Welcome back to our podcast HTN Let’s Talk, sponsored by Spirit Health!

For the latest episode, we interviewed Pritesh Mistry, policy fellow for digital technologies at The King’s Fund. We discussed digital priorities for the NHS, the opportunities for integrated care systems, challenges in interoperability and more.

To start off Pritesh spoke about his current role and career background.

Pritesh used to be a physicist and an engineer working on scientific apparatus, focusing on imaging cameras for space applications and life science applications. “I worked on imaging for very small things like cells, and I also did imaging for really big things like stars and galaxies – some of the stuff I worked on went in the Mars Rover and the Hubble Space Telescope,” he shared. “It sounds really exciting, but in reality I actually spent a lot of time in a darkroom testing cameras.”

Moving on, Pritesh worked within green energy for a while, on the development of renewables and buildings. About 10 years ago, he began working in the NHS, in innovation, research on entrepreneurship and transformation, “building collaborations across different stakeholders to get new things happening in the NHS.”

The King’s Fund

Pritesh works on the policy side of The King’s Fund, researching what is happening around digital technologies and how they are being used – or not used – in health and social care.

“We use that knowledge to comment on or provide feedback on policy initiatives that may be happening through NHS England or Department of Health and Social Care,” he explained. “How can they be improved upon? How can we make sure that they work for staff and for patients? We use the knowledge that we’ve gathered through the conversations we have – with staff, patients, carers – and try to make change, or improve how things are being funded or prioritised.”

In September 2022, The King’s Fund published a report on interoperability, examining “how interoperability is a 20-year challenge,” Pritesh said, “and what some of the solutions and ways forward might be.”

There is also a review underway on digital transformation in the NHS. “I was invited to the House of Commons to provide evidence to the Health and Social Care Select Committee,” Pritesh explained. “It was great to input some of our findings around interoperability, but also some of the conversations that we’ve been having in the system.”

The King’s Fund is “putting some final touches to some work around digital exclusion and inclusion,” he added, noting that although this topic is very important it can sometimes be oversimplified. “There’s a misconception that as soon as everyone is online, that’s the problem solved. I think actually it’s a lot more complex than that. We’ve been speaking to about a dozen members of the public to understand what their experience expectations are. We’ve also run a couple of workshops with NHS organisations, charities and local authorities, to try and understand what they are working on, and what we could do more of on the ground.”

From this work, it’s then a case of using findings to influence policy. “There’s a lot of talk about how the NHS might need to be more innovative and how it needs to use more tech. But what does that actually take, and what does that mean? How can tech actually change some of the structures and the systems that we have in the NHS, and how they work?”

Digital in NHS priorities and operational planning

Moving on to discuss the role of digital in the NHS priorities and operational planning for 2023/24, Pritesh said that it was good to see “levelling up of digital infrastructure and improving connectivity within that guidance. It’s not a headline grabber, but infrastructure and connectivity are really the backbone of reliable digitally enabled services. You need them in place if you want to build cutting edge tech on top.”

He commented on the importance of having a baseline capability in place, noting that this is fed into the What Good Looks Like framework. “It’s due to be updated this year, and that will then feed into digital maturity assessments,” Pritesh said, which will then help measure what digital progress looks like in provider organisations. “It’s really promising because it looks like it will also take into account aspects that are beyond technology. It’s not just about having electronic health records or WiFi in place, it’s about whether the digital transformation is well-led – not just digitising existing ways of working, but making sure we’re using them more effectively.”

He also highlighted the NHS App for its role in helping patients “get to the right service and access records, and improving prescriptions and hospital appointments booking. We’re seeing more and more capabilities being built into the NHS app, which is going to be great for for patients.”

Two aspects that Pritesh says are “less well-formed” within the NHS’s guidance for the months ahead are the roles of federated data platforms and the faster data flows initiative. On the first, he said: “The tender was released recently and it’s a national procurement, so it’s going to be a national tool that is made available. The intention is for the platform to help maximise capacity and reduce waiting lists – it’s an intelligent way of prioritising systems and workflows.” On the latter, Pritesh noted that there is less information available at present but ultimately it will come down to applying technology to reduce the reporting burden on staff. “It’s about having more automated data collection and reporting,” he commented. “That will help to reduce workload on staff and free up time, which hopefully should translate into more time for patients.”

Opportunities for an ICS from a digital perspective 

Pritesh highlighted that it is anticipated that integrated care systems will receive funding to meet the minimum digital maturity requirements – mostly focusing on “basics around electronic health records and digitalisation of social care records. But it’s upon those that you can start building data led insights, prioritisation and intelligent waiting lists.”

This will provide ICSs with good opportunities to “bolster the baseline digital capability across the footprint. There’s a really good opportunity to start laying the foundations to make sure that the digital capability across the ICS is to a good level. It’s not just about being highly digitised in general practice, for example; you want a good level of digitisation across the patient journey.

“On top of that, you can start utilising some of the data-led aspects, you can build in population health management, you can improve population health data and analysis and start feeding that into your systems. Then you can make better decisions based on that information.” This can also lead to improvements such as risk management of populations and falls reduction, Pritesh added.

Improving interoperability

Coming back to the challenges around interoperability and how they can be tackled, Pritesh touched upon the report they released in September. “To be honest, it’s a huge issue and it’s been an issue for about 20 years.”

Going into this work, he said, The King’s Fund decided to look at interoperability across an ICS footprint, exploring how the components of a system work together. “We interviewed and ran workshops across the footprint – staff from hospitals, GPs, pharmacists, mental health trusts, ambulance trust, charities, local authorities, patients,” he explained.

They found that there was “no consensus” on interoperability. “What is it, what are the benefits? No-one could say ‘everyone agrees on this’. So one of the first things to be clear on is actually what we mean by interoperability, and what are the benefits we are trying to achieve? Without those, everyone is pulling in different directions and you don’t really make the progress that you might want to make.”

Interoperability is often seen as how technology gels together, he noted, and how information flows across technology. However, it’s not just about that. “We found that you need good working relationships. If people don’t want to share information and don’t want to work together, then it doesn’t matter how good the technology is, it won’t happen. You need people to want to share information as well as needing the technology to make it as easy as possible. Those two factors are of equal importance.”

You also need an enabling environment, Pritesh continued, acknowledging the importance of factors such as reliable funding, effective workflows and processes, and standards that people can understand. “We ended up moving away from some of the standard definitions of interoperability,” he said. “We would define it as how people, systems and processes talk and work together, across organisational structures and professions. It’s supported through technology. It’s a culture, it’s a way of working, and that needs to permeate how people in the system work; how professionals trust each other, how leaders work together to protect organisational capacity to share workforce.”

It’s also about making sure change management is there, and making sure that “when you procure technology, you don’t procure technology for an individual organisation,” Pritesh continued. “You need to think: ‘OK, how is this going to link in for GPs? What does it need to make sure it can be linked into pharmacists? What are the baseline features that we are trying to get across that ICS, and how do we make sure that every time we buy something or update something, it can be linked into all the other parts of the system?'”

How does an ICS foster innovation? 

ICSs taking a directorial role and providing a vision from the top can support innovation, Pritesh observed. “But it’s about taking that top level of vision and direction and combing it with bottom-up inventiveness of staff – we need that to percolate through. We need to encourage providers to support their staff to explore and find alternatives, to have opportunities to look at technology. They need to be able to play with tech and think about how it might work for them.”

ICSs could also help with protecting time and supporting staff with access to education, skills and opportunities to play with the tech, Pritesh noted. “It’s about convening people. I regularly say that the one of the under-utilised superpowers of the NHS is the knowledge and the expertise of the people, the staff. Being able to create a peer group of innovators across the ICS to be able to support each other, to navigate technologies being deployed and being optimised, is an amazing opportunity that doesn’t really happen in the way that it could.”

It’s also about linking innovators to an industry network, he added; whilst staff often have great knowledge of workflows, patients and challenges, they may not know much about the technologies or the potential there. “It’s about bringing groups of innovators in alongside a network of industry and tech people, and marrying the two to create solutions. This could really add benefit to an ICS and how innovation is fostered in an ICS.”

Ultimately, Pritesh said, “It’s something about creating this as a normal thing to be doing. Starting small, normalising change, working with little projects, continue to improve services and creating a culture that recognises that changes are important and needs to happen. Standing still is actually going backwards; it’s key that we embrace change and we become used to change happening.”

Elements to be successful for innovators breaking into the NHS

“There isn’t a magic formula,” Pritesh said with regards to how innovators can break into the NHS. “We’ve seen some things work well, we’ve seen other things that don’t work so well in different areas.”

Trying to copy and paste solutions rarely works on the national level; more than anything, he said, innovators need to be able to show that their technology addresses real problems faced by staff and patients.

“You need to be aligned with national priorities – look at things like the digital plan for health and social care, or the NHS long-term plan, and understand where priorities lay and what each part of the system should be doing when you’re targeting your solution. Whether it’s at an ICS level, hospital level or social care level; what is it your solution is aiming to do? What problem is it actually solving?”

Pritesh also commented the necessity to have the right evidence base in place, and to ensure that you are aligned with the relevant guidelines, in addition to ensuring support for implementation and optimisation.

“It’s rare that you can either drop a technology in place and just leave it,” he said. “Often you need to support staff to understand how technology can be used, how the workflows need to be changed; you need to upskill staff to be able to use and optimise the technology as well. Then it’s about cultivating some of those staff members you are working with to become champions, to change ways of working and about pivoting solutions to fit the problem as well.”

Many thanks to Pritesh for sharing his time and thoughts.

Welcome back to our podcast HTN Let’s Talk

For this episode we interview Niamh McKenna, chief information officer at NHS Resolution. We discussed the key digital projects Niamh has been involved in throughout her career, the strategic priorities for NHS Resolution going forward, the key factors are needed for innovation in healthcare, and more.

Niamh is the CIO at NHS Resolution, an organisation that provides expertise on resolving concerns and disputes, shares learning for improvement and preserves resources for patient care.

“I’ve been doing this role for about two and half years now,” Niamh said. “Prior to that, I worked for most of my career in a variety of professional services roles, both consulting and outsourcing. Immediately prior to taking on this role, I looked after Accenture’s healthcare practise in the UK. So I’ve been working in healthcare for a while now.”

Key digital projects and programmes 

NHS Resolution is currently focusing on a huge amount of transformation, Niamh said, adding that it is a very exciting time.

“When I’m recruiting, I’ll often tell people about all the different work we’re doing because there’s a unique chance to get involved right at the beginning, when an organisation really transforming almost everything it’s doing from a technology perspective,” she said.

She explained that NHS Resolution is focusing on transforming a set of legacy core systems at present. “They underpin our advice service, our appeal service and our claims service. So we’re in the middle of transforming those –  but as any technologist knows, there’s a huge amount of other things that have to happen.”

It’s not always glamorous, she joked. “Everyone knows about the apps, the digital surgeries, all the glamorous stuff. The dull tech is about underpinning the infrastructure – but you need it for any of the glamorous tech to work. There’s no point having a fancy app if it doesn’t connect to anything, if it can’t access data, if it’s not stable. So we’re doing a huge amount of core infrastructure work. We’re focusing on modernising our technology estate, moving things to the cloud, getting more resilience in there, improving our cyber security posture, all things like that.”

Other important transformation work focuses on data. Niamh explained that NHS Resolution has a “huge” amount of insightful data, calling it “the largest database of its type in the world, providing an incredible insight into claims and causes of harm. We’ve got records of the last 16 years or so, and a statutory duty to use that information for learning.”

It’s been difficult to access, she noted, and highlighted the complexities around data location. They are “giving the team better tools to do their job,” she said, and focusing on making sure that data is “organised and structured in better ways to allow easier access, then improving the reporting that we’re giving to the business as a result.”

NHSR strategic priorities

Following the publication of NHS Resolution strategic priorities, Niamh described how her team is working to support every element with the number one priority focusing on delivering fair resolution. She highlighted how the team need to be able to “concentrate on the job rather than being hindered – perhaps they have tools that are no longer fit for purpose or don’t reflect changes in how things are now done. For example, one of the things we’re doing is keeping things out of court as much as possible and providing alternative dispute resolution schemes. Having systems that can really support those alternative routes is important.”

Modernising the data estate is “absolutely critical” to being able to use data insights as a catalyst for improvement, she said. “If we can’t get our data into shareable formats and we can’t give those insights to the business, then we can’t use them for improvement work.”

Niamh noted that maternity is a big focus for NHSR at present. “It obviously costs a lot of money in terms of any harm that happens at that level, at that stage in maternity,” she said. “But at the heart of everything you’ve got to remember there’s a baby, a family who have been impacted. Being able to deliver improvements in that area is so important for us.”

It comes back to data. “If we can help give additional insight, find some information that we can share with colleagues around how to do something or change something, then that’s so important. It’s very motivating for my team, to feel that they can make a difference.”

The final strategic element Niamh highlighted is on “investing in our people and systems to transform our business.” An important part of this work is around reducing friction, she said. “When I first came in, one of the things I noticed was that there are lots of little areas of friction in the way that we do things – logging on, for example, accessing our systems.”

Niamh commented that given her background, she likes to pay attention as to how she can reduce these pain points. “It’s like in the wider NHS – there’s the famous 14 log-ins that every clinician has to deal with. We’re not quite frontline clinicians, but it’s still irritating!”

Key factors needed for innovation in healthcare 

In this area, Niamh said that commitment from the top is vital, but noted that the path to innovation is never straightforward.

“There’s always stuff that trips you along the way. I’ve never in a 30-year career had anything implement absolutely smoothly without any problems whatsoever. There are always hitches and so you’ve got to hold the faith.

“Having the backing of the board and senior colleagues is really important – not only so that they can support you, but so that they can provide leadership when inevitable problems happen. They can help teams to understand that this is normal, that we’ll get through it.”

Niamh also highlighted the importance of multidisciplinary teams, with the need for technology and business teams to work together. “It sounds trite, but actually achieving this in practice is not always easy. As humans we naturally divide into our different tribes, and even within a single organisation there’s always a team culture – this can sometimes include reluctance to work with other teams.”

She added: “I think having true partnership working in place is vital. It doesn’t matter what team you work in, if you’re an external supplier, a contractor, a member of the organisation, tech team, business team; we all work together to deliver the same outcome.”

Challenges and how to tackle them

Building on the above point, Niamh commented on the need for team building to drive the right culture. “Don’t forget to do some of the fun stuff together, even if it’s just doing a little coffee morning, a quiz, or whatever it might be,” she said. “Find ways to engage with people at a personal level as well as a professional level. It can be difficult in a remote working situation, but I think we learned a lot during the pandemic.”

She stated that having a no-blame culture is also very important to her. “I’ve always held that view as a supplier to clients and I still hold it now. If something goes wrong, it’s never about the person – it’s not about finding an individual and hanging them out to dry. If something goes wrong in my area, then that’s on me and I need to take accountability for the team.” She highlighted the importance of being able to have open conversations behind-the-scenes, to discuss what went wrong and how to improve.

The other challenge Niamh has experienced is the tension that can arise “between business as usual and transformation. It’s very, very demanding on the support teams, particularly the technology support teams. We’re pulling people in lots of different directions and that can be very difficult to manage.”

She explained how NHSR has a technology team in place to run their live services, who work to protect those services and ensure that project teams go through the right process. “It’s really important, as we get excited about innovation, not to throw out all of those really good disciplines around service introduction. We need to manage the workload of those technology support teams and make sure we don’t overload them.”

It can be very easy to keep asking for more, she acknowledged, and said that support teams are often “not great at saying no to additional work, because their job is to help so they accept things and it can become more than they can handle. So we have to make sure that when they say yes, that they do have the time and the capacity.”

What ‘good’ looks like in the future of health tech

“I really want to see us leveraging technology to transform in a couple of areas,” said Niamh. “One is the back office. I think that is one of those areas that is underserved. So many startups are trying to solve patient-facing problems, which can be very helpful. But actually there’s so much back office pain, areas of friction as I mentioned earlier. I’d love to see more technology solving those problems.”

She noted that data is key to the future of healthcare, acknowledging that it is a difficult topic to broach in the NHS. “We have this incredible resource and so much angst about how to use it, how best to use it, how to get data flowing properly. I think in the pandemic we unlocked a bit of that, but there’s still a great nervousness. I absolutely appreciate why people are cautious, but it does feel like it sometimes holds us back.”

Niamh also stated that data sharing agreements can be “quite complex to get put in place and it feels a shame that we can’t get a more systematic way of dealing with it.” She commented on how she welcomed the Goldacre report, “which touched on some really good ways around trusted research environments and how to how to unlock that data. But it feels like if we could fix that and get the right data into the right hands to do the right kind of insight and analysis again, we could really push forward with some incredible innovation.”

We would like to thank Niamh for sharing her time and thoughts with us.

Welcome back to our podcast HTN Let’s Talk, sponsored by Spirit Health!

For this episode, we interviewed Dr Janak Gunatilleke, director for healthcare data and analytics at KPMG UK. We discussed how AI can solve clinical problems, what is preventing AI solutions from being adopted, and his thoughts on to tackling the ongoing challenges in this area.

To start, Janak spoke about his current role and career in health tech. 

Working in healthcare for more than 17 years, Janak started his working life as a doctor. Over the last 14 years since leaving clinical practice, he has worked in a variety of areas within healthcare, including working for large and SME management consulting firms, freelancing as a consultant, operational roles and for a health tech startup in London.

“Last year I completed a Masters degree in data science and published a book exploring the potential of AI in healthcare, challenges to successful implementation and how to do things better,” Janak said. “I’ve also been on the evaluation panel for the NHS Transformation Directorate AI Awards. Now I’m a director at KPMG where I lead our healthcare data and analytics work in the UK.”

Digital projects

Janak explained how KPMG focus on three areas within data and analytics. The first area is about “helping clients think about how to make the best use of their data, how to develop an associated data strategy, and how to realise the benefits and improve citizen outcomes,” he stated.

He noted that there have been a lot of national policies published in the last year, such as Data Saves Lives and the Goldacre report, along with a number of national initiatives such as the federated data platform and secure data environments. Janak emphasised the importance of regions and organisations having an understanding around how this all fits together, and what it means for them at a local level. “We work with ICSs and help them understand this better, how data can ultimately help them deliver their overarching strategies,” he explained. “This includes coming up with prioritised road maps of key initiatives that they need to implement to get them where they need to be.”

The second key area for KPMG focuses on implementation and follows on from the data strategy. “A lot of the NHS still mainly relies on descriptive analytics, where the focus is on analysing events that have occurred in the past,” he said. “Due to challenges in collating, cleansing and managing data, some of these insights can be weeks old.” In his experience, he added, whilst there are a few organisations leading the way, “for many the focus should be on getting some of the fundamentals right – the data governance or infrastructure.”

Janak highlighted the importance of developing workforce capability, to equip them with the skills, confidence and the ability to adopt the different mindset that is needed.

“We work with organisations through our unique analytics learning programme, to help develop the technical and non-technical skills of data analysts,” he explained. “We aim to better equip them for an evolving data and technology landscape in the NHS, and for them to effectively enable particular initiatives.”

The third area of focus for KPMG looks at identifying common problems faced by clients and developing a repeatable solution and effective product to deploy quickly to help. “For example; we developed a great product that helps hospitals with their strategic workforce planning, which helps them understand their demand better, the impact of their workforce retirement rate and where the gaps are.”

With regards to AI, Janak commented that many people tend to be interested, “but the reality is that it’s quite hard to implement AI solutions at scale in the NHS at the moment. We’re doing a lot of work to help NHS organisations with the foundations that they need to move along the analytics maturity curve, and to begin to harness the full potential of advanced technologies such as AI.”

Challenges

Janak explained that he usually comes across three main challenges.

The first challenge is when there are “a number of initiatives and projects in progress, but there isn’t really an overarching vision or a structured plan. There is limited activity because either it’s not clear for the client where to start, or where the leadership is not bought into how data and analytics can add value.”

The second challenge comes about when the solution is technology led. Janak said, “It’s like getting it the wrong way round – having a cool piece of tech and trying to shoehorn it in by looking for a problem to solve. We really need to start with the problem.”

The third challenge is where the focus is solely on technology, with a lack of attention paid to other crucial factors such as stakeholder buy-in, integration into existing workflows, and training and support for end users.

“We work to help overcome these challenges, resulting in projects that deliver sustainable value,” Janak said. “For example; data strategies define a clear vision which the stakeholders can buy into, and which includes a prioritised road map. That sequences initiatives across the transformation timeline.”

He noted the importance of taking a user-centred approach, where the team “spends time upfront, talking to you and understanding the current situation and the challenges. As well as gaining stakeholder buying, this really clearly helps articulate and quantify some of the problems.”

Finally, he noted how they take multidisciplinary approach. “For example; if it’s a data strategy project, we don’t just have data analysts and technologists in the team. We bring in colleagues who have expertise in other areas, for example health operations or customer engagement. This really helps us to take a more holistic approach in terms of how to solve the problem and helps us address some of those key non-technical elements.”

How AI can solve clinical problems

Janak highlighted a controversial statement from Vinod Khosla, co-founder of Sun Microsystems. In 2017 at the Health Innovation Summit in San Francisco, Kholsa suggested “that machines will replace 80 percent of doctors in healthcare, and the future will be driven by entrepreneurs, not medical professionals.”

In terms of where we are now, Janak pointed out that AI is nowhere near replacing 80 percent of doctors. “If you look at real life results of AI-based solutions in healthcare, the results haven’t really been very impressive,” he commented.

The lack of adoption is reflected in academic publications where “the majority of studies are retrospective, so looking back instead of looking forward,” he said. He noted that small scale reviews and evaluation reports have found that actual AI adoption tends to be limited towards specific departments or use cases.

“Worryingly, there were a couple of reviews done on 647 AI tools that have developed during COVID and helped with COVID management,” he said. “The reviews found that actually none of them were really fit for clinical use, and that only two warranted any further evaluation. This brings us back to a question of where AI can help. Is there real potential?”

When identifying the potential of applications of AI to add value in healthcare delivery, Janak explained that there are two dimensions to consider. The first dimension involves looking at it from the perspective of the non-clinical area and frontline delivery of care. “In between those areas, there’s space for increasing productivity – it has some elements of back office work, but some elements of delivering care,” Janak said.

The second dimension is around the four stages of a patient journey and delivery of care: planning, prevention, delivery of care and ongoing management of care. If you put those two dimensions together, Janak said, “You get a nice grid which helps us look at identifying use cases for AI with more ease. Population health, for example, sits on that grid between back office work and prevention work. There’s an intersection there about enhancing care delivery, around things like supporting triage of patients, thinking about risk and so on. With ICSs and soon-to-be-established intelligence functions within the ICS, I’m excited at the opportunities within that particular space where AI could have a massive impact.”

Current challenges of AI solutions 

Looking at the current challenges around AI solutions and what is preventing them from being adopted, Janak said: “I like to first look outside of healthcare at industries and companies that are using AI well. For example; household names like Netflix, Uber or Amazon. Whether it’s personalising recommendations or making sure that their operations are more efficient, they’re actually using AI to deliver value to themselves and to their users.”

In considering why it might be easier for them, Janak noted: “In most of these cases, data is readily available to these companies and in large quantities that helps them develop and refine effective AI models. So most of these companies have more than 100 million users, which gives them a readily accessible pool of data.”

He explained that these companies have “invested huge amount of money in developing sophisticated methods” to make the collection and use of this data “much more efficient within their companies.”

In addition, he added, these companies are solving real life problems and doing it in a seamless manner; for example, Netflix personalising a user’s viewing habits. Viewers don’t notice that they are using AI, he pointed out; it just happens and makes your life easier, or adds value and insight to the task you are trying to achieve.

They also have more room for error, Janak noted. “Maybe a recommendation provided by Netflix wasn’t perfect, the user might not follow the recommendation, but there’s no real damage done.”

Considering the challenges to AI implementation in healthcare, Janak highlighted three main categories: people, systems and technology.

On people, Janak said, users need to be able to trust and have confidence in the output of solutions. “Individuals involved need to have the knowledge to make informed buying and use decisions,” he said. “Also, frontline staff need to have headspace and protected time to engage with the development and implementation of these solutions.”

With regards to systems, challenges include integration into established clinical pathways. “Some of these clinical pathways have been there for 10, 20, 30 years, and the solutions that are deployed need to take those into account. You need to think about the potential disruption those solutions might cost to those established processes.”

From a technology perspective, “access to data within healthcare is not easy. We have to consider things like bias, and solutions need to work as intended across different organisations and different populations which can vary quite a bit.”

To overcome some of these challenges and develop a better methodology to design, deploy and operate AI solutions in healthcare, Janak made a number of suggestions.

“Firstly – really focus on solving a real problem. Always start with the problem, rather than with the solution or with the technology.”

Secondly, he encouraged the use of a roadmap that considers the lifestyle of AI solution development and the different stakeholders that need to contribute and work together. “The road map has five stages,” Janak said. “It starts with identifying the problem; designing it; developing a solution that is safe, effective and scalable; implementing the solution; and then continuous improvement and monitoring.”

Janak’s third suggestion for overcoming AI challenges centred around enablers. “Enablers are a combination of elements that need to be achieved during a solution, and some that just need to be there during the solution lifecycle. They can be at solution level, an organisation level, regional or national level. No matter how good you are or how hard you try, it’s difficult to succeed if some of these enablers are not there.”

The future of AI in healthcare 

Looking at the future of AI in healthcare, Janak said: “I think it’s going to be a gradual process.” He noted that there tends to be a lot of interest in activity in areas such as radiology, where there has “always been a lot of digitised data and a more digitally savvy workforce.”

He added a belief that there is potential for AI to make a difference in the back office area. “There’s less risk to manage, which means you can experiment a little bit more than you can when it’s to do with delivering care. I think there’s a lot more that we can do, and much more quickly, in this area. If the right solutions are developed and implemented in the right way, it could have a massively positive impact on the workforce – we can get rid of some of the more mundane tasks and help with the more complex, to really help the workforce operate at the top of their license. This could be really beneficial in the current environment where there’s so many vacancies.”

He added: “On the flip side, the workforce does generally need to have the knowledge, skills and the confidence to choose and work with some of these solutions, and to be able to use them safely through understanding some of the risks and limitations.” He re-emphasised the importance of giving staff time and space to meaningfully engage with AI, adding: “I think there needs to be something done about how to create the right roles, the resourcing and the funding to make this happen.”

Overtime, Janak said that he believes we will start to see solutions succeed in wider clinical areas and on the frontline. “But I think there needs to be a number of things that needs to happen with the right investments and the right people working together,” he said.

We would like to thank Janak for sharing his time and thoughts with us. Janak’s book, ‘Artificial intelligence in healthcare: unlocking its potential’ is available here.

Welcome back to our podcast HTN Let’s Talk!

For this episode, we interviewed Chris Mason, chief information officer at Wirral University Teaching Hospital NHS Foundation Trust. We discussed what digital projects Chris has worked on throughout his career, the key factors needed for innovation in healthcare, the current challenges in digital health and more.

To start off, Chris spoke about his current role and career background.

Chris has been with Wirral for around 15 years and started as a project manager, joining at a time when the trust had just started its EPR journey.

His first implementation was the outpatients PAS (patient administration system) and following that he moved on to become programme manager which involved taking care of the team of project managers. In this role, Chris continued the trust’s journey with migration to Cerner.

From there, Chris moved into the service improvement team within Wirral. “I built up a lot of operational contacts, but also it gave me a chance to see the impact our digital systems were having on clinical and operational workforce,” he said.

When he moved back into the digital healthcare team, Chris was benefit lead for the GDE programme before progressing to deputy CIO, interim CIO and then onto the substantial post in December 2021.

Chris looks after all of the trust’s IT functions and staff, including technical development and clinical analysts, projects, integration information and business intelligence. “Under my remit I’ve also got medical records, information governance and clinical coding. So it’s really widespread, with great teams across the board. We’ve got a lot of great people in the organisation and particularly in individual healthcare teams. You’re only as good as your team and my team are fantastic, so I’m very lucky to have them.”

Key digital projects 

When Chris first started, his work focused on decommissioning their legacy system. The trust’s first intention was to move what they already had within their legacy system and build upon that. “We already had some sort of digital care pathways, the inpatients PAS, an element of e-prescribing,” said Chris. “We’ve now got the vast majority of our medical devices integrated into our EPR with all of that data flowing in from our medical devices. Where we have specialist systems, again the vast majority are integrated with a small amount of specialisms still to go. Most of our clinicians probably only log into one system, which is great. It’s a one-stop shop for everything.”

On a wider scale, the trust led initially on the implementation of Health Information Exchange, a shared care record for Wirral Place, and also on the population health solution for the Healthy Wirral Partners.

Chris described Wirral’s portfolio as fast-paced and said: “Nothing ever stands still – there’s still an awful lot to do. At the moment we’re planning for the next financial year, so we ensure that everything is prioritised so that we can keep our work in line with clinical strategies on a yearly basis.”

Whilst the trust has operational plans in place to ensure that they are meeting all of their clinical and operational requirements, Chris acknowledged that “things obviously do change throughout the year and we have change control in place to re-organise and be flexible around the up and coming requirements. But on the whole, those plans form a really important part of the year for us.”

As part of that, the trust is moving to a new PACS (picture archiving and communication system) which is aligning with the wider region. They are also working on their patient portal which will be coming up in the next financial year and which aims to get far greater coverage of their patients. This will offer patients the ability to book their own appointments and view elements of their record.

Chris continued: “We’ve also got outpatient transformation work which will focus on our self-checking kiosks, room management, dashboards for clinicians, virtual appointments, telephone appointments – it will really transform the offering to the patients of Wirral and provide a better patient experience when visiting the hospital.”

In terms of training, the trust has a learning management system that they are bringing in across the organisation. “We have tended to do traditional face-to-face training methods, but we realised that we need far bigger, far greater coverage and we need to allow people to do the training when they can fit it into their busy schedules.”

As part of elective recovery,  Chris explained that there is a major piece of work “that we’re going to be embarking on with Cheshire Merseyside around the data provision for the Cheshire Merseyside Surgical Centres. Where I’m based at the Clatterbridge site, there are two new theatres that have opened up recently. We’re currently taking patients from Chester, but it’s envisaged that we will take patients from other secondary care settings too.”

Key factors needed for innovation in healthcare

Chris said that the technology for innovation is there and has moved on in leaps and bounds.

“From an innovation perspective, I think the scope is massive, but the key factors for innovation in healthcare are around that engagement and embedding. Sometimes there is technology, but it doesn’t necessarily fulfil the use case.”

He highlighted that it is also key to make sure that systems are intuitive, as most clinicians and operational staff do not have time for extended learning. “When you pick up your phone and use an app and you’ve not had training in it, it works because it’s intuitive,” he said. “That’s what we need to make sure we achieve with clinical apps. We don’t want to have to set a clinician down for hours of training. They need to be able to work with it with a minimal amount of education. We also need to allow time for subject matter experts to be engaged and feed into requirements.”

Chris commented that there needs to be time to focus on “preventative measures and working as a system to make population healthier as a whole. The aim needs to be that we don’t need to treat these people in the first place, because they are well, better and healthier.”

Challenges 

For Chris, one of the challenges is demands on time. He noted that some projects had to stop during COVID but have taken off again now, and there are new projects coming into the frame. “The governance that we’ve put in place to help the organisation to prioritise this work has been invaluable,” he said. “We’ve got a really supportive exec board and they’re all signed up to our governance processes – it’s very transparent.”

Workforce can be another challenge. “I would imagine that if you ask any CIO, they would say that this is one of the major challenges. It’s a competitive market, not a shortage in professionals, but the A4C framework and the restrictions around that do pose some problems. We are really close across Cheshire and Merseyside, so we’re looking at ways in which we can work together to try and combat that issue.”

Chris noted that it is getting increasingly harder to recruit in digital. In Wirral, they are looking to grow their own staff. “We may get staff in entry level posts who also have an interest in this area. If we recruit and grow people from there, that helps us and it helps them as they have a good career path too.”

Another particular issue is around operational and clinical staff availability. “They’re extremely busy, and it has to be the priority to care for the patients that we have,” Chris said. “But of course time is also required from clinicians and from operational staff to help with these projects. It’s key that we get their engagement and that they lead on it.”

Due to pressurised environments, he noted, some projects remain IT-led. “That’s inevitable with the situation as it is, and how busy healthcare is,” he commented. However, he added, “there’s always a risk when you take those clinical subject matter experts out, or their time on the project is at a minimum. You’re going to get a product that doesn’t fit the bill 100 percent.”

The best way to fix this at Cheshire and Merseyside level is to work together, Chris said. “We need to come up with a strategic, collaborative way of working to enable us to help each other. There might be a bit of short-term pain, but there’s certainly long-term gain from the potential efficiencies and productivity enhancements.”

Ultimately, Chris pointed out, “There is one reason why we are all here and and that is for patient care. The technology side is fantastic and the work that the teams do is fantastic and but it’s got to contribute towards patient care and productivity and efficiencies.”

What ‘good’ looks like in the future of digital health

‘Good’ to Chris would be an environment where digital is embedded within thinking around clinical and operational strategy. “If you look at my organisation at the moment, we’ve got a clinical strategy and we’ve got a digital strategy,” he said. In the future, he would like to see no separate digital strategy because it is “part of those clinical elements instead, and that our awareness around the opportunities for digital are far wider understood.”

Chris added: “We need to step back and ask how we can do things differently. That would be ideal for me – to create that headspace so that we can forge our way forwards.”

He also raised the need for collaboration and standardisation. “If you’re going to one organisation or another as a patient, why should that make any difference? You should always be treated in the same way. The more we can collaborate to make the patient experience consistent, the better.”

On population health, Chris highlighted the importance of preventative measures and said: “Levelling up is a buzzword at the moment, but we need an environment where patients, no matter their postcode and no matter the organisation, are dealt with in an efficient and expert manner. This shouldn’t be impacted by digital ability.”

As a final note, Chris remarked: “We should give everybody the opportunity for that digital involvement and digital progression. We may not fix all the problems in the world, but we will give it our best go.”

Welcome back to our podcast HTN Let’s Talk!

For this episode we interview James Freed, chief digital and information officer at Health Education England (HEE). We discussed key digital projects James has been involved in, his thoughts and experiences in developing the digital workforce and more.

To start, James spoke about his current role and career background. He explained that every CIO or CDIO role is different, with each role playing “to the strengths that we bring to those roles and what the organisation needs from such a role. My role is there to try and help the organisation get the greatest value from data, information, knowledge and technology.”

James is also the senior responsible owner for a programme of work called Digital Readiness Education, supporting the delivery and development of the entire health and care workforce in digital skills.

On his background, he commented: “I didn’t come up through the server room and in fact I wouldn’t really describe myself as a technologist – I’m more of a change manager by background.”

James started a PhD in cancer research before moving to work within change management roles in the NHS. “I moved into central bodies, spent some time with the national programme for IT and then moved to the Health Protection Agency and Public Health England as their head of information strategy before moving to Health Education England,” he said. “That was eight  years ago this summer, and that was my first CIO role.”

On challenges and successes

One of the biggest challenges, James noted, is the word ‘digital’, as it means “lots of different things to lots of different people.”

He explained that he is working on a product alongside NHS providers, organisations and membership bodies to support NHS trust senior leaders, executives and non-executives in developing their own digital skills. “This isn’t about the chief information officer, it’s the chief operating officer, the chief executive, the chair – those roles you wouldn’t traditionally consider ‘digital’.”

The first thing they do in development sessions is have a conversation about what digital means. “We get that out on the table, try to work out what it means for a board to talk about digital,” he said.

Highlighting that it is important to recognise how digital underpins all of our lives now, James said: “Fundamentally technology has changed everything about how we experience life. It has massively changed our expectations about how we want to buy, sell, interact with one another.”

It’s also important that the board is fully engaged with digital, he pointed out; it is not something that can be pushed at people.

Another challenge James highlighted: “The technology needs to be there, but it’s everything else around it that needs to make it work,” he said. “It’s about the change management package. 70 percent of digital projects fail, but of those failures, only 20 percent fail because of the technology. 50 percent fail because of culture.”

Developing digital across a workforce

In 2017, James said, he was involved in a project which asked over 1000 digital professionals in the NHS a question: What did digital readiness mean and where are the gaps? What do you need to start, stop or do differently in order to achieve digital readiness?

With many varied responses received over several months, a model was developed to help structure conversations about what digital readiness means. “Digital readiness is being both digitally willing and digitally able,” James explained. “And that digital willingness and digital ability is at two different levels – there’s me as an individual, and there’s the organisation that I work for. You need that ability and willingness in both.”

Willing organisations, meanwhile, allow their workforce to make those changes, whilst a “digitally able organisation provides the digitally willing workforce with the right tools and data in order to make those changes happen.”

A separate consultation was held with 600 members of nursing staff. “They talked about the shiny stuff – AI, machine learning, robotic process automation. But they actually only wanted four key things.”

The first three things were access to modern devices with a camera; connectivity; and an electronic patient record. The fourth was a desire for more ease of use, with policies that allow them to make use of the first three elements.

“We’ve been heavy on governance, which means we slow things down,” he noted, adding that one positive outcome from the pandemic was the way it turned that on its head. “It didn’t mean we could be less safe. It just meant that we had to move fast. We couldn’t take 10 years to develop telemedicine solutions.

“That’s what the Topol review from 2019 predicted just before the pandemic,” James added. “The predictions based on the best available evidence suggested that telemedicine would hit an 80 percent prevalence in the NHS over a 10 to 20 year period. With the pandemic, suddenly we had telemedicine hitting an 80 percent prevalence in more like 10 months. It was a remarkably quick period of time to get substantial technological adoption and change within the NHS. It’s because we had to, we were forced to rebalance that governance and innovation model.”

However, James pointed out, there is a question around how you can educate every single person in every organisation to be digitally willing and able.

He outlined areas of support. The first, a digital boards development session, is aimed at creating digital willing organisations. “By the end of this financial year, we will have delivered 100 development sessions to trusts,” he shared. “That means about half of NHS trusts will have had development sessions – it doesn’t mean they’re perfect, but they’re on the road.”

Secondly, James described how he has developed a digital skills assessment tool which will shortly be launching, which focuses on “trying to develop the digital literacy of the entire workforce at scale. There are six broad domains, including things like basic digital safety, but also things like communications, learning and teaching, content creation and so on.”

The tool asks 32 questions with two dimensions. James provided an example: “Where do you think your job requires you to be and where do you think you’re at? The deficit between those two assessments points you through the tool to a set of learning products that are focused explicitly and uniquely on your needs.”

Achieving and measuring success within the digital readiness work

It’s always been difficult to measure impact, James noted. “As you get more specific it becomes easier, but it’s still very hard. Ultimately, through our digital readiness education work, we aim to deliver more value through the health and care system tomorrow than we did today.”

“Value” he added, “is described in the NHS’s Five Year Forward view and other policy documents through four areas; patient outcomes, population health, cash releasing benefits or efficiency criteria, or workforce satisfaction, and we want our contributions to add to at least one of the four areas.”

As part of the digital health leadership programme a chief information officer is supported with a learning module. “They are involved in one of the six modules, the one that is all about user-centred design. They spend their time developing a product that actually meets user needs rather than failing to do so,” James said.

He noted that this can often be a major contributor to failure in digitally delivered solutions. “Not concentrating on user needs and instead concentrating on perceived needs, guest needs or just organisational needs means that products end up not delivering value.”

What success looks like

For James, success in the future means that we can stop using the word digital. “Someone once said that there aren’t IT projects anymore, there are just change projects. I think that’s true.”

At the moment, James believes that the word still has value. “It’s still useful in terms of describing a change of philosophy and a certain approach,” he said, one where we can move to a more user-centred, iterative, devolved and trusting world with less hierarchies in place.

“Digitally mediated change is just a part of every single change that we undertake anyway,” he said. “When it becomes commonplace, when it’s just the way we do it – that’s when success has really hit home.”

When you can measure the value that you provide, he said, it should become a habit to measure the impact of each service and to empower the people running those services to improve on that value.

“When we listen to our patients and service users more, when we enable those individuals to take more control of their own health and care – I think that all of these are little indicators that we are on the right track.”

Advice to anyone wanting a career within the NHS

James shared that he also undertakes work with school leavers. “There are two projects that we support, one around university technical colleges and one in partnership with an organisation called Avada,” he said. “They run a programme called Fast Futures and they train every cohort once a quarter or so. They train about 1000 school leavers and university leavers through a bootcamp for digital skills, I sometimes do talks for them. The big thing that I say is that the NHS is not just about doctors and nurses. Every single career is represented somewhere in the NHS.”

If you want to save lives, James said, the NHS is the best place to work. “You can do that as a lorry driver or a porter, as a software developer, as an agilist, as a user-centred designer, an IT helpdesk professional, a knowledge manager, a librarian.”

Over the next few years, he added, “We’re going to see more structure and career paths – more opportunities and recognition for all of these people in digital, data, technology and knowledge services.”

Many thanks to James for sharing his time and thoughts.

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Welcome back to our podcast HTN Let’s Talk!

For this episode, we interviewed Ayesha Rahim, clinical lead for digital mental health in the NHS England Transformation Directorate. We discussed what digital projects Ayesha has worked on throughout her career, the challenges that lie in digital mental health in relation to digital exclusion, and more.

To start off Ayesha spoke about her current role and career background.

Ayesha has worked in the NHS for nearly 20 years. “I work as a psychiatrist, treating people’s mental health. I spend about one day a week on that these days and in the rest of my time I’m focusing on other jobs, mostly in digital. Apart from my psychiatrist role, I also work in a mental health trust as their chief medical information officer, which means I’m their medical lead for digital transformation.” She explained that she works with her colleagues in the digital department to think about “how we can improve our digital services for staff and also therefore for patients as well.”

Ayesha’s other main role is with NHS England as the clinical lead for digital mental health. “I work with national teams around policy regarding mental health and digital, where those two things collide,” she said.

The impact of digital on mental health care

Ayesha noted that mental health wide spectrum – from people who may not be mentally ill but have some needs around their psychological wellbeing, to people with significant mental health conditions who are treated in a mental health trust or specialist service.

“There are opportunities to support people at every point in that journey with technology,” she added.

Ayesha highlighted that there is a lot of potential impact for digital in mental health care for children and young people. “We know that effectively treating the mental wellbeing of younger people not only improves their wellbeing at that point in time, but also reduces the risk of them going on to to develop longer term conditions.”

If we can get things right for young people in society, Ayesha said, then hopefully “they won’t need to make lots of use of mental health services when they are adults. It’s pretty clear at the moment that it’s really quite difficult for young people to access mental health services in a timely fashion and there are many different reasons for that.”

“A lot of the narrative around improving mental health and improving digital mental health often focuses on that early phase, around wellbeing, which is of course extremely important,” she said, adding that it is important to try and prevent problems before they get worse; however, she pointed out a need for more focus on people at the more severe end of the spectrum.

Something that could improve experience and outcomes for this group of people, Ayesha said, would be the ability to access their own notes and contribute to their own care plan. “That’s something that we’re not great at, currently, but we are making progress in that space.”

Key projects with digital mental health 

Ayesha described how she is heavily involved with the electronic patient record at her mental health trust, and how it can be optimised.

This work includes focus on “how we can make that experience better for staff who are spending lots of time seeing patients, but also lots of time entering data into health records as well,” she said. “That can sometimes be quite an onerous, time-consuming task.” She explained that her colleagues are working together to ensure that the design of this system “makes it easy for people to do their jobs, spending more time seeing patients and less time entering notes and doing administration.”

Looking to her NHS England role, Ayesha commented on her passion around the Mental Health Act. “This is legislation that supports people who are at the most severe end of the spectrum of mental ill health. There is legislation to govern how people are admitted into hospital under those circumstances and we need to think about how we digitise that process, because at the moment that process largely relies on bits of paper.”

Ayesha highlighted another project around building the evidence base for digital mental health interventions, to help people have confidence that the products are effective and safe. She noted that if you search for an app about mental health, you will find hundreds of products out there, and emphasised  that patients, citizens and staff need to know which of these products have met the thresholds for a good evidence base.

Key learnings and challenges

“I’ve had a very steep learning curve because I started off as a psychiatrist, as a doctor in mental health,” Ayesha said, “so the digital world has been one that I’ve had to get to grips with.”

One important thing to recognise when trying to improve digital services is “the importance of involving the people that are using those products,” she said. “It might be patients, it might be staff – and it goes for mental health and every other kind of digital transformation project that you’ve got.”

If you are implementing a digital product or platform, “you need to know that people feel comfortable and confident using it and they see it as an important thing that they can use in their day-to-day roles. You don’t want it to be something additional that somebody has asked them to do without any consideration of the impact that that has on their working life.”

This engagement can be a “real missed opportunity,” Ayesha said, “because what’s been neglected is that focus on helping people, managing people through change. And that’s what real transformation is about from me.”

Successful digital transformation in mental healthcare

“It’s really important that we try and address the challenge of people struggling to access mental healthcare in a timely fashion,” she stated.

She explained that instead of working harder, we must work smarter, and digital can support us in this. “I wouldn’t want to say or imply that digital care is a complete replacement to human touch – of course that’s always going to be needed and necessary.

“But digital is there to try and address some of the gaps that we have between demand for mental health care and our current resources. That’s what good transformation looks like, to me – meeting people’s needs so that they can access care quickly, helping them to feel better.”

Digital exclusion and the uptake of mental health services

“I often hear from people who aren’t in the digital health space about worries that technology and digital will exclude more and more people. It’s something we are very conscious of and absolutely want to avoid,” Ayesha said. “We can’t create digital channels that then act as a barrier.”

It’s about opening up the offer and increasing choice, she said. “One thing to be aware of is that it’s not always a case of not wanting it. There are a variety of reasons as to why people can’t access digital services – they might not have the connectivity, skills or confidence. It could be because they do not have the devices needed to access care, she suggested, or the data available to do so.

If you have issues with connectivity, it doesn’t matter “what kind of brilliant well-evidenced digital product or app you’ve got access to – if you can’t connect to the internet, you’re not going to be able to make use of it.”

On how to tackle these challenges, Ayesha highlighted that some places are working around this issue by offering a community space where people can access a digital service.

On the services themselves, Ayesha commented: “We know that there are many people out there who really struggled to use mental health services in the way that they are currently configured.”

Additionally, whilst it’s important to improve the quality and standard of services, “wouldn’t it be better if we’re trying to prevent people becoming unwell in the first place?”

Ayesha highlighted the need to support people with factors such as education, employment, finance and accommodation in order to support prevention work. “All of these things can impact on people’s wellbeing. If you have a vulnerability to developing a mental health condition, for example, then these circumstances might trigger a problem.”

Addressing these social determinants can have “a massively positive impact on people’s mental wellbeing, which will also then have a positive impact on the reducing the demand for mental health services,” she said. “We want to try and nip things in the bud and do our best to reduce the likelihood of people developing a mental health condition.”

Health inequalities 

Again, Ayesha said, accessing care in a timely fashion plays an important role in reducing health inequalities

“If we can think about what digital interventions we can provide for people who are on waiting lists, for example giving them some level of support whilst they are waiting for a formal appointment, I think that would be one space that we could really consider,” she said.

Another area to highlight is “being able to monitor people’s response to treatment in a really objective way.” She noted that her organisation is currently working to roll out a rating scale to support with this, whereby people can indicate what elements in their life are causing them the most distress, such as housing, mental health symptoms, medication or employment.

“That’s the dialogue plus scale that was developed by a mental health trust in London and it’s something that’s been rolled out in lots of different mental health organisations,” Ayesha said. This scale is then repeated at various points throughout the patient’s journey, to monitor the elements that are in place to support the individual. It allows health professionals to see whether those elements are effective, and if not, whether there is something else that can be put in place to help.

Many thanks to Ayesha for sharing her thoughts.

Welcome back to our podcast HTN Let’s Talk, sponsored by Spirit Health!

For this episode we interview Leonardo Tantari (Chief Digital Information Officer) and Stephen Blackburn (Innovation Manager) at Leeds City Council and NHS West Yorkshire ICB. We discussed the Leeds Integrated Digital Service strategy and the future for digital within Leeds.

To start off Leonardo and Stephen spoke about their current role and career background.

Leonardo has equal responsibility for both Leeds City Council and NHS West Yorkshire ICB. “As part of the those responsibilities I run the integrated digital services team, which is a team comprised of resources for the local authority and therefore the NHS West Yorkshire ICB. I’m also the designated West Yorkshire ICB lead for digital in Leeds.”

Leonardo has a responsibility to ensure that there is a “digital strategy in place for the City of Leeds, and we work collaboratively with our colleagues at regional level as well. I’ve been here for two years now working in this dual role and prior to that I was working in the private sector for organisation like Boots, Travelex, Expedia, and so on.”

Stephen has been working for Leeds City Council for over 18 years and started in database management. “It took me onto information governance and leading on our open data work, and that took me onto innovation. I look at how we can reuse open data and deliver our services using that data in new and innovative ways.”

He also leads on the smart cities programme, which is known as Smart Leeds. This involves exploring “how we utilise, for example, Internet of Things technology to collect the data in real time and then work that data in innovative ways.”

More recently, Stephen has been working in the strategy and innovation team. “I’ve been working on our city digital strategy and I’ve also been putting together our innovation programme which will align to that strategy.”

Consultation and engagement with other industries 

In terms of the consultation and engagement process with stakeholders and different areas, Leonardo explained that a lot of work has gone into the formulation of the new city digital strategy. “We took an approach to develop a strategy at city level, not just for one organisation. Therefore it keeps in account what the city council needs to deliver from a digital perspective, but also from a city ambition perspective,” he said.

He added that the strategy also needed to fulfil the aspiration direction from the ICB. A number of workshops have been run already, but Leonardo said that the focus has always been to ensure “no one is left behind in terms of our digital inclusion agenda. We wanted to ensure that we had a strong focus on infrastructure in terms of getting the basics right on data, particularly when it comes to sharing data between our organisations.”

Emphasising the need for interoperability and a more efficient system flow, Leonardo highlighted that this “helps a lot of people and and particularly the NHS in the current climate to actually deliver more for our citizens. So it’s very much been an inclusive approach in ensuring that all the organisations are reflected in terms of what is contained in the city digital strategy.”

On public engagement, Stephen noted that the “first batch of workshops that were held were mainly outward-facing”, and explained that they reached out to other public sector organisations, third sector industry and academia, to encourage participation in those workshops which focused on digital inclusion, innovation, and digital and data ethics.

“Really what we wanted to do is get feedback from people who were living and working and contributing right across the city, so that they can see their views, their challenges and their priorities reflected in the strategy as well,” said Stephen. They wanted the strategy to be something everybody can sign up to collectively across the city and district. “People can see themselves in it and they can contribute to its delivery and to the delivery of those priorities that are highlighted in there.”

The second batch of workshops were inwardly focused. “There’s a close working relationship now between Leeds City Council and the healthcare system. So we held a number of workshops with council colleagues but also people within the NHS as well. Again, all of their contributions and feedback fed into that strategy as well.”

The challenges and how they were tackled 

Leonardo commented that bringing colleagues from all organisations to work together was a challenge, along with ensuring that everyone had a shared understanding of how the health system works and the challenges within it.

He noted an ambition to continue bringing partners together to better understand each other’s ways of working. “As always, navigating the healthcare side can be sometimes challenging and complex because of the way it is organised, and because it is changing frequently as well,” he said.

“I would say that the approach of engaging with everybody in this way worked – everyone listens to what needs to be delivered, everyone notes the challenges of the initiative that both the authority and the health organisations are already working on. It helped people to focus and find the energy to get involved, and then make the most of what the others are doing.”

Challenges in the healthcare space around interoperability and data sharing are still in discussion, Leonardo said, “particularly when it comes in relation to the development of the shared healthcare record moving forward, and for the integration into systems like the Humber Care Record as well.” He added that interoperability integration “is a challenge which has been there for a while and is still there and we are working actively to resolve it… I would say that we focus a lot on understanding the work that we are doing collectively and each other’s priorities.”

Stephen commented that the approach they have taken on the strategy is high level and broad ranging. “It’s not getting into the nitty gritty of whether we will deliver this specific project, that’s for other people to work on and to deal with in terms of our digital road maps,” he said.

“The strategy is structured in such a way that is hopefully understandable and meaningful to everyone in Leeds – we focus on the foundations first of all. There are building blocks that we need in place before we do anything else. Leonardo mentioned better use of data for example; connectivity and infrastructure, digital skills, digital inclusion and also digital and data ethics.”

Moving on, the main part of the strategy focuses on bringing together wider collaboration and connections within the city.

“How can digital support people through every stage of their life?” asked Stephen. “We take a life core approach, looking at how it can support you through starting well, living well, working well and ageing. We’ve set out clear priorities in each of those areas, along with outputs that we would expect to see if we achieve those priorities.”

Key aims and ambitions of the digital strategy

“We need to find a way to have access to the right data at the right time, in a way that truly represents a single version of the truth,” Leonardo said.

They have recruited a Chief Data Officer as part of their integrated digital services team. “There are lots of intelligence reports and a dashboard coming out which helps with decision making,” he said. “The future is very much to move towards more predictive analytics for machine learning, artificial intelligence and so on.”

For Stephen, a key aim is for the strategy to help people “have the very best start in life, to be able to access our services and to live long healthy and independent lives. Digital and technology is just an enabler.”

The technology shouldn’t be the starting point, he said. Instead it should be about the “problem that we’re trying to solve. Then we need to work backwards from that. How can better use of data and technology help us to deliver the services that we need to our customers, and to people who live, work and visit Leeds?”

Stephen emphasised the importance of digital and data ethics, raising a need to be “really clear on what we want to do, and that we do it in the right way”.

He added: “We only collect the data that we need to collect, for the purpose we need it for. It’s really important – there’s lots of new technology out there at the moment and people can occasionally be quite wary of that.”

Another ambition focuses on digital inclusion and digital skills. Leonardo shared that they have a team that has been working on digital inclusion for a number of years, expanding on increasing digital skills and accessibility to digital services. “If we can reach more people using digital, then we can provide quicker interventions.”

Stephen highlighted a phrase from the strategy: “digital first but not digital only.” He stressed that increasing digital is not about moving away from face-to-face and traditional means of contact, but about providing additional ways to deliver services.

The future for Leeds City Council and NHS West Yorkshire ICB

“The integrated digital services have demonstrated that there is a true potential when we approach things together collaboratively as a team, and it also drives quicker resolution of issues and quicker development of innovative solutions,” said Leonardo. “The concept of working together and solving the problems once instead of having to solve the same problem multiple times obviously brings efficiency in terms of using those limited and scarce resources, including funds and ultimately deliver better services and quicker to our citizens.”

The future is bright, he said, with “more and more programmes of work that we are working on with the ICB at West Yorkshire level.” This includes work to increase reach of solutions: “if we implement a solution in Leeds for example, we can reuse that solution and drive the benefits to other localities within the region.”

He added that it is a learning process: “We’re all learning and it’s exciting – I hope other authorities will follow through in the same manner.”

In terms of the broader partnership and wider collaborative working, Stephen said there is “great work going on all over the city at the moment. From my role as innovation manager, I’m familiar with work that’s going on at the University of Leeds or the Leeds Teaching Hospital innovation pop up space. We are due to launch a new digital Leeds website very soon which will really promote our innovation work.”

Stephen is keen to encourage others across the city to utilise the platform to connect and collaborate, to “ensure that we’re not duplicating effort and we know what others are doing.” He also wants the platform to be used “to really promote the great work that is taking place in Leeds and to encourage others from outside of the city to come in and collaborate with us. That’s what we want to do and how we want to promote Leeds going forward.”

Their hope for digital in Leeds

Leonardo noted a hope to continue working with the digital inclusion team and to expand work in this area, particularly around digital skills.

He noted that if you are not connected to digital, you can struggle with services such as applying for jobs, housing or training, making it more and more important to have the necessary digital skills to access basic services.

“I also look forward to have a more connected setting where the services are accessible and they are easier to work with,” he said. “That is why we are focusing a lot, particularly in the authority, to move more and more services to online.”

From Stephen’s perspective, he is keen to promote Leeds as a city of “innovation excellence, and the broader region for that matter. We want people and businesses to come and invest here, to settle here and we want to work with those startups and SMEs and do some really innovative work with them.”

He raised the growing tech sector in the area and the Leeds Digital Festival. “We ran a hackathon in September last year as part of that digital festival, looking at how can digital technology help people live independently for longer in older age. So there’s there’s loads of activity taking place at the moment.”

Stephen added: “Recently we’ve had some health tech delegations from the likes of Estonia, Norway and Sweden.”

Advice for organisations looking to develop their own strategy

Reflecting on their digital strategy, Leonardo explained that there is always an element of learning from others. “It is something we have done, looking what other cities have done in terms of digital strategy,” he said. “I think that is a very good thing to do.”

“We can all learn from each other,” Stephen agreed, noting that he looked at various other strategies for inspiration. “We have taken our own approach – I think taking that person-centred, life core approach is something that others haven’t done. We wanted to be as high level and as inclusive as possible.”

Inclusion is key, Leonardo added, emphasising the importance of including everybody in the formulation process and “to agree at the outset to the broader schemes and objectives, the key aspect of what the digital strategy needs to deliver on. That comes through relationship and with communication.”

It’s about “encouraging collaboration and engaging with people,” Stephen said. “If you’re wanting to deliver a digital strategy for your city, for your place, one organisation on its own cannot deliver that. An organisation can lead on it, promote it and encourage collaboration. But ultimately, if we’re wanting to improve the skills of our broader workforce across the city, we need to encourage other organisations in the public sector, private, and third sector to all encourage them to to improve the skills of their own workforces as well.”

Many thanks to Leonardo and Stephen for joining us.

Welcome back to another episode of HTN Let’s Talk!

For this edition of our podcast, we interviewed Andy Webster (CCIO) and Georgie Duncan (Associate CCIO) at Leeds Teaching Hospitals. We discussed the implementation of their electronic health record (EHR), how its gone developing their own, challenges, benefits, future plans and more.

On their roles

To begin with, Andy and Georgie spoke about their current roles at Leeds. Andy has been a CCIO since 2018.

“I started at Lancaster in 2006 and worked there until 2011, then the bright lights of Leeds attracted me and I’ve been a consultant here since 2011 and seen massive change,” he said. “IT and digital is quite a nice job to do. It gives you a bit of variety and you can see the change you make in digital and how they lead to improvements on the shop floor.”

Georgie is a nurse and works as an intensive care nurse by professional trained background. “I’ve worked at Leeds for quite a long time but originally did my nurse training in London and worked in a number of big hospitals within London,” she said. “I moved to Leeds and held a range of roles which included predominantly working as a manager within intensive care. Then I worked within corporate nursing, so I was responsible for lots of trust-wide projects, but it also meant supporting wards where they need some help and working on quality improvement projects.”

She continued: “Within that role I got really interested in digital healthcare and developed some quality dashboards and nursing metric dashboards as well. That paved the way for moving into DIT.”

EHR in focus

Patient Pathway Manager (PPM+) is LTHT’s EHR. Designed to consolidate data from disparate systems, both within LTHT and across local organisational boundaries, it allows clinicians to view a single patient record including information from several organisations to provide an informed and rich outlook of patient needs.

The development of the EHR started before Andy’s involvement. He described how it “started out as a cancer tracking system in 2002 that tracked cancer waiting times. In about 2012-2014 it was decided that Leeds needed an EHR that catered for the whole of the trust. At the time, money was tight and we already had that experience of building the cancer waiting times electronic health record.”

It was decided that they would build a modern platform in Leeds working with other partners, in collaboration with Aire Logic who helped to develop PPM+ alongside the trust’s in-house development integration team.

“The journey has evolved quite significantly over the last eight years,” Andy shared. “We have quite a mature shared care record solution in Leeds, so that enables us to share data with our partners in primary care, adult and children social care, some third sector organisations, mental health trusts and our community health team.”

“Those digital interfaces are really important because those relationships really help in terms of our development, and they’re fundamental for patient safety and ongoing care,” said Georgie.

Andy noted that when he first started working in emergency medicine consultation in Leeds, it was not easy to get patient information such as medication and allergies after 6pm on a Friday. “If the patient didn’t know themselves you really couldn’t get any information,” he said. “Even in the day time… you had to try and get through to general practice and telephone lines were a nightmare. We initially went live with GP information using the MIG and that was an amazing transformation because we could get all that information through – allergies, medicines, encounters.”

Andy also highlighted how Leeds was one of the first trusts to connect using GP Connect, which meant that “we could actually see the recent discussions patients had had with their GPs, which gave us vital information when were making decisions in real time about what investigations they would need, whether they would need further inpatient follow up, where they could be safely discharged back to primary care. So it helps us maximise the use of our resources but also makes safer patient decisions.”

How they developed the EHR

Georgie emphasised the importance of having a good, clear digital strategy that “encompasses not just the EHR development but all digital transformation that we support. It’s about engaging our workforce including the clinicians who use it and we as a CCIO group. With our operations team, we look at how we prioritise the work that needs to happen against the digital strategy. There is lots of communication and robust analysis in terms of what we need to do and what we need to deliver on. But there’s also supporting and running a busy hospital, and national reporting requirements. There are lots of different things that come into the mix when we are considering what developments we need to do, when we need to do them and how we prioritise them. It’s very much a collaborative conversation.”

Andy explained how there were projects that they could quickly adapt and deliver in an agile way during the COVID pandemic due to the EHR. “If we had a commercial solution, we may not have been able to do this,” he noted. “For example, within two to three weeks we turned quite a paper-heavy hospital into one using real time pick up and scan.”

Another example focuses on point of care, which Georgie was also involved with.

At the beginning of the pandemic, Georgie said, “We didn’t have any vaccinations and swab results for COVID were coming back taking around 15 hours. We integrated our point of care machines for COVID swabs which meant that you could do the swab and get the result back in 20-30 minutes. With our fantastic digital team, we built a solution that integrated the results within PPM+ so the results were visible and generated alerts for our staff, keeping our staff and patients safe.”

How staff adapted

“It’s not always quick, it’s not always easy,” said Georgie. “I think sometimes part of our role is to articulate the vision and help people understand about what we’ve got and how we can use it. It’s also about that forward planning horizon scanning in terms of what does the future look like. And it’s about supporting our colleagues to articulate what they want and how they can work alongside digital colleagues – working together so that they can start to speak the same language. Mutual respect is really important in terms of getting projects over the line.”

She added: “It’s not always been that easy to adopt certain things. Sometimes you release something and you don’t get the adoption that you expect at the start. That’s why it’s important to get good data for what we’ve released and where it’s being used, and then we can concentrate on the areas where these new releases aren’t having the new functionality adopted well.”

Challenges and benefits

“Managing people’s expectations around delivery times can be an issue,” Georgie said. “It’s complicated and you can go through a testing process and find lots of bugs. I think that can be one issue.”

Andy commented that people’s expectations often expand. “When we first started, actually getting a computer that turned on, that clinicians could log into, was the level of expectation for most. But now they can see the power of digital tech and what it can do for them. We’ve got lots of clever people who can see the benefits, so for us, the challenge is delivering on all those ideas, developing and implementing them.”

Criteria led discharge (CLD)

In Leeds, criteria-led discharge is a process they have digitalised. Georgie said: “It used to be on a piece of paper – a clinician will view a patient and determine what they need to achieve, which could be getting a test result back for example or being able to eat and drink before they are suitable for discharge. The idea is that by pre-determining the criteria, a patient can be safely discharged when they achieve it without the doctor or clinician needing to re-review them.”

The team created a dashboard with widgets within the system in which they can “write down the criteria that determines that patient for discharge. Any team member involved with that patient’s care can interface to say whether that patient has achieved the criteria or if they’ve had any issues. It also takes note of their estimated discharge, and the dashboard can be seen on electronic whiteboards in each ward.”

Georgie shared that the main challenge in this is primarily embedding it in practice when people are so busy. “We need to get clinicians to use CLD as a single point of articulation for what those patients need,” she said. “For example, a lot of our surgical colleagues will write key things that patients need before discharge within the operation notes. It’s actually about transposing those or getting them to use the CLD pathways so that they can get them discharged.”

Would you develop your own EHR again? 

“Absolutely!” Georgie stated. “There definitely can be some challenges with it, but with the responsiveness we’ve got we’re able to prioritise what is needed for our organisations and for our patients.”

PPM+ has evolved over time, Georgie noted, and needs to have an element of longevity. “It’s also about learning from other people and other organisations as they develop their digital maturity as well. I would say for the period of time I’ve been in my post, I’ve learnt a lot in terms of digital.”

Andy mused: “It’s a complex question. I think it was the right thing for Leeds to do because of the circumstances at the time… I think because it’s been something that has evolved over 20 years, it’s grown and developed into a really good product now. For Leeds, I think if we were making a decision now to buy a new product off the shelf, we would have to think of all the change for the organisation, because we have this product that has developed over 20 years.”

Ultimately, Andy said, the development of PPM+ was “born out of necessity, given our historical journey and finances available at the time. The answer to this question is very nuanced – we’ve done it and it turned out to be a good decision, but when it comes to recommending another trust to do it, I would say that is down to the individual trust. It’s a complex decision. I think we have ended up with a good product and I want us to get better over the next few years.”

Lessons learnt

“Don’t underestimate how long it takes to do things,” said Andy. “Working in emergency medicine, I’m probably used to being with a patient for less than four hours. It tends to be a bit longer now. I’m used to turning things around quite quickly and I’ve got a short attention span! So I think when I first came into digital technologies, I was a bit naive in terms of thinking ‘why does it take so long to do things?’ But I understand the complexities now of identifying what you need to build, capturing requirements, checking with different stakeholders, getting time in the developing and testing cycle to define what has been built so that it actually meets your ideas… things take a lot longer. But out of the blue you might get a priority within the trust or something from NHSE, and then you have to stop developing what you’re doing and move on. These are the challenges, these never work as smoothly as you think.”

“I wouldn’t say this is a lesson learnt, but something I’d definitely recommend is learning all about technical and digital colleague roles and what they do, understanding their jobs,” Georgie said. “In Leeds we aim to ‘walk in their shoes’ which is about understanding that the decisions I make need to be the right decisions at the right time to help them do their jobs, rather than creating more work for them.”

Future plans

Leeds has a digital strategy outlined and are currently aiming to reach a HIMSS level 5. Andy said: “A lot of our digital strategy over the next couple of years is looking at the elements of our electronic health record, not just PPM+. We need to advance to meet that HIMMS level 5 and beyond – we’re not looking at that as our target, but as our minimum baseline.”

They are also looking at work areas they need to concentrate on and develop over the next three to four years. “We’re still building up to the development of two new hospitals in Leeds, there is an outline business case going through to the department of health. If we get the green light to that, it will be a massive change for the organisation,” said Andy. “What will a digital hospital look like in those new builds, what will a digital hospital or digital way of working look like for the rest of the organisation?”

Georgia added that she is looking forward to development of the What Good Looks Like guidance and “how we can do an assessment for Leeds within that framework… I’m really keen for our trust to work within the framework and see what we can achieve and what it means for the future for digital nursing.”

Another aim is to make it easier for clinicians to use digital technologies and reduce frustrations. “It’s not a perfect system, some things take longer than they should,” acknowledged Andy. “We’ve got 20 years of cancer data and ten years of observational data – how can we make better use of that data we are collecting? We’re really data rich and at times we don’t analyse it well.” He shared that they are developing a new data platform which will “give us much better access to that data and let us make better use of it for the benefit of our patients.”

Many thanks to Andy and Georgie for sharing their thoughts.

Welcome back to our podcast HTN Let’s Talk!

In this episode we interview Graham Walsh, Medical Director at Yorkshire and Humber Academic Health Science Network. We discuss his current role, his previous experience at Calderdale and Huddersfield, challenges he has faced, what success for digital looks like, and much more.

To start off, Graham spoke about his current role with the AHSN: “I’ve been at the Allied Health Science Network for the past three months, so I’m fairly new to the role. I’m currently learning what the job involves.”

Prior to joining the AHSN, for 12 years Graham worked at Calderdale and Huddersfield Foundation Trust as a knee surgeon. For the past four years, he was the Chief Clinical Information Officer and was “involved in digital transformation at the trust following the digital strategy, and it was doing that work which led me to want to take up the medical director role.”

Digital projects

Talking about digital projects at Calderdale, Graham shared, “I oversaw many projects around digital consent, documentation and introducing our EPR… we had lots of small pockets of digital transformation, whereas the role as Medical Director at the AHSN is much more all embracing.”

The AHSN covers three integrated care boards (ICBs) across Humber, West Yorkshire and South Yorkshire. “My role is about looking at the bigger picture now, looking at how we can bring in innovation and transformation across the whole population, not just health,” he said.

He described how the AHSN is involved in a “huge amount” of projects; they are not always quick fixes or quick wins, but all are designed to improve population health.

His role at Calderdale and Huddersfield

Reflecting on his role at Calderdale and Huddersfield, Graham noted that anyone who is involved in digital transformation “learns a lot quickly”.

He commented that getting hold of shiny tech to bring in can seem like a fantastic idea, “but I think that you learn as you go through the role that shiny tech is not just about the technology itself. You’ve really got to focus on the people, whether that’s the patient or the staff. You may have a good idea on paper, but it has to add value and it has to add worth to both patients and staff.”

As his greatest learning from the role, Graham highlighted how important it is to make sure that there is real world value to what you are bringing in, with this feeding directly into how well the technology is adopted and the the nature of the outcomes and benefits that can be realised at the end of the project. Also, he added, it is important to involve clinical teams and patients in decision-making.

Tackling challenges

The above point around involving people in the digital journey can also be a challenge, Graham pointed out.

“At the end of the day, people in healthcare are conscious that we are looking after patients and we shouldn’t just make change for the sake of change,” he said. “Clinicians can have that mindset and not necessarily want to change, and that can be one of the biggest barriers.”

He emphasised the importance of taking people along the journey with you and showing them the benefits to the technology, with focus on how it will make their life and patient experience better.

“Build the story,” he advised. “A lot of what I do now is storytelling. You paint the picture of why we want to introduce something, you paint the picture of what the benefits are. Take the teams with you and make them want to start using some of this technology because they can see the real benefits.”

It’s good that people have questions, he noted. “They’re not being obstructive, they’re just being cautious because any change you make has an endpoint.”

Plans and aims in his current role

As his current role as the Medical Director at the AHSN is fairly new, “it’s a learning role for me and it’s a learning role for them.”

Since ICBs have been introduced, Graham commented on the change seen across the whole healthcare system. “I see my role as influencing some of that change,” he said, “and bringing clinicians together, bringing them into the conversations about transformation.”

He added that a key aspect of his role is identifying the problems and bringing clinicians into the conversations about how that change can be shaped. That could mean “how we can work with suppliers, with industry, with commerce, with councils, with academia… to find the right solution for the patients and at the same time, bring health networks together.

“It’s a very much an overarching role, but I think it’s a role that hopefully will allow us to make sure that we get those conversations started, whether it’s clinician to clinician or system to system.”

The impact of COVID

Since the pandemic, Graham believes that healthcare has gone through a huge change, highlighting how the pandemic likely drove a “huge amount of transformation” within the NHS.

“Prior to COVID we would approach change and it would be difficult to get things moving, projects would take time,” he said. “When we had COVID there was a need to change, there wasn’t another option, we had to work virtually.” Graham described this as “forced adoption” – “we adopted things really quickly but not necessarily well.”

However, as innovators in healthcare, Graham noted the importance of learning lessons from COVID. Through looking back at how projects and programmes were adapted and adopted quickly, he said, we can bring back some of that transformation drive.

Learning from other industries

On whether or not the NHS takes learnings from other industries, Graham said, “I think, traditionally, yes and no.”

In the NHS, he commented that people can still have a tendency to push paper and unnecessary tasks. “I think we need to move forward and share learnings with our partners, and that’s part of our role as the AHSN – to bring industry into those conversations,” he said.

“Just because it’s not healthcare doesn’t mean to say it’s not relevant. If you look at Amazon’s logistics and everything else attached to Amazon, it’s massive. The cloud services – we could learn a huge amount from them.”

Keeping up-to-date

When asked for tips on keeping yourself updated with changes in the medical and health tech field, Graham laughed. “We just read HTN!”

As the NHS moves into new areas of transformation, he noted that there are lots of resources on the internet that he strives to keep up-to-date with.

“There are lots of conferences and companies that put on events, and  networks for innovation and digital health leaders,” he said. “We have to share knowledge. There is no point in coming out with some fantastic in innovation in one area and not sharing it with colleagues in other areas.”

The AHSN, as an example, has a network of innovation hubs around the country aiming to help people learn from each other and to share knowledge.

“Staying up-to-date is important,” Graham stressed. “You don’t want to miss out on the next big thing.”

Success for digital in the future

“In three or five years’ time, the world is going to be a very different place,” Graham mused.

There are many questions to consider in this area. “Are we all going to be wearing headsets, visiting our doctors from our front rooms?” he asked. “Is that going to be the future?

“I think what is important is that we have a much more consumer-facing healthcare system, where we put the patient at the forefront of healthcare, and not necessarily the clinician or the hospital.”

Many thanks to Graham for sharing his thoughts.

Welcome back to another episode of HTN Let’s Talk!

For this edition of our podcast, we interviewed Jeffrey Wood, Deputy Director of ICT at The Princess Alexandra Hospital NHS Trust. Jeffrey discusses his career, digital programmes across the hospital and ICS, challenges he has faced, how to develop digital across a workforce and more.

To start off, Jeffrey talked about his current role and career in health: “I started life a long time ago in the Royal Navy, before joining a number of private sector industries. Then I moved to public sector probably about 10-15 years ago, working in local authorities, county councils and then to the NHS… so it’s been quite a journey for me to get used to the NHS way of working and to understand why we do things in a certain way.”

In terms of The Princess Alexandra, Jeffrey highlighted how it is a forward thinking trust: “We are one of the eight hospitals that were originally told we could build a brand new hospital. Being in one of those top eight gives us a unique ability to try proof of concepts and try out lots of different things.” He added that coming from the private sector, there are “masses” of ideas he would like to put into the NHS.

Princess Alexandra has many digital programmes running throughout the trust. Jeffrey explains these in great detail, highlighting their new electronic health record as a main project. “We bought a new electronic health record which is one of the biggest spends that a NHS trust has to do,” he said. “So that project will take us a couple of years.”

They are also doing a lot of work with automating their transactional processes to “make sure that we can be more efficient and take out some of the manual error that can occur.”

Jeffrey added: “We are doing a lot of work with intelligent watches and tablets for our community midwives who are out in the field to try and improve things for them… we have picked up a clinical communications tool which will take away all of our bleeps and emergency pagers which is a major step forward for us.”

In terms of challenges, he said: “We have a lot of people that have been running without technology for a long time and we sometimes forget that what we think is really easy will be a struggle for some people. Technology can be really useful to record things and to look back, but it becomes hard to actually input all of that data.”

However, on the flip side to that, an element that has gone well is that “a lot of new junior doctors are very excited about new technology… they have grown up with having that fingertip information. To provide that to them and to see how they use it in ways that we had not even thought of is what I really enjoy.”

On developing digital across a workforce, Jeffrey said: “We’re really fortunate at Princess Alexandra that our Chief Clinical Information Officer and Head of Digital Nursing have joined us. Before them we found it difficult to get the information out to the right places, and to encourage people to use things.”

To support people with technology, Jeffrey described how “we have set-up our equivalent to an Apple squad – we have our own tech bar that we have on a Tuesday and Thursday morning where anyone can drop in and ask any questions to the IT team in a nice lounge type environment… and that’s made big difference.”

Next, we spoke about the growing issue of waiting lists. Jeffrey commented, “That’s always going to be to be difficult. We are in very a difficult place in running in an old hospital, which is why we are after a new hospital.”

He added: “We have taken on board cloud telephony which gives us a customer-focused management system contact centre for booking our waiting list people in.”

Jeffrey highlighted how the NHS has learnt not only from other industries but also from other hospital trusts: “When I first joined three and a half years ago, we were going to put in a new piece of software that I knew other trusts had worked with. I spoke to my team about who we know at that trust and said let’s go and talk to them… I’m seeing that happen very regularly now. We have a number of talks during the week about what we’ve done with other trusts and we pull ideas from them and they pull ideas from us.”

Regarding what success looks like in digital, he said: “For me it would be that patient portal, that would probably be the one resounding success that I would really like to get right. I think the NHS has come a really long way in helping people get used to the idea of having information at their fingertips.”

In terms of future tech, Jeffrey added, “Proof of concepts is something I’m always thinking of and how we can get the best from new technologies that are coming out.”

Concluding the interview, Jeffrey commented on working for the NHS. “I think the NHS is a career. Most other places you go to are jobs,” he said. “With the NHS, you need to want to help people and make a difference. It is such a satisfactory feeling when you know you are making that difference.”

Many thanks to Jeffrey for joining us!