game away; the outcomes tell the truth.
Peter Thiel once said the quiet part out loud: whenever a field feels the need to bolt the word “science” onto its name, it is usually trying to borrow credibility it has not earned, because nobody says “physical science” or “chemical science,” yet we routinely hear “political science” and “economic science,” and the extra word functions less as a marker of rigour and more as a fig leaf for its absence.
The NHS has its own version of this linguistic tell, and once you notice it you begin to hear it everywhere: title inflation that signals movement without progress, activity without delivery, performance without outcomes, and if you listen closely the words themselves quietly admit that nothing of consequence is actually shipping.
The label implies mastery of code, systems, and product, yet all too often it denotes someone who has never written a single line, never shipped a feature into production, and never sat up late to debug a live incident, even though they can run a spirited workshop on agile methodology, speak confidently about APIs without recognising a real payload, and produce a strategy paper on “leveraging digital” that never once starts from a concrete problem statement.
The phrase sounds muscular and decisive, but in practice it describes a budget line for people who convene, partner, explore opportunities, and announce roadmaps while avoiding the hard, irreversible work of deleting broken processes, tearing down unsafe systems, and rebuilding the pathways by which care is actually delivered, which is to say they move language around while reality remains in place.
When the word “innovation” appears in the title, you can assume the substance is thin, because these roles are too often tied to pilots that never leave pilot phase, living indefinitely in the cul-de-sac of “evaluation,” where the dominant skills are grant writing, PowerPoint production, and showcase hosting for software that does not scale, does not matter, and will not reach patients.
This is the diplomatic way to admit that neither party knows how to deliver and both would prefer a shared alibi when nothing ships, since the partnership is not organised around patient outcomes or measurable change but around continued meetings until the budget runs out, which is coordination as camouflage.
This one should matter most and so it hurts the most when it is hollow, because a true CSO understands DCB0129, writes hazard logs, runs safety cases, and signs off risk-mitigated design, acting as the guardrail when new systems go live; yet in too many organisations the role is reduced to a box-tick for audit, present enough to satisfy a form but not present enough to prevent harm, which is not oversight so much as negligence with paperwork.
When the NHS performs instead of delivers, patients pay the price: bad software is procured on the strength of buzzwords, clinically unsafe systems are rolled out without challenge, budgets are spent on theatre while real care fragments, and the people actually trying to fix it - engineers wrestling with broken APIs, GPs running double clinics, and practice managers firefighting daily chaos - end up buried under the weight of these tells.
At Hummingbirds Medical we set a simple rule: no tells, which means we do not chase titles, we ship code; we do not polish roadmaps, we release; and we do not write strategy until something is already working in the real world, because the only credible story is the one that runs in production.
That is why we built BookYourGP without funding and without permission, and put it live in real surgeries where it transforms the unglamorous workflows that actually keep patients safe, replacing theatre with delivery and language with outcomes.
If you want to fix the NHS, look for the tells and then do the opposite: ignore the titles, follow the releases, and measure what reaches patients.