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  • April 19, 2022
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Discussing Digital Transformation with NHS Tech Leaders 


Digital transformation is changing the face of the NHS. From EPR (electronic patient records) to RPA (robotic process automation), technological innovation is improving both the efficiency of the organisation and outcomes for patients as a whole.  

Driving this charge are technical leaders across the entire NHS who work with their teams to change processes and bring in cutting-edge technology. We spoke to four of these leaders about the digital transformation in their trusts, the challenges they face and how digital transformation is improving the care delivered. 

In this open conversation, each tech leader asked a question to discuss with their peers, leading to some fascinating discussions. 

Graham Walsh, Chief Clinical Information Officer at Calderdale and Huddersfield Foundation Trust asked: “Healthcare saw a rapid explosion of digital transformation during the COVID pandemic, what do you see as the key area of change that has improved how we deliver care?” 

Graham: I think what COVID brought to us was a realisation from both clinical staff and patients that virtual is possible. Patients got the care that they needed with the convenience they should expect. They didn’t want to park in a car park, wait four hours to see a consultant to be told everything is OK and they can come again in another four months’ time. Doctors also saw that they could deliver care virtually and it was safe and effective; they could get all the information they needed from the patient during the consultation and they could offer the care the patient deserved. 

That for me was really important, but it’s almost a false adoption. We were forced into it. We had to do it, and therefore we all went along with it. What we’ve seen recently is that virtualness is taking a back seat and old ways are beginning to creep back with more consultations happening face to face that could be delivered virtually. For me the big thing is to try and engage with clinicians and patients to make them want to keep some of the virtual world, to do this we need to enhance the experience and offer something more than we can deliver face to face. 

Katherine: The thing that I’ve really noticed is it’s really affected the supply and demand of who wants brand new things. Who’s actually calling us in, who’s desperate for us to come and give them new modules, who’s desperate for us to do all of these new digital processes? 

The main thing that COVID has given us in my particular department is this willingness and readiness to want to embark on as much change as possible. 

Richard: Virtual assessments are starting to lead into the beginnings of a patient portal where the patient can actually go in and see what’s going on in their care and start to interact with their care with that care becoming more collaborative. That online ability really enhances your approach.  

I think it needs to be seen as one of the tools in the arsenal that the clinician has. There isn’t one way better than the other. The organisation needs to say hang on a minute. We’ve seen great benefits here. We’re going to maintain these benefits, but what we’re going to do is we’re going to offer it as part of our daily care as options. What we’re trying to do with our EPR project is ask people how they want to be communicated with, and then the system will facilitate that.  

We’ve just got to be aware of changing generations. How they communicate is changing and having this ability in in our in our toolkit is very positive for me. 

Mandy: One of the things that we continued to concentrate on at CHFT was digital inclusion and exclusion, because it’s really important to understand that not everybody has access to digital, but what digital enables us to do is to treat those patients who can use digital virtually, and it creates a bit more space for those that can’t.  

The other thing is, we are using a lot of technology, systems and solutions out there, but a lot of them aren’t really set up for virtual practice. When we had a broader discussion about Microsoft Teams, it wasn’t always easy to set up clinics virtually. That’s changing now, so it’s really important that we go back to these suppliers systems and just make sure that when we’re building the solution, we’re building a solution that can cope with virtual and face to face. I think that’s really important, and I don’t think we’ve got there yet. 

Richard Yaldren, Head of EPR Programme at Tees, Esk and Wears Valleys NHS Trust asked: “How can you engage with clinicians and users to ensure that innovation becomes the norm rather than remaining as potential?” 

Richard: My goal is always for patient care, and there are lots of really good ideas that seem to get started, but never become common practice and you still find old and inefficient ways of working are the norm. I’m currently working on an EPR project and we have good engagement with clinical. We don’t go live until September, but I’m always aware that the success factor is its acceptance with the people involved.  

Mandy: Some of the key things that we implemented as part of our EPR deployment was making sure the leadership came from the clinical area. The board was very supportive, which is important. You would need to get your Board of Directors engaged, especially the Chief Executive We appointed a Chief Nurse Information Officer who was the deputy chief nurse at the time it demonstrated a level of ambition. It gave it some seniority. The deputy chief nurse was very well respected across the nursing community.  

As part of your EPR build, you do integration testing – that’s about getting clinicians in a room to really test the system. 

The most important thing is that groundwork right at the very beginning, using the health care professionals to actually do that engagement.  

Graham: Adoption requires you to take the clinicians on a journey, show them where they need to be, and the benefits they’ll see. You have to pre-empt the problems, solve the problems before they’re raised and be constantly engaged. Be there in the clinic. Come on the ward, walk around. Be there to solve problems as you see them, and that’s the key to engagement 

It’s important for us to show the reason why we want to use digitalisation, whether it’s to improve processes to make patient care safer and to make clinicians’ lives easier. It’s been a terrible time, but we’re still managing to innovate and bring new technology to the table. But engagement is the key and it’s bringing the clinicians along with us on that journey. 

Katherine: On the flip side of that, when I’ve done process optimisation projects where perhaps the anticipated benefits hadn’t been realised, you can really see how important that clinical buy in is and how that innovation really falls away when people lose faith in what can be provided in that. 

Katherine Sykes, Digital Programme Project Manager at North Tees and Hartlepool NHS Foundation Trust, asked: “When planning digital transformation in the NHS, what factors affect us all and what factors are specific to certain organisations or services?”  

Katherine: I’ve come from a lot of different worlds and a lot of different areas. It’s struck me that there are many barriers that would probably be the same in the NHS across most types of service, however. 

I would also envision that in different areas you’ve got different barriers and in different types of trust and different types of service, so it is interesting to see what people think are the key barriers, risks and opportunities that they think are universal to successful digital transformation in the NHS and which ones they think are actually going to be specific to their particular organisation or service. 

Richard: It’s my experience from the EPR project at the moment that time is definitely a factor. People are so busy at the moment; they’re busy with the NHS and then with patients and there is also the backlog. Finding time with someone so they can absorb what it is you’re trying to do and achieve, because then I think they’d understand what the benefits are for them. 

Mandy: Another challenge is capability. We’re slowly losing people that are very capable of doing these things to the private sector or other industries. Something we need to do is look very carefully at job descriptions and agenda for change so we get the right people who will help the clinical people develop systems that work for them. I don’t think we’re there yet, I think there’s not enough understanding about the skills and capability that is required in our trusts to make these things happen. 

Graham: I echo everything that’s been said, but I think that probably the main barrier is the people saying, this is the way we’ve always done it. Why do we need to change? It’s worked in the past. 

Another barrier is the way that organisations tend to adopt technology at different rates in, so within ICS different trusts have different levels of digital maturity. This can slow growth and confuse patients. People also have different rates of adoption; people adopt different things and I think that can be a barrier sometimes. But NHSX are addressing some of this with centralisation 

Mandy Griffin, Non-Executive Director at South West Yorkshire Partnership Foundation Trust, asked: We all write business cases to justify our investments in digital transformation projects. They all describe the realisation of benefits. Do we believe the benefits described are ever realised, if not why not? 

Mandy: When I was at Calderdale and Huddersfield NHS FT I inherited the business case however I have to say the trust went through a really robust procurement and out of that evolved a really good business case. But the expectation was that we would start to see cash releasing benefit benefits within six months. I quickly realised that wasn’t going to be the case, however we did see some really good quality benefits such as multiple remote access to patient information any time any place. 

There was a real challenge in going back to the board and saying we’re probably not going to see the cash releasing benefits for at least another two years. I think it’s really important that when these business cases are produced, we’re really clear about what we mean by cash releasing because for me, it’s about time to care. It’s about focusing on the patient.  

Graham: The benefits financially will come because naturally improving, with more adoption you automate services, you reduce staffing levels, you improve patient safety, ultimately patient care, reduce litigation. There are many unintended consequences of moving digital. 

Business planning always tends to be a financial thing that you have to deliver on next year’s budget. I don’t think technology allows you to do that because the initial outlay is colossal. You can’t expect to recover that finance, potentially even in the first five years of that contract. But you have to think beyond that, business case is not just about money, it’s about improving the working life of clinicians.  

Richard: I do believe it’s getting more accepted and people are really seeing the need for transformation. There’s a lot more clinical engagement, and I think if you can express that in your business cases and say it’ll take time but actually it’s about quality of care and it’s about patient safety. When I got mine through, I based on that really rather than the financial benefits. It has been an investment, but where we are now with such demands for reporting and information, the organisation wouldn’t have been able to do that. 

It’s about how mature peoples understanding of digital is and it’s definitely improved over the last few years. 

Katherine: I think if you look at the beginning of it, how it’s funded, the problem with an organisation that’s publicly funded is that the vision of how the money is doled out is a lot shorter term and it’s in chunks. When you couple that with how expensive digital transformation is, and the fact that you don’t really get those rewards until maybe seven years on down the line, and actually that benefit is in the quality of care and the efficiencies rather than actual money that you get back, I think it’s very, very tricky. 

I’ve written quite a lot of business cases now before this and when they’re reviewing a digital business case as well against money for extra volunteers and extra patient facing care, it must be very hard for the board to weigh up. You’ve got extra people helping extra patients physically, and then you’ve got something that’s quite intangible of what this thing in the air and this thing in cables is going to provide and how that’s going to look and how that’s going to help people. It’s very important to really try and drill down to what the actual true measurables are of what the baseline of those benefits are. 

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