The topic of whether healthcare providers should appoint Chief AI Officers (CAIOs) is no longer theoretical. The United States has been embedding these roles within healthcare systems for a number of years, and just recently a trailblazing consultant has been named as Scotland’s first Head of AI in medicine. But should England’s NHS trusts follow suit, or carve their own path?

Artificial intelligence (AI) is rapidly becoming a key focus in the new digital strategies of Trusts and in the recently published North London NHS Foundation Trust Digital Strategy 2025 – 2029 it features as one of five key themes. From ambient clinical scribes and large language models (LLMs), to imaging algorithms and digital pathology, AI covers a vast area, and what’s emerging isn’t just hype, it has the potential to become a future tidal shift.

The question now, at a time when Trusts are struggling to deliver their digital aspirations because of staff shortages, is whether the NHS is structurally equipped to manage this shift without creating dedicated roles to oversee it.

CAIOs are already in the US

Across the Atlantic, CAIO roles are increasingly appearing in major health systems. These positions are being created with the aim of bringing cohesion and clarity to the AI strategies emerging in ever increasing pockets of the health sector.

The rationale is clear, someone needs to own the AI agenda. Someone needs to vet the 200+ radiology models available, ensure the data governance around ChatGPT-style deployments is watertight, and set Trust-wide strategy for ambient documentation, predictive analytics, and precision medicine. But simply mirroring this trend may not be the right move for the NHS, particularly at a time of incoming cuts and the recently announced ICB blueprint.

NHS CIOs are under pressure

The idea of adding yet another ‘chief’ into NHS Trust leadership teams, especially at a time when Trusts are planning to shrink their workforce by up to 1,500 posts each to save money, feels contradictory. If those posts are seen as non-essential, how politically and practically viable is it to introduce a CAIO? More importantly, what does a CAIO offer that a capable Chief Information Officer (CIO) can’t? CIOs already own the digital strategy and architecture. They oversee data governance, interoperability, and cybersecurity. Theoretically AI, as an emerging domain of digital, should fall under their remit.

There’s also the unicorn problem. A CAIO would need to understand AI’s real-world application across diverse clinical domains, including radiology, genomics, language models, and more. That’s an extremely broad skillset to expect from one individual. The US may be willing to place bets on these unicorns, but the NHS shouldn’t.

A pragmatic approach

Rather than creating new C-suite titles, Trusts should think in terms of AI leadership embedded under their existing digital governance and encourage a bottom-up approach. People close to the workflows can actively guide and improve processes, so with this in mind, roles reporting to the CIO makes far more sense. This retains strategic alignment, whilst enabling Trusts to build domain-specific expertise in key areas such as imaging AI, ambient scribing and LLM deployment, and data security and regulatory compliance, especially as models become more integrated into clinical decision-making.

We don’t need another chief to do this. We need empowered, specialised teams working under cohesive digital strategies, driven by CIOs, and enabled by the right data infrastructure. Without sound data infrastructure the AI simply is not effective.

The big unanswered question that this leaves is how do we train the domain-specific experts in the options and best adoption practices that allow them to safely deploy AI into their workflows? This includes, where we can, enabling the Trust to benefit from economies of scale for future adoption from this initial effort. It isn’t fair to assume that staff have the capacity to pick up AI alongside their current responsibilities.

These implementations will impact both staff incorporating AI into their workflows and those who have a remit to ensure requirements are met around regulation, research and ethics, cyber and data security, technical strategy, training programmes and clinical safety. So this whole piece needs to be addressed at a strategic level in the Trust to ensure we don’t slip into siloed processes in each department.

What would a job description look like?

If we were to define one specific role focused on AI within the NHS, the job description could include some specific themes:

• Evaluation and prioritisation of AI use cases across clinical, operational and administrative services
• Assessing vendors and models for clinical safety, data governance, and monitoring return on investment
• Liaising with Information Governance, clinical safety, regulatory, cyber and data security leads to ensure compliance
• Liaising with technical and cyber security teams to ensure a scalable and secure deployment approach that aligns to the technical strategy
• Keeping pace with global AI trends, from ChatGPT to the latest releases, such as DeepSeek that could bring deployment cost savings but pose ethical concerns
• Collaborating with clinical leadership to ensure that the tools being used enhance, not undermine, care pathways.
• Building an empowered and trained in AI workforce across clinical and non-clinical departments to trial AI implementations that will benefit their roles

And that’s before you even consider genomics, predictive analytics, and patient-facing AI tools. However, the NHS doesn’t need to solve this through job titles. It needs scalable operating models.

What success could look like

Rather than focusing on hierarchy or new roles, Trusts should ask themselves ‘What does successful AI adoption look like over the next two years and beyond?’ To me success should be based on having:

• A clear strategy with short, medium, and long-term goals for AI deployment across clinical and operational domains
• Defined accountability. Whether it’s a Head of AI or a multi-functional digital team, someone must own the roadmap
• Secure deployment. Trusts must know who is using generative AI, and how, and where the data is going
• Evidence of value with selected pilots that provide measurable and meaningful insights.
• The biggest bang for our buck today might not be in clinical AI deployments, but in looking at resource intensive administrative / finance / operational tasks where AI could support those roles in data entry or analysis.

This is where partners like Answer Digital come in. We’re already supporting NHS Trusts with open-source platforms that enable secure, scalable AI testing, particularly in imaging, note summarisation and data curation; areas where Trusts are sitting on mountains of untapped data.

Build the infrastructure

The pace of change in AI is exponential. Three or four years ago, no-one was talking about ambient scribes. Now it’s a core topic of discussion. LLMs have also gone from novelty to necessity in under 18 months, and that velocity will only accelerate.

When we adopted the cloud, we didn’t create Chief Cloud Officers. Instead, CIOs built teams with domain-specific heads of function. AI should be no different to these examples and we must build the infrastructure that supports effective delivery in the NHS.

Empower CIOs, don’t bypass them

Ultimately, AI leadership in the NHS must be about capability, not titles. The risk of creating a new chief role is that we introduce confusion and fragmentation at a time when integration is vital.

Instead, let’s empower our CIOs. Give them the resources and remit to lead the right talent, whether that’s a head of imaging AI, a data compliance specialist, or a strategic AI lead. Build AI into the digital operating model, not around it.

The US may be moving fast, but the NHS can move smart.

Article originally posted: https://www.fmai-hub.com/chief-ai-officer-a-role-the-nhs-doesnt-need/

HT World: https://www.htworld.co.uk/insight/opinion/chief-ai-officer-a-role-the-nhs-doesnt-need-sb25/
Journal of Health: https://thejournalofmhealth.com/chief-ai-officer-a-role-the-nhs-doesnt-need/
Building Better Healthcare: https://buildingbetterhealthcare.com/chief-ai-officer-a-role-the-nhs-doesn-t