Speaker 1

Yeah, I think everything. Mean. Welcome to Voices of Care. Thank you for taking time out in a very busy schedule. Given the publication of the ten year plan. Great to have you here.

00:00:11:09 - 00:00:13:13

Speaker 2

To you. Absolute pleasure to be here.

00:00:13:15 - 00:00:35:05

Speaker 1

And I'm just going to step back a bit because I think, you know, your background in pharmacy consulting. I think you joined the NHS. I don't I hate to remind you, is about 15 years ago, and I think you're intending to stick around for two years, but it's you're right in the middle of a technological revolution where the analog to digital change is promising, the most digitally enabled system in the world.

00:00:35:07 - 00:00:55:06

Speaker 2

Yeah. I mean, I've never really managed my career in systematic ways. And I go where the opportunities are. And this was working then just gave me such a lot of ability to to, to direct and create some value. So I stuck around while I think still I value.

00:00:55:08 - 00:01:21:19

Speaker 1

Absolutely. And obviously the ten year plan we've had the three shifts which have been around in compensation and policy for a long time, but I think the Kings Fund, reporting on it, talked about the the digital transformation being perhaps the golden thread that walks all the way through. And I think you've been on record as saying it's really part of the fight back against disease and the promise of genomics and technology.

00:01:21:21 - 00:01:25:11

Speaker 1

There's a chance here to really make a big difference in people's lives.

00:01:25:13 - 00:01:48:16

Speaker 2

Yeah, very much so. I don't think we can do prevention unless we tackle those two things. Right. Because so much of it is behavioral. Yes. As well as you got your genomes and your junk sequences, these provide certain markers that have give you different risk profiles. So I think that's really important. It's really important to understand that and to help people understand that.

00:01:48:16 - 00:02:17:00

Speaker 2

So we're using technology to really assist patients to better understand that we have to do lots more counseling as as the profiles come out. But what's really appealing to me at the moment is that we, we can actually use technology in a systematic way to change the way, transform the way that we deliver services, but also transform the relationship between the public and the NHS, which is a really difficult thing to do in normal days.

00:02:17:04 - 00:02:51:10

Speaker 1

And actually require, given the fact that obviously over the last decade or so, the approval ratings of the NHS have fallen significantly. This is a watershed moment. I know we're going to really focus on this in this discussion around patients, the people within the NHS and really the promise in the future. So I'd like to start with perhaps the fulcrum of all of this, which is the patients in the ten year report, plan, it makes it very clear that whatever the three shifts are, the core purpose is to empower patients and redistribute power, build the relationship.

00:02:51:12 - 00:03:03:04

Speaker 1

And there's a number of things that do that. I'd like to start, perhaps, with what's going to be the front door, with the NHS app. I know you've worked on that. That's I think it translates data into action.

00:03:03:06 - 00:03:13:17

Speaker 2

Yeah, very much so. So in a way, let's step a little bit back. Say actually the NHS is becoming 40% of our actual money.

00:03:13:23 - 00:03:14:11

Speaker 1

Yes.

00:03:14:13 - 00:03:22:06

Speaker 2

GDP. That's a lot. Yeah. Isn't it fantastic to live in a country where carers free to walk?

00:03:22:08 - 00:03:23:16

Speaker 1

Of course.

00:03:23:18 - 00:03:56:21

Speaker 2

So to do that, we need a public contract change. Because we've kind of drifted into whatever you can't solve the NHS, we solve, we can't solve all problems. I think using technology in the NHS app is a method of really engaging with patients is really important. So when we say the digital front door, it's really to make it more convenient, bring the NHS up to speed with other things that you do with retailers and Amazon, your banking, everything is kind of you love in that pool.

00:03:57:01 - 00:04:24:22

Speaker 2

So why we have enough for the NHS at the moment? The app doesn't allow you to do all the things you would like. To create access better. So really engaging the the interface for the app for our other core services making appointments available. Yeah. Clear that you can get your tests allow you to see your patient data allowing you to really juggle things in a more 24 seven way rather than when we're open is really important.

00:04:24:24 - 00:04:29:02

Speaker 2

But also with all the disinformation around out there.

00:04:30:02 - 00:04:36:21

Speaker 2

Having the NHS up as a trusted source of information about your health is going to become increasingly important.

00:04:37:02 - 00:04:48:16

Speaker 1

And also it's also a platform potentially the ten year plan is painting a picture of a patient power. The feedback from patients could inform decision and where resources flow.

00:04:48:18 - 00:05:13:17

Speaker 2

Yeah. No. Absolutely. So these are kind of policy tests that we would need to test over time. But the technology enables and enables a very personalized experience. Whereas you know, when we normally do public engagement and it's all through emails or texts or so, it's quite a blanket. Whereas with the app you can have a very personal, you can almost target for this particular condition.

00:05:13:17 - 00:05:36:06

Speaker 2

You are one of those people with a long term condition. How would you like. How is your service. How would you like to be treated? What additional information do you need to help? Look after yourself. Can we connect you with other services? This is where we bring in kind of the voluntary sets. Yeah. So for those who are more disadvantaged and don't always have access to family, that's really important, bringing in those other services.

00:05:36:06 - 00:05:41:21

Speaker 2

So that is in your neighborhood. The health is such a part of your neighborhood.

00:05:41:23 - 00:06:06:03

Speaker 1

And I think that's really fascinating. The personalized nature of it. But from a productivity point, going back to your bigger picture around GDP, and I think the Health Foundation projections to 2040 say 1 in 5 people, 1 in 6 people have got major conditions now that's going to become 1 in 5. And talking about productivity, I think the numbers on the NHS spend approximately 200 million pounds sending texts and letters.

00:06:06:04 - 00:06:11:21

Speaker 1

So just an example of how the NHS app actually can be preventative, personalized but also productive.

00:06:11:23 - 00:06:43:11

Speaker 2

Yeah, very much so. So what a lot of people you'll notice yourself as a patient there all disconnections in the NHS for lots of chasing around, waiting for emails, waiting for letters and taxes and which yeah, you quite often get an appointment when you've just had one or, you know, all those things happen. So the logistics of all of that, because they're not synchronized and not done to follow the person who follows the service means that we waste a lot of money.

00:06:43:13 - 00:06:58:01

Speaker 2

I think by getting behind a more patient centric lens will help us get rid of some of these misconceptions. I mean, kind of safer, make it a smoother journey, waste less time for the staff and for individuals.

00:06:58:03 - 00:07:21:22

Speaker 1

And talking about time and disconnect. And, I'm someone who's looked after my my mum and one of the relatives and like to know think I know the system, but my goodness, it can be challenging. Just briefly on the last point on the patient journey, although the patient is central to everything is talk to us a little bit about how important data and access will be for the single patient record, because that promises quite a fundamental change.

00:07:21:24 - 00:07:46:23

Speaker 2

Yeah. So the single patient record is borne of if we really want to make the NHS person centric, patient centric, we have to gather all the information, all the events, all the touchpoints you have with the NHS, it's going to be necessary to have a chat, a thread of that, you know, maybe not to be able to go detail, but actually, we're working through the technology, how we do this.

00:07:46:23 - 00:08:04:00

Speaker 2

But, the way I see it is it's a series of events that need to be coordinated. You need to have information so that you can, you know which part of the pathway you are. The clinicians need to know that the test they ask for or someone else else will, they can be used then have to really do tests.

00:08:04:02 - 00:08:24:04

Speaker 2

So all of that is really important. That means it's fundamental for us to get our data quality right. Yep. Getting the data. The source systems where it's actually your consultation with your clinician and he runs into your medical needs. That still becomes the source data without changing. This is about orchestration of that data to free that data up.

00:08:24:04 - 00:08:44:23

Speaker 2

So it can be used to help the activities and the orchestration of the patient journey. And make sure that the right information is presented to the clinician. This is a productivity piece because a clinician can't be expected in a 15 minute consultation to read your whole history. No. So that's why they often Rios. Because they want to double check.

00:08:45:00 - 00:09:08:00

Speaker 2

Maybe they've already skimmed read it, but they want to double check. And that's frustrating for patients, particularly if you've got complex conditions and you're going to see many in professions. So that's that's the aim of this single patient record is to bring it all together. The nice thing is, once you've done that, you can then do different things with that information and you can then start forecasting the usage.

00:09:08:02 - 00:09:30:13

Speaker 2

You can then actually help anticipate the next steps in the pathway for a patient, help give them more choices. You can actually provide more information at the right place. And actually there will be some patients that you say, actually you don't need to see a person anymore. You will be better doing a full mental health or whatever, or actually you're well enough to look after yourself.

00:09:30:15 - 00:09:44:08

Speaker 2

You know, here's some monitoring equipment that you can actually look after yourself will always be there in the background for you. It just means you don't have to have the check ups until something goes wrong. Having all that information is really important for those new ways of.

00:09:44:08 - 00:10:01:09

Speaker 1

Working, and it brings to alive the potential for the virtual wards, remote monitoring. And I guess for someone who's not a data expert. It brings to the fact that what can seem like a dry subject data, actually, the analysis of it makes huge data, saves lives. Yes.

00:10:01:11 - 00:10:28:00

Speaker 2

Very much so. So if you think about how data is used for research, for finding new conditions in surgery, how we can actually get better, feedback on what procedures actually work in medicines, actually making sure that we're identifying those medicines where there are side effects, where again, they can they antagonize each other in the field. In the future, your genomic profile will determine what drugs will be more suitable for you.

00:10:28:02 - 00:10:37:07

Speaker 2

All of that is dependent on data. So I think data is the hub of everything, not just in health but other aspects of life too.

00:10:37:10 - 00:11:03:00

Speaker 1

No, absolutely. Let's move on to the people of the the NHS. Obviously again we have a productive productivity imperative. The workforce is going to look very different in 2035, probably less people doing different things. The plan says talking about the digital transformation and what you and your team are doing. I wanted to focus on the promise of the ambient voice technology because the small iterations can have a big, big difference.

00:11:03:00 - 00:11:14:22

Speaker 1

I think the stats are showing something like 14% of clinician time is taking data entry. So talk a little about that technology because it's it is around already and it shows tremendous promise I think.

00:11:14:24 - 00:11:40:03

Speaker 2

I think I mean voice it shows tremendous, benefits. We have to make sure we're setting it up to succeed. Yep. And we don't waste that opportunity. Right. So in a way, when we've created electronic patient records, we've made a cadre of very good clinicians into administrative data. So the technology is now caught up the, you know, the benefits.

00:11:40:04 - 00:12:01:08

Speaker 2

Or you can spend more time with your patients. It wouldn't automatically transfer a data benefit. You can then decide how to codify it based on. Once it's digitized you can codify, using it on. So that will improve data quality and completeness. And all these things. So it's all benefits. We need to understand how to roll it out where it's used.

00:12:01:09 - 00:12:30:18

Speaker 2

Yeah. Make sure that is part of it was checked in terms of it will be a clinical device. So of course we will have regulations around it. But also making sure that the the way that the data is captured is suitable and ethical. And actually the endpoints are actually safe and secure because what we don't want is that information from a very personal consultation going into the wide web, because we we've not secure the inputs.

00:12:30:24 - 00:12:49:08

Speaker 2

So all of those have some kind of administrative technical governance of ideals. Had a really exciting conversation about it with the Royal College of Physicians. This week actually earlier on this week we want to embrace it. We want to do it in a way that actually enables everybody.

00:12:49:10 - 00:13:16:21

Speaker 1

And also protects, of course, the patient data, because I think the plan makes it the access to this secure transparent data is a right, rather than a privilege. I want quick other part, but I know you've led this now, the federated data platform again, an ability for interoperability for different systems to speak to each other. Tell us how important that's going to be in this architecture, as we add additional functional functionality for clinicians to be at the top of their license.

00:13:17:02 - 00:13:25:13

Speaker 2

So the really lovely thing about FTP that people don't often realize is it is a data platform that helps you connect all the data.

00:13:25:14 - 00:13:28:22

Speaker 1

Yes, it may not be pretty. I think you said once that yeah.

00:13:28:24 - 00:13:51:23

Speaker 2

It connects all the data points, brings all that disparate data together. The NHS owns a data model that is conforming to. Yeah, because we can lift it and use it elsewhere. The second bit about it is that it's quite an unusual product in that it has workflow integrations with it. Right. So the whole point of bringing data together a decision point is because you want to take action.

00:13:51:24 - 00:14:12:03

Speaker 2

Yep. FTP allows you to do is create products that allow you to take that action, to do that coordination, to do that follow up, to show you what other information around that patient is available to do, planning or research or whatever it is. Not research. But, you know, if you want to change the way that you want to setup processes.

00:14:12:05 - 00:14:34:00

Speaker 2

Yes, you can do that quite easily. You can test in it. The other thing is because of that, you're automatically creating metrics that can then give you a very good view of productivity and product and actually, performance. So all of these things are fairly automated, which means you don't have to have lots of teams doing separate reporting and gathering of that data.

00:14:34:02 - 00:14:59:10

Speaker 2

So that's the benefit of it. The biggest benefit. Well, if well, we use it properly is that you do certain things once. And it allows the NHS to learn from others. Build on that and augment. Right. So the solution exchange allows other people to build on the infrastructure using a consistent data model. Using the workflows so that you can test it in a new source.

00:14:59:10 - 00:15:00:18

Speaker 2

And if it's suitable.

00:15:00:20 - 00:15:01:12

Speaker 1

Roll it out.

00:15:01:13 - 00:15:02:07

Speaker 2

Roll it out.

00:15:02:13 - 00:15:07:08

Speaker 1

That's the so the variation of performance. You're actually going to see.

00:15:07:10 - 00:15:19:19

Speaker 2

And it's not all going to be centralized. No no no. In doing that you know local instances will allow local licenses at local trusts. And CVS means that they can do the things that are important for the population.

00:15:19:21 - 00:15:41:20

Speaker 1

Absolutely. Now, this is a brilliant vista that we're painting. In terms of the patient empowerment and, of course, the workforce. On a couple of the items we've talked about, low doses report, from a year or so ago was very open, saying the NHS sometimes is, not. He was drawing on the National Audit Office report saying that digital transformation in the NHS sometimes doesn't go according to plan.

00:15:41:22 - 00:16:01:06

Speaker 1

Sort of highlights some of the pitfalls. One of the things that we need to make sure, that we have to get right for this vision. I'm thinking of the basic foundations. I think it was the, the BMA saying something like 13.5 million hours of clinician time was diverted because of malfunctioning it. So just the basics, I guess.

00:16:01:12 - 00:16:02:18

Speaker 1

Must be start there, don't we?

00:16:02:20 - 00:16:14:16

Speaker 2

Yeah. So I think in in the ten year plan you have to be visionary. You're not going to talk about the nuts and bolts. No. So if people say oh you didn't talk about digital foundations, it was in the working group.

00:16:14:18 - 00:16:16:09

Speaker 1

Yeah. Which you led.

00:16:16:11 - 00:16:44:13

Speaker 2

Yeah. So and there is the all. So we all we need to continue to, invest in, you know, more devices and all those things. We're not walking away from that. And I think there is a bit of making sure that people are ready. Yes. So change doesn't happen. You know, technology will not create change. What we need to do is really combine process, change people's acceptance and we train and we.

00:16:44:15 - 00:16:47:10

Speaker 1

So upskilling digital skills are going to be vital aren't they.

00:16:47:12 - 00:17:07:00

Speaker 2

Yes. If one thing is digital skills I mean, you know, you really see many people trying to use an Apple phone. I'm sure it's quite intuitive. Yeah. So that's the target we need to get to. So it's intuitive, but we will need to change some of the processes. Because what we're really creating is a platform to support multidisciplinary work.

00:17:07:02 - 00:17:31:08

Speaker 2

Yeah. More collaborative working which has always been difficult and managed by spreadsheets and phone calls and all of that. So that's what we're taking away, some of that with the SDP. The other bits of digital is just having that digital assistant will help people do their jobs more effectively. I really value the technology. But this is only going to survive if it's an augmentation of the human.

00:17:31:10 - 00:17:52:15

Speaker 2

Yeah. Yeah. We need clinicians focused on the clinical activities. We need porters to be able to know where to go next with the beds, etc.. That is technology is also helping them do their job. So I'm really passionate the the as the technology advances we're actually making people's lives easier. Yep. That is by far staff and for patients.

00:17:52:19 - 00:18:19:10

Speaker 1

Absolutely. And staying on that point of making sure everybody comes on the journey. Digital inclusion of course, is really, really important from the fundamentals of people from particular backgrounds not having access to the latest devices and people not being able to get access to training, etc.. Talk to us a little bit. So I know that you're personally extremely passionate about making sure that plan makes it very clear that inclusion must be at very, but by default it's going to be included.

00:18:19:12 - 00:18:42:17

Speaker 2

So I think inclusion is actually quite hard a national level. The diversity is only one you need to appreciate diversity. So I think first thing is now that we're moving much more towards devolved administrations. Yeah. With the neighborhood teams there's a real opportunity. Has we found you in Covid to work with local people and local, charities and other.

00:18:42:18 - 00:18:51:16

Speaker 2

Yeah. People that know their population to say, how do we tailor it? Yes. So in a way, I think you're asking about how do we deliver? Make sure that we include.

00:18:51:18 - 00:18:52:14

Speaker 1

Absolutely.

00:18:52:16 - 00:19:14:14

Speaker 2

I think that is the way that we have to design deliver is on delivering supplies locally. So nationally will create the standards in what we do, how to connect to those services so that local people can have a say of the flavors of vanilla that they want. In the, you know, tech, will be quite clear on roles and what they can and can't do.

00:19:14:16 - 00:19:36:06

Speaker 2

But there are some really simple things we can do nationally that, you know, being Chinese background, I feel very passionate that I would do some of the things I had to do for my parents if there was translation service. Yeah. Yeah. So digital, we have a good opportunity to make that consistent reality. And that is a huge amount of cost.

00:19:36:08 - 00:19:56:11

Speaker 2

We then need to really take notes from local populations, what they need, the things that it does support, diversity supports everybody. So making things more accessible, being a bit more considerate about how we engage with the public will support us.

00:19:56:13 - 00:20:16:12

Speaker 1

Absolutely. And just as a a tangential to that, the plan has been very candid and that the NHS doesn't have a monopoly on the insights of digital transformation, etc.. And one of the key pillars will be to be very open in terms of partnerships, with people coming with ideas about how we move from where we are from, you know, bricks to clicks.

00:20:16:14 - 00:20:43:10

Speaker 2

Ya know, very much so. And we've taken that to heart. That's why for the single patient record, we've actually gone out with a request for information is that this is the concept. How do we do it. So can shortlist to a number of concepts that we're going retest with the market. Yep. Very much open to you know pull carbon calls and we have to change the way the NHS is operating with industry.

00:20:43:10 - 00:21:02:20

Speaker 2

Not totally agree with us. I think we can be much more open. I think there's a win win on the commercial background. So, you know we have to appreciate as an NHS people don't go to business to fail and use money. So but in partnership you can always find win wins. We've that's been very open and so thoughtful upfront.

00:21:02:22 - 00:21:28:02

Speaker 2

Yeah. Well I think we one of my criticisms of what we haven't done well in the past is probably only got to a situation when the get sticking and tell the supplier you've got sorted for us was actually you need to build that trust in that relationship upfront. You need the contracts, the commercial arrangements that allow you to have that freedom, but more importantly, to have that, win win investment type conversation.

00:21:28:02 - 00:21:51:14

Speaker 2

So it's not, you know, all about price. So I think we're always going to be a public sector kind of bodies, never going to be free for all. But we do need to be a bit more mature in the way that we engage with organizations so they can bring their best to us, because we've found is most organizations really want to support, what they find difficult is the how.

00:21:51:16 - 00:21:56:05

Speaker 2

And yeah, the way that we often put tenders out doesn't make it that easy.

00:21:56:07 - 00:22:13:20

Speaker 1

We'll have to do a separate podcast on about the principles of procurement. Otherwise we might get stuck based on your consulting. Final point. I wanted to look at that step back and look at the vision piece a little bit. We've talked about the shift, obviously, to neighborhood and prevention, and obviously analog to digital, but I want to go back to hospital.

00:22:13:20 - 00:22:33:15

Speaker 1

Actually, I know the plan says it's been two hospital centric, but the hospitals are going to stay. They are going to play a part. A couple of quick things there. The promise one of the big bets is robotics. And, it draws on international comparisons and a very bold vision for hospitals to be AI enabled before the end of the lifetime of the plan.

00:22:33:15 - 00:22:39:18

Speaker 1

Drawing on, I think, the Korean smart model paint that picture because it sounds almost Star Trek like at the moment.

00:22:39:18 - 00:22:51:03

Speaker 2

Yeah. As has been said, the staff briefings, they're going to build surgery. It is if you think about surgery and it's not going to be right for the procedure.

00:22:51:04 - 00:22:52:18

Speaker 1

Yeah.

00:22:52:20 - 00:22:57:02

Speaker 2

A lot of it is about precision and a lot of it is about being able to see round corners.

00:22:57:04 - 00:22:58:07

Speaker 1

Sure, sure.

00:22:58:09 - 00:23:23:05

Speaker 2

But these are never the same. You never quite know until you open it up. Having, assisted AI to help the clinicians still perform the surgery is much more precise, no less shaky hands, much more you can program in which like on which side to do things and not make mistakes because it's been moved around on paper. So I think it's really exciting.

00:23:23:05 - 00:23:49:24

Speaker 2

And but I think some of the treatments will be in the future of genetic cutting. And changing kind of policy, which you can't really do that as a surgeon. It's going to be very different. So there are those robotics I think devices in surgery, the clinicians are embracing it. I think the question for us is we know there are 1 or 2 sensors are doing it well.

00:23:50:01 - 00:24:07:17

Speaker 2

We have other sensors. And this is where the specialization really starts coming in. Because you really want to be able to have people that are really well trained and can do these well. And it probably isn't for every DCH to have that. Yep. And having those helps will help to maintain a sense of excellence for these things.

00:24:07:19 - 00:24:34:01

Speaker 1

And one final thing I can't resist because I know you began your career as in pharmacy trained in that. So we'll go back to the human human genome, the other big bits. You've mentioned it slightly earlier, but there's a huge, excitement around the promise of genomics and the closer ties with the life sciences industry, which Lord Darzi called for, with the NHS is an engine not just for the health mission, but for the broader economic mission.

00:24:34:03 - 00:25:03:12

Speaker 2

Yeah. So in our public engagement, we've we've explored this subject. And the British public are very altruistic. They want their data to be used to get better medicines, better treatments actually have more opportunity to participate in clinical trials. So all of those things are really important to life sciences. Underpinning all of that, obviously, as a data, if we can pull off a single patient record, if we can pull off really connected data, that's longitudinal.

00:25:03:12 - 00:25:20:19

Speaker 2

We have a very diverse population that's really important to life sciences in the way that they look at new treatments, etc.. So I think we have a lot to offer. I think we do need to keep the public with us. They have some red lines that we we've heard loud