CHAPTER 2

EMBRACING DIGITAL TRANSFORMATION

Long-term strategies to redefine public sector health

IN THIS CHAPTER

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INVESTING IN DIGITAL

INTERVIEW WITH SONIA PATEL - SYSTEM CHIEF EXECUTIVE OFFICER, NHS ENGLAND

ADOPTING TECH IN THE PUBLIC SECTOR

INTERVIEW WITH JOANNA KILLIAN - Chief Executive, Surrey County Council

INTERVIEW WITH ANTHONY MAY - Chief Executive, Nottingham University Hospitals Trust

Investing in digital

The last decade has seen huge growth in digital solutions across sectors, with organisations looking to embrace technological advances and maximise efficiencies. Those working within the NHS are now embarking on a period where adopting new technologies, combined with open and agile mindsets, will be crucial. As such, most NHS trusts are developing new leadership roles such as Chief Transformation Officers and Chief Data and Innovation Officers.

Our research has uncovered the real opportunities presented to leaders who are looking to adopt forward-thinking frameworks and take advantage of the new collaborative opportunities provided by the ICS.

The adoption of digital solutions in the public sector may facilitate further partnership opportunities with private sector providers to find innovative solutions. Leaders must know what, when and where to invest in digital.

The investment decisions taken now will be key to more easily incorporate future digital solutions into the system. Staying focused on how new innovations will improve patient outcomes and workload must be the north star by which decisions are reached.

“We are on the brink of a new dawn for
the NHS.”

Sonia Patel
System Chief Information Officer,
NHS England

As System CIO, Sonia Patel is responsible for levelling up digital maturity across the NHS in England. She drives efforts to achieve universal coverage of electronic patient records and seamless sharing of clinical information between different agencies in the interest of patients. Patel’s priorities also include championing green in digital, ensuring that reducing emissions and supporting sustainability are at the heart of the NHS’ digitisation journey.

The COVID inflection point - and beyond
The past three years have undoubtedly seen an acceleration in digital initiatives across the health service. The pandemic, Patel argues, has served as a catalyst for transformation by highlighting the pressing need to build resilience, while also demonstrating how greater technology integration can fundamentally change the way care is delivered across the country. “COVID-19 was a huge inflection point in that it grew confidence in leaders to explore what they can do with technology, and made them realise the impact it can have in optimising our services.”

Sonia Patel
System Chief Information Office,
NHS England

“The progress we have made would have easily taken 10-15 years had it not been for the crisis we were forced to address. We found people embracing change more readily than they otherwise would have”. However, she points out that it’s now time to look ahead and explore how technology can be leveraged to make service provision more accessible and equitable.

“We need an omni-channel approach to healthcare - one that is innovative and ambitious but at the same time also considers digital inclusion and patient experience.”

Patel sees artificial intelligence as the next inflection point in tech-enabled healthcare. “We are on the brink of a new dawn for the NHS. The consumerisation of AI, and particularly our plans for the NHS app, will enable us to make great strides in ensuring that people can conveniently access care at a time they need in a place that is best for them.”

Information flows - from intention to reality
Patel says that seamless information sharing is a core element of the NHS’ digital agenda. “We know that patient data is often sitting in siloes, and it's a key problem we need to fix" - she admits. “We have made significant progress in the development of shared care records, which are allowing clinicians or caregivers access to information about the patient in order to ensure they receive the best possible care”. Over the next 18 months, the NHS is aiming to achieve ubiquitous sharing of care information across all care settings. “It’s a sizeable agenda, because many organisations still need to digitise their care records. It’s going to be a fair challenge but one we must - and will - overcome" - Patel stresses.

Data is also essential, Patel notes, to the mapping of population health trends and needs. “From a digital perspective, one of the key benefits of the integrated care system is that it helps us to gain a deeper understanding of patient behaviours and workforce utilisation across care settings, and better identify the needs of local populations.” She notes that while a clear national perspective is important, having a focal eye on the local geographic and socio-cultural context in each community is of technology that is best suited to augment service provision in local areas.

Sonia Patel
System Chief Information Office,
NHS England

The future of the NHS - with talent at its core

Patel believes that there has been a breakthrough in terms of top-level commitment across the health service to leverage the potential of technology. “Board leaders are having exciting conversations about how technology makes a difference" - she says. She points out, however, that delivering on the vision of a fully digital NHS requires a robust talent base.

“Just like in any other sector, digital skills are at a premium. There is a UK talent shortage in DDIT skills, and we have done significant work to figure out what our projections look like over the next 5-10 years.” She adds that the NHS is currently working on a ‘National Digital Workforce Plan’, looking at effective ways to recruit, retain and grow talent across the organisation.

When asked about her vision for the future of the health service, Patel emphasised the need for the NHS to evolve continuously to be able to serve the needs of citizens across the country.

“Doing more of the same is not the answer - we need to do more of different. It's time for healthcare to change and technology and data have a key role to play" - she says. I'm beyond excited by the opportunities we can unlock to personalise the services we provide and empower our patients to be more integral decision-makers in their own care journey.”

The adoption of technologies in the public sector has received an optimistic yet cautious reception.

When we asked senior leaders their view towards embracing digital solutions, we found they are less likely to be keen than front-line staff or managers (14% vs 22% and 23% respectively).

Conversely, they are more likely to label themselves as ’sceptics’ than front-line staff or managers (13% vs 8% and 9% respectively). Convincing public sector leaders of the case for innovation must demonstrate the value it can bring to help balance resource challenges, often with finite budgets.

There is a growing stream of digital solutions becoming available within the healthcare space, with many sector-agnostic. Policymakers are looking to implement electronic patient records across all care setting, including local authorities as well as the NHS.

Across the public sector, leaders in health services recognise the
necessity to further the adoption of technologies such as telemedicine, online consultations, virtual wards and wearable health sensors and monitors. Leaders are passionate about maximising outcomes for their patients and understand that embracing technology will better serve their needs. These solutions will help healthcare professionals reach their local targets, while better prioritising their workforce and resources where an in-person delivery is most needed.

As a leader, what is your approach towards embracing technology and digital solutions?

Reluctant
Sceptical
Hesitant
Open
Keen

"We’re just about to start the shared transformation programme recognising the need for change, not just from a money point of view.”

Joanna Killian
Chief Executive,
Surrey County Council

Joanna Killian has more than 30 years’ experience working in the public sector and joined Surrey County Council in 2018. During this interview she discusses the future of health in the UK, alongside the necessity for digitalisation in public health services. The recently mandated integrated care systems (ICS) are at the forefront of a new approach which provides a regional framework to support NHS national health policy. Joanna discusses the challenges and opportunities that are directing the future of Surrey’s public health services.

Focus on prevention
With a broader shift in focus to preventative healthcare, Killian outlines the Surrey ICS’ targeted and local approach. She views patient self-care as a key preventative measure, alongside other long-term preventative methods such as anti-smoking and healthy eating campaigns. “The quality of food that we eat is the biggest determinant of our wellbeing nowadays" - she notes. Killian explains that the fundamental objective of prevention is to ease NHS waiting times by reducing the amount of people seeking clinical treatment.

Joanna Killian
Chief Executive,
Surrey County Council

The Surrey Heartlands ICS seeks to streamline preventative healthcare while targeting areas and demographics where health inequalities are most prevalent. “ICS operational partnerships must align our force into our ‘town and street model’ to identify the hotspots where we know that inequalities exist.” The ‘town and street model’ she describes intends to pinpoint exactly where preventative measures to health risks are required, and the communities that need them most (such as the traveller community). “This kind of model will tackle and intervene earlier.”

Opportunities in digitalisation

With the Surrey Heartlands ICS focusing on prevention and health inequalities, Killian recognises significant challenges - notably the lack of absolute indicators and an adequate workforce. The ICS must collect and sort its own data in order to predict areas of health risk.

“For people who might seek a clinical intervention, there is a sort of self-reporting component to this" - she explains.

Killian suggests that digital methods can be instrumental in solving demographic-based health inequalities. Reflecting on the potential opportunity of digital solutions, she says: “The future of medicine is about pinpoint personalisation: understanding how your gene you.” One example Killian mentions is DataLink, a national database recording longitudinal patient information. “DataLink is a core pot of knowledge that informs how we target our public health interventions. It can accumulate intelligence to help us think about grouping together operationally into hyper local areas and supporting individuals in their streets.”

Killian believes that digital solutions can also play a role in bridging the service gaps caused by workforce shortages across the NHS.

Joanna Killian
Chief Executive,
Surrey County Council

One area she highlights where digitisation can be used to ease workforce pressure is mental health services, particularly for children. “The waiting list for children with developing mental health issues is extraordinary and this is where I think some of the digital and technology solutions need to come in. Many young people would prefer therapy online, which could become an enabler to better mental health among young generations.”

However, Killian notes that digital solutions have see pushback, particularly around treating mental health patients online or on the phone. “This pushback is mostly a cultural issue, because there is a professional view that it wouldn’t be right for patients to receive service by phone.” Killian argues that this attitude must change in order to fully utilise the power of digital solutions in healthcare. “It’s time we stopped thinking of online solutions as this horrid, depersonalised thing.”

Developing the ICS

Reflecting on the ICS partnership, Killian says that "there are some really strong and established relationships, which were deepened by the pandemic.” She believes that the administration of the ICS is founded upon each partner’s shared responsibility. “Across our system, we’ve got a number of shared roles and shared activities, we’re just about to start the shared transformation programme recognising the need for change, not just from a money point of view.” Killian believes the need for change needs to be focused on broad determiners of health, such as smoking and obesity. She explains that the key to shared responsibility is mutual respect and that, since Heartland’s foundation, they have developed to become much more mature and ready to have some of these difficult conversations.

Increasing the use of data has led to growth in insight-led, targeted and collaborative approaches to tackling pressing health issues – as seen by the micro targeting street model to health campaigns described by Joanna Killian.

As the focus in health has shifted towards promoting good health and preventative care, digital solutions have provided new ways of answering these challenges, such as investment in the NHS website to support patients to better practice self-care, and know when it’s appropriate to reach out to a healthcare professional. However, when we asked public sector leaders how well they leverage technological capabilities in their services, we found that there is still room for improvement.

These findings are supportive of the insights from our interviews with public sector leaders, who described the ad hoc and inconsistent manner through which digital innovations have been introduced to date, leading to a patchwork approach across the UK. This was particularly the case for those leaders who had worked in multiple healthcare or public sector organisations, who had seen the variation of approaches first hand.

Ultimately, digitisation can lead to better and more effective strategies in the long-term, helping them move from being reactive to proactive, as recognised by the growing number of appointments for Chief Digital Information Officers within NHS Trusts.

A key part of being proactive for many is implementing the right strategies and making the right investments of time and money into the most effective digital products and solutions, as described in the decision-making process by Anthony May.

“Health services can be very pressured. We face critical incidents, industrial action, winter pressures, post-COVID recovery… the opportunity to think strategically is limited.”

Anthony May
Chief Executive,
Nottingham University Hospitals Trust

Anthony May has worked for the Nottinghamshire County Council for 18 years. He became the Chief Executive of Nottingham University Hospitals (NUH) NHS Trust in September 2022. In this interview, Anthony describes how the digital space provides an opportunity to transform public healthcare and how he intends to use digital solutions to increase healthcare efficiency for the implementation of long-term strategies.

Strategising digital transformation

Since joining NUH, Anthony has focused on the possibilities of digital solutions in healthcare. “There is a growing market for electronic patient records and electronic prescribing. There has been a market in things like pharmacy robots for decades”. While strategising for NUH’s digital investments, Anthony lays out his priorities for utilising technologies that offer new forms of patient self-service. “What we want to do is support clinicians, colleagues and our patients in the best and most coherent way. Digital solutions should remove redundant processes and systems that are not serving our needs".

Anthony May
Chief Executive,
Nottingham University Hospitals Trust

These priorities fit neatly into his People First approach published in January 2023, which will “help NUH set the blueprint and future strategic roadmap.” Anthony notes it’s crucial to pick the right investments for healthcare technologies. “Quite a lot of the technology is mature, the issue is where you place your bets... we do robotic surgery, we’ll use AI, there are lots of ways that we embrace it already. These investments in technologies join strategy with necessity. We think a lot about where we get the most from our investments, whether that is along the employee line to do self-service, enterprise resource platforms, or robotics and AI…”

Shifting mindset within the Trust
The digitalisation of health services also requires a shift in perspectives within the Trust. “When we asked colleagues for feedback on their systems, they gave us brilliant information about how our systems are currently not aligned with each other.

There are too many logins, hardware doesn’t always meet their needs and it isn’t always available in the right place at the right time.”

However, digitalisation has helped change the mindset of staff within the Trust. “As an organisation, we sometimes play with our head down because we are dealing with the day-to-day. We face critical incidents, industrial action winter pressures, post-COVID recovery… the opportunity to think strategically is limited.”

Anthony wishes to shift from this “day-to-day” mindset to look more broadly in scope. “I am asking senior colleagues to try and spend a third of their time on planning, a third of their time on stakeholder management and a third of their time on the day-to-day. Digital solutions are fundamental to this shift, to implement horizon scanning and planning.”

Anthony May
Chief Executive,
Nottingham University Hospitals Trust

Collaborations, partnerships, and recruitment

The scale and size of NUH requires extensive collaboration. Since becoming Chief Executive, Anthony has appointed a new Chief Digital Information Officer, a position which he describes as receiving a better response than other jobs advertised at the same level, due to the innovative nature of the role. The first task included compiling together the two technological arms of the Trust: ICT services and systems, and information and data to bolt them together, and think about how they can collaborate and complement each other.

The Trust’s partnership with Nottingham’s two universities has supported the development of the National Rehabilitation Centre (NRC), which acts as a vector for digital transformation. Students at both Nottingham University and Nottingham Trent University can learn and experience the latest available technologies. Anthony suggests this offers “new ways of recruiting and retaining people, but that can only be done through better use of technology and data.”

Navigating digital transformation through the partnership between the Trust and the local universities rounds out a succinct strategy, exemplified in the construction of NRC. “In terms of designing the NRC, the research and innovation around observing patients, wearable tech, robotics and AI is the cutting-edge stuff that will make the hospital run more as a digital enterprise and less as a physical analogue enterprise.”

Choosing the right investments into digital health tech will be key to future innovations in health and social care. Our survey found that healthcare leaders across the private and public sector agree on this - even agreeing on the importance of the same digital solutions. This highlights further collaborative opportunities between the public and private sectors and builds on the success of existing partnerships.

Our research found that implementing digitalisation in the public sector can face challenges but provides space for leaders to strategise and collaborate, with the long-term benefits of freeing up resource from process-based tasks, as described in our interviews. The public sector is operating in a more proactive and forward-thinking manner than ever before. By putting in place digital strategies from local to national levels, the public sector can plan and adapt to new and existing challenges in a way that will futureproof the healthcare system, and ultimately improve patient outcomes across the UK.