75: HealthTech Hour with Steve Roest - Episode 75

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You're listening to UK Health Radio, Real Feel Good Radio.

Hi, this is Steve Roost and you're listening to Health Tech Hour on UK Health Radio.

Each week we give you the best news, views, and interviews from the health technology world.

From CEOs and founders to entrepreneurs and clinicians.

The companies and people that are shaping the future face of healthcare.

All on the world's number one taught health radio.

Hello and welcome to this week's Health Tech Hour, a very special Health Tech Hour.

We are broadcasting live from Rewired in Birmingham and Rewired, if you don't know, is one of the largest health tech conferences.

It's definitely the leading health tech conference in the UK.

This show Health Tech Hour is very, very lucky to be a media partner of the event.

Part of that is we get to do a completely unique podcast at the show.

We are going to be speaking to three amazing people over the next hour and I hope you love it.

Let's get straight into it.

Thank you very much for joining, if you're listening live.

Thank you very much for listening, if you're listening on any of the podcast channels.

We get downloads in over 40 countries every single month and it gives me great pleasure to introduce my first guest, Alex Guitha, from the Health Foundation.

Hi, great to be here.

How is your Rewired going? It's Alexander Lawrence because it's Haley Guitha.

See look, I already messed up my show. This is why we don't, this is why we rehearse.

So, Alex Lawrence, Alexander Lawrence, nice to see you. How are you?

I'm great, yeah, it's great to be here.

I was trying to work out how many Rewords I've been doing now. I think this is probably going to be number five or six.

Number five, maybe.

Okay, what was the first one like? Is it smaller? Has it gotten bigger? Has it gotten smaller?

Well, I used to work at a trade association called Tech UK, which had over 350 health tech companies in membership.

We represented them to government regulators, etc.

And so I used to know pretty much everyone here and I'd walk around and know pretty much every stall

and just spend the whole day bumping into members, which was great.

It definitely feels bigger now and I definitely know less people.

Okay, well I guess that's progress in some way.

So, you recently, in the last couple of days I believe, published some research

and it's that research that you're here to talk about, which I think is,

well, if I walk around the conference, I can see that there are so many businesses involved in electronic patient records.

Yes. In some way, shape or form.

And a lot of them say something very similar from what I can tell.

And what is it that you're kind of here to talk about and your area of interest?

Yeah, absolutely. So the research came out this morning, so it's hot off the press.

Yep.

Published by the Health Foundation, it looks at a staff survey we did of over 1,700 NHS staff

across all different care settings, asking them about their experience of using electronic patient records.

We wanted to talk, we wanted to ask staff about this for a few reasons.

Firstly, because EPRs are almost at 100%.

Is that right?

You'll keep seeing those headlines of three trusts left, two trusts left.

Okay.

Those ones, yeah, so we get to reach 100%, but we're almost there.

Okay.

And that kind of provided an impetus for us to think, you know, all this money and all of these resources

and this effort and attention has been spent on getting to 100%,

but has anyone thought about what happens next?

It's not these EPRs in place, but how are we actually using them?

What are we, what benefits are we actually hoping to get out of them?

Where are we going?

So that prompted us to do it.

And also, you know, staff experiences, it's such a good metric for whether tech is actually working well on the ground.

And I think we can't underestimate that.

Okay. And when we talk about an electronic patient record, just for everyone listening,

because we're a broad church, you know, there's all kinds of different people that listen to the show,

from all kinds of different countries.

What are we really talking about at the call?

I was the simplest definition of it.

We are talking about the systems that are in GP surgeries, in hospitals,

that ambulances use, any care setting, basically.

They're using systems, they're inputting your data into those systems,

and they're functioning as electronic versions of paper health records, basically.

That is what they are in their simplest form.

In their kind of higher form, they can do much, much more than that.

They can help optimize workflows.

They can triage patients.

They can send you appointment reminders.

You can integrate AI tools into them.

But in their simplest form, that's about it.

And there's a lot of talk, or there was a lot of talk in the NHS 10-year plan,

and around that time, that this sort of concept of electronic patient record

is the beginning of the unlock of massive efficiency gains, massive prevention gains.

What's your kind of take on that and how far away we are from that sort of alleged utopia?

Yeah, we're definitely not there yet.

I think that would be hard to argue.

I don't think that electronic thresholds in the state in which they are in

in the majority of organisations are providing significant productivity gains yet.

Interesting.

But we did some work last year looking at a really advanced healthcare provider in the US,

looking at their electronic patient record system, which they've spent billions of pounds.

Billions.

Billions.

Billions investing in, and around 15 years.

Wow.

And that is delivering significant productivity gains.

In what areas are those productivity gains coming?

It's being used as a very sophisticated clinical decision making tool to help clinicians.

It's being used to coordinate care across different parts of this provider,

which has lots of different hospitals and care settings under a umbrella.

It's being used for quality improvement tools, population health analysis,

which is kind of like what the 10-year plan said would be the thing that happens here.

So how many patients, roughly, is that system or that example?

Do you know how does it compare?

It's got to be in the millions, right?

It's in the millions, but I can't pretend I can remember the exact figure.

No, but it's basically a decent population size, is what we're talking about.

Yeah.

Okay, so do you feel like we're potentially underestimating the scale of investment

and the timeline here to unlock this thing, and unlock these benefits?

I think that when EPRs were first introduced in the UK,

and we sat out on this mission to digitize our records,

that the NHS thought that it was kind of a natural, modernizing step that needed to happen,

and not much thought was put into it beyond that.

In terms of the specific benefits, we wanted to see the specific areas where it might improve productivity.

And the amount of investment, both training of staff,

which is a really important point that came up a lot in our survey,

training of staff, the money that you need to spend to update the hardware

that these systems are running on, all of these kind of things.

There might be legacy hardware that just can't run the version.

Not fast enough, Wi-Fi, all of these things.

So yeah, 100% the scale of investment needed to optimize these systems,

a bit of a kind of, it's not a very nice word to use,

but it is like the right, it is a useful word,

but essentially how effectively these systems are running, how useful they are,

the investment you need to get them working well is considerable.

And I was chairing a panel earlier today, which was on AI.

It was really interesting, so Joe Zhang and Jess Morley,

who are two of the leading researchers in the field of AI,

they were kind of delivering a reality check.

Sort of, they framed it as like reality versus snake oil in the AI space.

And one of the things that came up was the vendor lock on the EPR system.

IE, a lot of the data that supposedly will unlock these benefits

is actually locked down in a vendor system.

Like how has that come out in anything that you've been looking at?

Yeah, it has, it came up both in the qualitative research we did last year.

We found that a lot of trust told us that it was much harder to access the data store

in the EPR system than they had anticipated, all of them they had been told.

And then it also came up in our staff survey in the sense of over 70% of staff

telling us they have to use more than one system on a daily basis

and kind of fragmentation and differences between systems being the number one barrier,

some more effective use of EPRs, which is a wider point

but kind of speaks to that problem of data access and interactability.

Yeah, because it's all well and good putting in place an EPR.

And EPRs should exist just because it doesn't make any sense to use paper.

I mean like so fundamentally there should be an EPR.

But actually when you're looking to go to the secondary and tertiary levels of benefit of an EPR,

that's when you get into what you're talking about, which is the interoperability,

the wall garden, the vendor lock and all that kind of stuff, right?

Yeah, exactly and it's those kind of more complicated uses,

more complicated functionalities where we think and where other countries have shown us

you start to get productivity benefits.

Yeah.

You start to make life easier rather than harder for staff on the ground.

Patient care starts to improve all of those stuff.

I've been shocked at how many companies here basically say they do the same thing in this hall.

Like it looks like there's a lot of people roughly doing similar things.

So it must be quite difficult for trust to be able to differentiate between all of these providers.

I don't know if that's come up as well in research about how staff deal with things that look

and sound very similar but might not actually be similar.

Yeah, we didn't look at kind of different vendors specifically,

like we didn't ask for staff to use on one vendor versus another.

But I think that there is a significant lack of procurement expertise

on digital health generally within trusts.

Like I think that's something that potentially the centre can help a lot more with.

Do you know what?

I love talking about this issue of procurement.

So I sit on the NHS England SME advisory board and that's across all SMEs.

So yes, there's some digital people like Pockdog,

but there's also, for example, one of the guys that sits on it,

Danny, Danny is the king of milk in the southwest.

So Danny delivers all of the milk to all hospitals in the southwest.

So if you're listening in the southwest of England,

you're having a cost of coffee in a hospital, Danny delivered the milk.

So I think to that point, NHS trusts and NHS institutions

are actually pretty good at procuring hardware, physical items,

like NHS supply chain, et cetera, et cetera, unit pricing,

all that stuff.

I think they're not great at procuring stuff where it's more service-based

and definitely not digital.

I don't know if you put anything.

Yeah, we published a report.

I think this time last year it called the cost of digitising the NHS,

which is fantastic for everyone should go and read it.

We basically tried to calculate how much money it would cost

if the government basically fulfilled all of the promises it's made

or what it's going to do.

I love that exam question.

If the government did everything it said it would do,

how much would that cost?

Yeah, a lot.

That's a great question.

Sorry, I've completely forgotten.

That's OK, it was me laughing.

They published a paper around how much it would cost

and it was to do with procurement of services.

And basically one of the problems that highlighted

or one of the recommendations that came out of it

was around changing the kind of,

the way that things are funded

in terms of capital funding to suit more software services.

We found that it was totally not suited.

I completely agree with you.

And I actually think this is one of the things

that I harp on consistently about to anyone that will listen,

which is the digital health industry

as an industry needs to be learning from people

that have gotten really, really, really good at managing procurement

with the NHS around physical items.

We should be learning from those people,

Danny, the king of milk, and whoever supplies the bog roll,

and all these people, they supply billions of units of these things

every single year.

And somehow, somewhere we need to try and figure out

some working groups as to how we can take that

and apply it over there, because even supply chain,

NHS supply chain, which I'm sure you've heard of,

that only works in hospitals.

The NHS supply chain only applies in a hospital setting.

So it completely is completely irrelevant

to the vast majority of the NHS.

I think there's a lot in there.

I think that's really interesting, because I think people often focus

on how different procuring tech and digitalism,

what you're saying is there's actually a lot to learn

from existing ways of working.

I'm saying, well, it might take on anything in life.

It's like, let's go figure out who's done it better,

or who's doing it really well,

and then go and see what we can learn.

I think that there's a tendency,

and I don't know why, but I've definitely noticed it

within the UK digital health industry at large,

and the kind of counterparts in the NHS system,

like who look at digital health,

to try and reinvent the wheel positive.

Yeah, 100%, we're always trying to look,

especially at international examples,

I think because the NHS is unique in lots of ways,

sometimes there can be hesitancy

to learning from other countries,

particularly with the US,

and a lot of that hesitancy is warranted,

and you always have to kind of cover out

when you're saying the US did this,

why can't we do it?

Nevertheless, with the EPR example,

it's so useful that they're ahead of us,

because we can look at what they did wrong

and what they got right,

and try and emulate that.

And actually, when it comes to electronic patient records,

records, the US took a fairly kind of NHS-y approach.

They had a national, they called it a meaningful use programme,

which they said,

this is how we're going to get to meaningful use of EPRs.

This is where every single provider needs to be,

by this date, they had financial incentives.

I love this, okay, because we're,

with Impoc. We're lucky enough to now be looking ahead

to submitting to the FDA for our US launch,

which is super exciting.

Yeah, the FDA has blown me away

in terms of this efficacy versus,

and it's along the same lines,

which is like, people like to stereotype the US health care system.

And I don't disagree with, you know,

probably a lot of things that you wouldn't disagree with

around health inequity and costs and all that kind of stuff.

But there are some things that they are so much further ahead of me.

Like the FDA, for example, is a government-run institution

with guaranteed timelines on responses

and approvals or denials.

You can sit down with the people that are going to

analyse your submission in advance, etc.

It costs a few thousand dollars to go through

because it's government-funded.

And you compare that to the system here,

or in Europe, in the UK, where we've privatised

medical device regulation.

So it's not nationalised.

So you have to go find a private provider who's interested

in profit.

And every time they question your file,

you have to pay them.

And there's no timelines.

So I completely agree with you.

I think that this blanket, the NHS, sorry,

the way the US does healthcare is bad, is really done.

Yeah.

And I think, you know, the MHRA is thinking at the moment

about how it approaches regulating AI.

We're acting as the research partner to the MHRA

on that piece of work.

And I think that international examples are going to form

a really important part of that.

So you spoke to the FDA example.

And I know that they've also got a kind of

sort of fast track pipeline for innovative devices

that they think have, that the system has a real need for.

Yeah, they're much more interested and much braver

around making bets, or sort of accelerating things

that they think will help.

Then for some reason, I don't think we're really brave enough

to provide those, except it's not to say everyone

in that pathway will get approved.

It's just to say that, well, our business needs,

our customer needs are this.

So if you're in that bucket, we're going to accelerate the analysis.

I just don't feel like we're there yet at any level.

And I think part of it is because we haven't centralized

that regulatory pathway.

It's been privatized.

So those private companies are for-profit companies.

So they're going to do whatever maximizes their profit.

So that's why I think a big difference is, unfortunately.

And that goes across all of Europe, all European governments

have outsourced medical device regulation on them.

Yeah.

No, it's really interesting to think about.

Are there any European countries that you look at

and think they're doing something interesting?

Obviously, there's a certain amount that's centralized across the EU.

But there's like DeGa in Germany or whatever.

So here's what's really interesting.

What governments in Europe and the UK can influence

all happens after you've been approved.

They are unable to influence approval because

it is not in their gift to approve.

Because the people that approve of this network of about 60

notified bodies, BSI is the one that everyone knows here,

but there's loads.

And you have to apply to them for your approval.

And it's that notified body that would then update MHRA, etc.

The MHRA plays no role whatsoever in the actual approval

of any device.

It doesn't play a role at all.

So what you find is governments are actually quite good at

European governments like DeGa is a really good example in Germany.

That's a really good program that applies after you've been approved.

That applies after you've been approved.

It's around uptake and funding and scale.

And it makes total sense.

Nobody is able to influence actually speeding up the actual regulatory pathway.

And that's a really thorny question that no one's wanted to get that hands round.

Ever.

I mean, I've been talking about it for a few years now

and no one wants to go near it.

Which is really interesting.

Obviously, we did this EPR polling, which was just with NHS staff,

but we also do much wider public polling.

We do this nationally representative survey where we ask questions

about how the public feel about technology, data, AI,

and we do it every year.

So we can track changes in attitude and stuff.

That also came out a couple of weeks ago.

And one of the questions that we ask this year around AI and regulation

is what trade-offs people are willing to accept when you ask them questions

about regulation versus speed of adoption.

And I won't go into the results in detail.

But essentially, I think it's much more complicated than people would anticipate.

It really depends on what kind of scenario that particular device is intended for,

what the trade-off is, how long is the waiting list of that device?

Isn't used these kinds of things.

And also it varies a lot by gender, by age, by socioeconomic group.

So as I said, it's a really thorny issue that someone,

hopefully the MHRA is going to get their hands on it.

If the MHRA could take control back of that,

if they could replicate the FDA, that would be a huge step.

But I would love to dig into that at some point,

but that's a whole show in and of itself.

So Alex, thank you so much for coming on.

Where do people go to find out about all of these papers and such

and if they want to do some research themselves?

Yeah, so just go to the Health Foundation website

and you'll find absolutely everything there.

The EPR survey is on the front page today.

And what is the Health Foundation?

The Health Foundation, sorry, I should have thought about that.

That's right, that's right.

It's an independent charity and I think tank,

we are working to build a healthier UK.

We do a mixture of kind of in-house research,

economics, data analysis, funding programs and campaigns.

Brilliant, Alex, thank you so much for coming on.

Thank you for having me.

Thanks for coming on.

UK Health Radio.

The station, I make you feel good.

Brilliant.

UK Health Radio.

The station, I make you feel good.

So you're kind of a fixture at Rewind, right?

Like this is your, these are your people, you know what I mean?

It's very kind of you to say so.

I do love the community.

Yeah.

And actually I'm going to use the phrase communities.

Yep.

Because this is a show full of tribes.

Oh, lots of tribes.

Yeah.

You've got the CIO network, CCIO network and CNIO network.

So digital health convenes them.

But you've got lots of other networks.

Chief, sorry, clinical safety officers are here.

Yeah.

Everyone's coming together.

The Shuri network is here.

What's the Shuri network?

Oh, so the Shuri network is a wonderful group of people

who believe that women of color, so the intersection,

they should be represented more in digital health.

And actually.

And I don't disagree with that premise.

And actually you find that they aren't.

Sometimes they're not given the opportunities.

They're not given the chance to shine.

So the Shuri network lift as you climb.

Oh, nice.

Go higher as you grow.

And there's such a supportive group.

Amazing.

I'm lucky to be an advisor to them.

Yeah.

And rewired has been a friend to the Shuri network

and a friend to so many communities.

I think that's a really good point.

Of all the conferences, this is the one that I know

where it really calls out the different communities.

So it calls them out by name.

So the CCIO, the CIO, the Integrated Care, the Shuri.

Whereas other conferences, they sort of...

There's a bit more thematic, you know what I mean?

Whereas this one, actually, you can come here

and definitively find your people.

You're so right.

And I'm going to make a distinction.

That's probably unfair.

Go for it, man.

I'm here for it.

You've got lots of companies that are events, companies,

trying to do healthcare.

Oh, yeah.

Digital health is a group of people who do healthcare

as their main thing.

Yeah.

Doing an event.

Yes.

So they're from the inside out, rather than from the outside in.

Yeah, it does feel like it's always felt a rewind

that this is sort of the industry's conference.

Yeah.

You know, this is like for people to come together

and feel free to talk to each other.

So how many panels are you on this time?

Three, is it four?

What is it?

I'm lucky to be on the committee.

Right.

So if there's a gap, just put your hand up.

Yeah.

You know, it's one of those.

So you're on later talking about AI, is it?

Or what are you talking about?

I'm on tomorrow and I'm on an imaging one.

Oh, yes, imaging.

Yeah.

And I'm also on the closing panel.

Okay.

When it comes to digital transformation

and how do we get to the 10-year plan?

All right.

So let's talk about that.

Because I have heard a rumor.

I'm not sure this could be a fact.

I get confused with rumor and facts sometimes in the images.

But it could be a fact.

It could be a rumor that the government is about to announce

that it is about to release the funding to deliver the 10-year plan.

What is your take on this issue?

I think that we have got the same problem for many years.

Organizational memory, gone.

Yeah.

And so we have to reinvent the wheel.

That's happening a lot.

Right. So as an entrepreneur yourself,

you'll find that sometimes you're trying to sell to somebody

and you're having to persuade them of something

and you're thinking, but why didn't they get that?

That was the same problem last year, year before, year before.

Yeah.

A lot of these problems are the same problems

that we have for a long time.

Right.

So if you end up losing the staff

who've got the digital transformation skills

and they've got the experience,

what happens to your ability to do it next year?

Yeah.

That's going, right?

And that's where my main concern is,

I think we're losing organizational memory.

You can give me money.

You can't give me time.

You can't give me experience.

I think that's a really interesting take on,

and I'm not going to get into the cuts and things like that,

because we're supposed to be,

there's a positive conference talking about future

and excitement and things like that.

However, that being said,

I think people, and you can tell me if you think I'm wrong,

but people talk about digital transformation

as if it happens digitally.

And it doesn't.

It happens by people doing stuff, you know?

Like it's, you can't just,

yes, it's digital technology,

but someone still has to actually

get off their back side.

So, like Pogdog's a great example,

where like last week,

we were at a Sikh temple in the Black Country, right?

And we upskilled local community workers

to deliver screenings in the temple during prayers,

to a particular group that's considered to be underserved.

Yes, that's part of digital transformation,

but it was delivered quite a lot to people, right?

And if those people had been there,

they wouldn't have happened.

You've hit the nail on the head on an idea

that people don't often have a name for.

Right.

And I'm a Ronald Heifetz nerd,

so I look at adaptive leadership.

Right.

How do you change things?

Can you anesthetize people and say,

we're going to freeze you and we're going to impose change?

Yeah.

Or do you get them to be not only the problem

and the solution at the same time,

because they are the problem.

If they don't move, you get nothing.

Absolutely.

But if you treat them as partners in what's happening

and then they lead it,

the adaptive leadership is for you to say,

look, I'm on the balcony looking down,

helping people change themselves.

Well, I think that in my experience,

obviously I don't come from a healthcare background, as you know.

So I'm kind of, you know,

the last few years doing this learning as I go.

So this, again, might be off base,

but I think the health care system,

because it's not just the NHS,

it's the pharmacy and everything,

the wider system.

I think is uniquely misplaced

to accept top-down change mandates.

Brightly or wrongly.

And there's been lots of examples of that.

So if you're not able to work from the ground up

and bring people with you and get people excited

and coalescing around change,

I think you're dead in the water.

I just don't believe it comes from the top.

I don't believe you can stand there waving to say,

oh, we need to do this and then people are going to do it.

I'm going to add, there's a health and care system.

Yes, exactly.

And we always forget about the care sometimes.

And there's wider determinants of health and the neighbourhoods.

Yep.

I think that multistakeholder work requires ownership

at the lowest possible level.

Yes.

Subsidiarity.

And that requires a new form of leadership,

which is why I look at high-fets for a natural leadership.

Yeah.

And you look at what's going on,

for example, Dr. Minal Bakai and her work in the neighbourhoods.

There are people out there who understand this implicitly.

Yeah.

You've got to delegate and devolve leadership down.

Yes.

And you have to enable them to deploy.

You have to enable them to deploy things that can actually have an impact.

And yeah, I mean, I think a great example, though,

it's got a little bit spicy recently.

But they're the AVT thing, right?

So AVT really took off because GPs and they were like,

this is amazing.

I'm going to try this.

So those kind of things just come from the ground up

and now obviously we're in a whole kerfuffle around Microsoft

and whatever else.

But again.

Can I add something on AVT, right?

Yeah, please.

So I'm lucky I was at Great Ormond Street when we did the biggest trial.

This is across London.

Is that right?

Of AVT.

Cool.

I didn't know that.

And it was really, really well handled.

Was that with tortoise?

Was that the tortoise one?

Yes.

And the way it was done was because pediatrics enter doing this.

People thought it was going to be pediatrics, don't they?

Right.

And they did everything.

Adults, outpatient, ambulance, GP.

Right.

What they found was ED, emergency department,

is where people wanted to hand over more.

Is that right?

And that's where they got the biggest benefit.

Because there was a goal of making that benefit happen.

But then I thought to myself, but then the metrics are wrong.

Yeah.

The benefit isn't just about seeing more people.

What's the clinical quality, for example?

Yes.

And sometimes we use the wrong metrics to measure things.

Oh, I agree with that.

And again, that's another imposition.

Yeah.

It needs to be self-defined sometimes.

Yes.

And what's difficult here is that you obviously can't end up in the situation

where you're trying to hurt cats.

So it's a very difficult balance between centralizing around priorities

to then allowing local deployment and local specialization, right?

There's some tension between what's central and what's devolved, right?

Yes.

And look, I'll go on the record and say this.

I think in the UK, in the NHS, we've made a mistake sometimes of being too strong at the centre.

And not enough, for example, out in the regions and so on.

What we need to do now with the loss of what's happening at the centre

is redefine that and hold it.

Yeah.

And we're going to lose the people that would have helped us define it.

I think this people thing, because obviously you walk around,

you walk around rewired if anyone's ever come.

It's amazing.

If you haven't come, you should come.

It's a fantastic comment.

The only one I would say that rivals this for me is health in Amsterdam,

which is a completely different vibe and a completely different concept.

But rewired in health in Amsterdam are really, really up there.

So this is really all about, for the most part, solutions,

technology driven solutions to problems,

clinical, operational, whatever they happen to be.

But where is the discussion around the people, do you think?

Do you think that we're missing that sort of transparency

around this people-based discussion?

What do you think?

Elephant in the room is that no one wants to be overly critical

when we all do know the answers are not going to change.

Right.

But, yeah, the overall feeling across the conference for the last two or three years

has been, why don't we help the people do the jobs better?

Because technology is never going to be the full answer.

In fact, when it comes to transformation, there's this argument

that half of the money that you need, maybe even more than that,

needs to go on the transformation rather than the solution.

I mean, will it, we've seen this first hand again?

I mean, in so many ways, what we realized when we started PopDoc

was really that one of the things that had held back

point of care screening as a concept, in any,

it wasn't just some kind of asking, but across the board,

was that it was dominated by people that made plastic boxes

and dropped off plastic boxes on the door of the customer.

And then left.

And we're like, well, you know, you've spent £5,000 on my box.

Thank you very much.

I'll, you know, if you want more consumer voices, my consumable team.

But that was so far away from delivering impact.

And that the organization itself needed so much support to deploy.

We now need to move to this era where people are empowered, as you said.

Yeah.

Empowering people isn't what we are used to doing in healthcare.

We're used to doing things to people.

Yes.

And I think that's the culture shift that I'm hoping will happen.

Yeah.

And technology is now moving so fast.

Rapid.

Where people are saying, I'm going to take control away from those who used to have power.

Yeah.

So there's now this tension of, I used to have power when I hold onto it.

Yeah.

And those saying, now I'm going to run away with it.

Yeah.

And they're going to use, for example, an LLM to look at their symptoms.

There's a tension that no one's really resolved.

I'm not quite sure what it's going to land up.

Well, I think this LLM thing is a really interesting one.

So my wife put this on LinkedIn recently, but she's just sadly been diagnosed with breast cancer

about six weeks ago.

So she comes from an oncology background.

And so she's very well versed in oncology, very understanding.

But she uploaded her, so she had a PET scan.

And she uploaded the PET scan, which was in French, by the way, to Claude.

And it gave her an unbelievably detailed breakdown.

That matched almost exactly what the oncologist later said.

And so I think that there's a, to your point, this technology is moving so fast

where it's going to be very interesting to determine where the regulatory,

empowerment, encouragement, concept kind of even comes in.

It's like you have to completely reframe the debate.

This is really technical, but we've moved away from convolutional neural networks, right?

CNNs.

Yeah.

To having foundational models.

Yeah.

And the problem with the foundation model is that it's ingested a lot of rubbish as well as a lot of goods.

Yeah.

So fine tuning is important.

The fine tuning of the foundation model requires tons and tons of work and effort and skill.

But if someone manages to get that done, they don't know whether they're going to get the approvals,

the regulation, I get the market.

100%.

And also, actually, weirdly, we're a medical device company.

So we've been through every single regulatory hoop and herd or et cetera.

So I'm not saying this about us, but technology businesses don't willingly walk into regulatory environments.

So they aren't going to want to do things that would accidentally qualify themselves as a medical device

and bring themselves under that regulation.

So it becomes very weird to figure out how it's going to end up, you know?

And you also look at the size of the market.

So if you can go into a market that's less regulated, you're going to go for it.

And at the moment, a lot of companies think, well, I'm staying in the US.

I'm going to enjoy the US rather than come to Europe, because Europe is going to make it harder for me.

It might be safer and that's debatable, but it's going to be harder and more expensive.

And that's why Europe is currently debating where its line should be.

I think also, I was talking about this with Alex.

And then we'll do this, and then I've got our next guest coming on.

But the FDA, we're going to be doing the US imminently, which is very exciting.

And the FDA has blown me away with the quality versus Europe.

So this isn't like NHS banking.

It's actually got nothing to do with the NHS because it's the regulatory thing.

But the FDA is government-funded institution that by law guarantees when it responds,

it has a maximum stop date for being able to provide you with an answer.

Both of those things, by the way, are absolutely critical if you're trying to raise investment.

So you can communicate accurately to investors and so on and so forth.

And then they offer basically a pro bono service where you can speak to the examiners beforehand

so you can check your thesis before you submit.

None of that exists in Europe. None.

And the other thing the FDA does is it's very, very clear about signalling winners.

So it says, right, if you're developing this type of technology,

we will accelerate your process.

And I just feel like that would be amazing if we could get to that point in Europe.

It's not to say that those people have an easier right to get approved.

That's not what I'm saying. It's not about lowering the bar on quality of the actual evaluation.

It's just about accelerating and making it more transparent.

Europe needs to take a lesson from the entrepreneurial culture and the commercialisation culture

that the US does so well, risk capital and the ability for an entrepreneur to just dream and go for it.

Yeah.

Because angel funding, VC funding, all of that's there.

Europe is going to struggle if it doesn't match some of those things soon.

Yeah, I think so, particularly on some of these big attack bets.

I think it's going to struggle.

So what are you, apart from your talks, what have you found most exciting that you've seen so far?

I think there's two things that really come to mind.

The first is that there are lots of companies here saying we are going to go for other markets.

Interesting.

And they're saying it not because they doubt this is the market.

It's because they know this is not the current market for them.

If you stay in the NHS alone, a lot of VCs are saying,

we're just not going to be investing in you.

Yeah.

The NHS is not the solo market.

So they're wondering what market there is and problems in the GCC.

Yeah, that's tough, right?

I've sort of closed the door a little.

I would argue that actually there's a lot of opportunity.

It's never easy and it's never a good time to go to the GCC.

No, there's always hurdles.

But if you were to go now, you're showing solidarity at a time when you probably should be showing solidarity.

Right.

I'd say don't close it on the GCC.

I think the poor is an amazing market, but it's a reference market.

It's how you get to other markets.

Yeah, it's what is a couple of million people.

Small.

Yeah.

The US is always the eventual market.

It's a holy grail for any healthcare business.

But it's a scary, it's a scary jump.

And so a lot of companies are saying this is the way they're going to go.

Second thing that's really exciting, a lot of companies here are saying to me

that they have found somebody within the system

who despite all the mess believes in them and is willing to help them to get through

and so they're green shoots of, shall we say, recovery?

Yeah.

It's not all doom and gloom.

No, I don't buy into this doom and gloom narrative.

I mean, I was talking to someone earlier.

My take is that the NHS is always going to be in a semi-permanent state of restructure anyway.

It's going to be such a perpetual change thing.

So if you let yourself get too synced up with those changes, you're going to go mad.

And you've got to listen to people who can give you the advice.

I love Liam Cahill for example.

Liam, love that guy.

Right.

And that's the kind of advice you need.

Go at the right time.

Make the right comment.

Have the right business plan.

Those are the kind of things that you need.

And if you listen to the right people, you will find success.

Perfect.

And NHS innovation accelerator, they're going to watch the new fellow.

Yeah, when's that?

Tomorrow.

Tomorrow is it.

Great companies on there.

I won't give you anything away.

Yeah.

We were here last year on that one.

So Hassan, thank you so much for coming.

Good luck with the speeches later.

Good luck with the talks.

And thanks a lot for helping co-producing an amazing conference.

Thank you so much.

Brilliant.

Okay, health radio.

The station I make you feel good.

Okay, health radio.

The station I make you feel good.

Haley?

Calling Haley.

Hi.

How's it going?

Thank you.

How are you?

Yeah, get your hands on.

Get your headphones on.

Hi.

How's it going?

All right.

How are you?

I'm very good.

Thank you very much.

Thanks for joining our show.

It's really good.

So how have you found real world so far?

Oh, I love it.

It's like a family reunion.

Yeah.

I mean, all your cousins.

Some you like, some you don't.

Actual cousins?

No.

No, okay.

That's what it feels like.

Because it's quite often the same faces.

You know, we're quite tight network, I think,

across the digital health industry.

So yeah, it's great.

And in your role in nursing,

how have you interacted with digital health?

Because this is predominantly a digital health driven conference.

Yeah, yeah.

So what is, what, I guess, well, yeah,

what has your interaction been and, you know,

what you're doing?

No, just in general, right?

In your role and things like that.

Yeah.

How does nursing cross over with it?

It's not always, it's not always what,

when you talk about digital health,

I don't know if necessarily everyone always thinks about nurses

in nursing, you know?

And they absolutely should.

Yeah.

The best workforce in the NHS.

Is that right?

Yeah, by far.

Is it?

Of course, yeah.

You know, you think it took probably every doctor,

you've got probably five, six nurses.

Is that right?

Yeah, yeah.

Wow.

You need to check on the actual details.

Yeah, I mean, we're not going to, you know,

we're going to hold your feet to the finals.

So exactly.

Yeah.

So no, actually, the biggest workforce,

the most consistent workforce.

Okay.

So you think, you know, you think of a normal ward in a hospital.

The doctors and the consultants and everyone are obviously

instrumental, but they come and go.

But it's the nurses that are sat there, next to patients.

No.

And why is it that nurses are more consistent?

I think it's just the nature of the role, isn't it?

They are.

They're kind of place-based rather than follow the patients

if you like.

Interesting.

And I think they're key enablers to any digital change because

of that consistency.

And the fact that they don't rotate necessarily through different

trust, like our junior doctors would.

And so they are often best placed to be that driver of change,

even if it's not impacting them.

So, you know, for example, my trust we're launching some digital

documentation and we're probably going to launch the nursing

side first, because then once they get to grips with it, they can

then help the doctors.

What type of documentation?

So basically digitising bits of paper that they still use.

So the nursing admission.

Okay.

So as the patient arrives, we're all interested in.

So that form that you write out and sometimes have to write

out a few times?

Yes.

Okay.

Repetitive and repetitive.

But equally also exploring how AVT might support that.

So let's just have a conversation with our patients and let

the documentation do itself.

That would be amazing.

So you're open to that type of pathway conceptually?

Absolutely.

Anything that helps take up, you know, documentation is hugely

burdensome.

I think it's been found that about 25% of the nurses' time is

spent documenting.

Right.

So that's 25.

That's a quarter of your day that you're not with your patient

and you're doing, you know, direct patient care.

So anything to reduce that burden?

And with this AVT thing, because it's got, I don't know if you saw,

but it got a bit spicy over the last couple of weeks with this

Microsoft rumour.

Absolutely.

Which I'm still not sure whether it's a rumour or a fact.

Yeah, who knows?

We'll see.

We'll find out, I tell you.

But do you have any particular like dog in the fight?

So to speak, or are you just focused on what's best for nurses

and it will be what it will be?

Yeah, absolutely.

I think, I think, I think much, I don't know.

I've not worked with them all.

I think you just send up the space.

I couldn't.

It's amazing.

I could possibly comment.

But, yeah, I think for me,

and this is, in my role as Chief Nursing Information Officer,

that is exactly, I advocate for our users, our colleagues,

our patients, nurses, whoever.

But, you know, the tech, I don't care who it comes from.

I just need the work.

Yeah.

And it needs the work for the user is intended for.

And when it hits the nursing work for us,

so this again, this is my impression having been seen by nurses

and whatever, but this is very much the sample of one

as opposed to like a professional sort of viewpoint.

But nurses are often extremely hard workers

with a huge burden on them.

So, how much time do you guys have with the nurses

have to try stuff, new stuff?

Or does it have to be like, oven ready, good to go

when it hits that front line?

It does really.

They have a very little time.

So, I've been lobbying our trust to really, to enable nurses

to have some time as to be digital champions.

So, actually, to have some dedicated time

where they can come out, put their heads above the parapet

and actually look at what's happening.

Like a battle with some stars from Texas.

Yeah, even just tell us what their problems are.

So, what does need fixing?

So, quite often we have to be creative.

So, you know, the arguments I have with our comms team

about you cannot send a nurse an email.

They're not reading them.

Yeah, how would they...

As a computer waiting for the next email.

So, we need to go to them.

They need to do road shows.

We need to go and infiltrate their handovers.

We need to be creative.

But posters on the back of the lute door, you know,

those sort of things.

Interesting.

So, you know...

But that for me, that for me, I was talking to Hassan

a second ago about actual human change.

People change.

Like that, I think that there's a big danger

that people just assume that digitization

is almost like a self-perpetuating cycle,

which is if you use digital technology, then it deploys itself.

Well, actually, you're talking about humans

that are working a 10-hour, 12-hour shift,

12-hour shift on their feet.

Not checking their...

You've got to figure out a way to talk to them.

Because they're the people you're saying will use the thing.

Absolutely.

And it's got to work.

It's got to be the best and easiest thing to do

because they will always choose

the part of the least resistance.

Right.

You know, we see it all the time, you know, with broken kit.

Instead of reporting it, it could put a note on it, broken,

and stick it to the...

Interesting.

Because they're just so busy.

That's not their priority.

Their priority is caring for their patients

and doing what they need to do for them during their shift.

So...

I mean, that's the reality.

And we've got to come down to that level, haven't we?

And satisfy that.

So that's why jobs like mine exist really

is to try and bridge that gap between them.

And how do you feel that that's going generally?

Not a loaded question.

No, absolutely.

That's fantastic.

Yeah, I mean, I'm not saying I'm just saying.

I'm just curious as to sort of...

Because that's a hell of a job.

It is.

And it's really tricky.

Look, it comes in the...

It starts really.

You know, some things...

We've done really well.

Some things we haven't.

So I think it depends what it is.

It depends how much resource we have behind it.

How much time we get to do it.

Yeah.

And the impact and interest of people.

So I think the ABT stuff has really started.

I think it's new.

It's everywhere, isn't it?

It's big list, it's the minute.

So people are engaged and probably will go over and above

and do things in the extracurricular, you know, time.

And that's what the NHS has built on really is.

Goodwill.

And so if you pitch it right and you get the right interest,

then you're quite often a bit more successful.

So it's very...

Apart from ABT, what areas do you believe have the greatest potential

unlock for nursing staff in general?

So I think we need to get the basics right.

I don't think we're there yet.

So we've digitised a lot of nursing processes,

but we've just digitised nursing processes

and we haven't transformed them.

Right.

And so, you know, we talk about

documentation and massive thing.

Medications administration, obviously,

is a huge part of a nurse's workflow.

And so that means...

So the doctor or consultant said this person should be taking this?

Yes.

The nurse then has to go make sure they get that thing

from the dispensary or what happened.

So we're doing some innovative stuff

with closed-loop medication.

So that is when you can basically track a medication

from this production right through to it going to a patient.

Okay.

When you use barcode scanning.

Okay.

And the best and only way to do it properly really

is to have unit dose dispensing.

So the drugs are dispensed.

So in some of our wards, we've got big massive robots

that dispense individual doses.

So if you're prescribed a paracetal,

it will give you the two tablets of paracetal in a packet.

Yeah.

That then gets...

You push the trolley,

so you know if you think about a nurse doing drugs around their collins.

You do rounds.

You push that up against the robot.

It fills the drawers automatically.

And so one drawer is for one patient.

Wow.

So as I come to you at the bedside,

I'll scan your wristband,

make sure I've got the right patient.

It will open up the drug chart.

Okay.

I then take the drugs in that drawer.

I'll scan those.

It is then telling me,

I've got the right patient,

the right drug at the right time,

and the right dose.

And that,

what you've just explained there,

strikes me, again,

example of one,

not a nurse,

but is requiring quite a lot of transformation work

to like embed that.

Yes.

So we've been at it about two and a half,

it may be longer,

three years now,

and we're on our tenth ward.

Okay.

So it's taken a lot of time.

And what impact have you seen?

So we've actually done some work

with the University Hospitals of Birmingham,

and we're starting to see results.

We haven't had them officially yet,

but it's quite stark.

So the release of like whole-time nurses.

Oh, really?

It's actually a time saving.

Time saving, efficiency safety.

Safety, so I can completely get it.

Safety, I can completely get it.

But also waste management.

So actually,

the ability for us to rotate

and give them the drug

is going to update the soonest.

You don't waste them.

You don't get less errors.

Interesting.

Like stock control and stuff.

Yeah.

So it's a massive pharmacy.

Yeah.

So did this kind of come over a little bit

from the pharmacy space a little bit?

Yes.

So it's been completely driven by pharmacy, actually.

We've got a nurse on the project team,

which they tried to remove,

and I was like,

we are having a nurse on this.

Yes.

The nurses are mostly impacted.

So yes, it's been mostly driven by pharmacy,

and certainly the return of investment

we're seeing mostly there.

Yeah.

Like I said, they've reduced wasted things

and the better stock control.

But, you know, to see the kind of

probably unintended good consequences

for our nursing team.

And what's the like satisfaction

around nurses for stuff like that?

It's mixed.

Yeah.

And it's interesting because, you know,

we've now, which is quite exciting for us,

because we've now got the evidence to say

it's not taking longer.

But the perception is that it takes longer.

Interesting.

Because it's new and it's,

and it's probably the actual act of

filling the trolley and actually giving the drugs.

Probably does take a little bit longer back.

So when you factor in the fact

you haven't then had to go and look for the drug chart.

And you haven't had to go and check

next door for stock because everything's there.

Yeah, nothing's run out.

It's accumatively saving a huge amount of time.

Yeah, that's amazing.

I think it really is so testament

about that need to evidence things.

Yes.

So we're really good in NHS

and making changes and we're getting better at it

and we're doing digital transformation.

But very, we don't ever spend enough time

going back and looking at what we've done

and have we done it well.

Is it working?

Is it working?

What I think about that,

what you've just explained there,

is a really great example of sort of a common sense

approach to digital transformation.

And become a sense, who knew?

Well, yeah, but somehow somewhere,

you or some group of people were given

or fought for a long timeline,

two and a half years,

and the ability to go slowly,

like ten words over two and a half years,

is not like,

that's not setting any records in terms of speed,

but actually you did it right

and now you've got great data

about how great data.

So just how can we replicate that

more in more places?

Because I feel like there's just a cult,

and sometimes a tendency to sort of like,

do a small pilot quickly,

then not follow through,

or just chop and change,

and did it, did it.

Yeah, absolutely.

And that's the pace we normally work at,

must admit, you know,

that chopping, changing,

just quick decisions,

just get it out there.

So I think we, I think, you know,

it's important to say that the research

that we have done has been in partnership

with the supplier,

so they funded some of it,

which is obviously important.

Of course, helps.

But I think the fact that it's been a higher education

gives it a real rigor,

and gives it the kind of,

in-depth of research that we needed.

So maybe there's something in that,

but actually as we contract with suppliers,

there's something in it to say,

you know, you will help us fund some evaluation.

Maybe there's something that you think about there.

I think it's really,

it's really useful.

Because it only benefits the supplier.

Well, I, the fact that you believe,

I'm going to go on a bit of a rant now,

some of which is,

but the fact that you believe

that a supplier should have to be educated

about the value of evaluating their technology,

is shocking to me.

You know what I mean?

Like that.

If you're a supplier,

selling into what health is B2B sales?

Straight out.

That B2B enterprise sales, right?

Like if you're selling robots for good and safe,

that's a fair,

that's an enterprise sales.

Yeah, yeah.

And the fact that you don't,

that you would have to be educated, for example,

around why it might be good

to run an evaluation is insane to me.

And I feel like there's a lot of,

if I could wave a magic wand,

I would love to be able to inject a bit of realism

sometimes into the entrepreneurial culture

around digital health.

And like,

just because you built the thing,

that's like,

that's table stakes.

Building the thing is like,

well, if you don't have a thing,

then don't talk to anyone.

Yeah.

So I don't know.

I just feel like there's something there,

but I don't know if you found the same thing.

No, absolutely.

Like I say, I think,

it then, well,

I think it would benefit the supplier,

because then they have the evidence.

You know, we all know,

as soon as a supplier starts talking to us in the NHS,

it's like,

where else are you live,

what's the evidence?

Well, how does it work?

Yeah.

Who can I talk to?

You're like, who else can I talk to

that's using your roadblock?

So actually,

if it's built into contracting

and the kind of supplier things,

that you will come back in your evaluate,

you'll tell us what's working,

what's not.

It surely benefits everyone.

And maybe it's because they don't want

the negative things to come out,

I don't know.

But surely,

they're just things you can build on.

Well, yeah.

And I think, I mean,

if I think about Popdog,

for example,

which is the company that I run,

you know,

some of the harshest feedback we got was obviously

very in the early days

from NHS people that were huge nurses

and community workers

and things like that,

that we're using it.

And it was,

it was given in an extremely blunt way,

but we knew that would happen

because it was the first version of the product.

Yeah.

Not surely,

because you wanted to work

with who you're intending to.

You can stick your head in the sand.

Yeah.

And that's all well and good.

But then it won't get any better

and you won't scale

and you won't grow.

So, yeah.

I think it's a,

I just think it's a really,

if you think about in the United States, for example,

they're all about solving customer problems.

Yeah.

And the customer's king or queen, you know.

So I just think,

maybe there's a little bit of that

and then it's coming up here.

And I think you hit the nail and head there.

It's about solving problems.

So it's not about

creating something

because you think it's

you know,

you actually need to solve a problem.

Yeah.

We're really,

we're not great at that in the NHS.

You know, we are,

especially with the likes of me

as a bit of a nerdy nurse

that goes out

to things like this

and the next shiny thing

and I want it.

Sure.

And then I try and find a use case for it.

But actually, you know,

we need to be speaking

problem solving rather than

just putting something in for something safe.

How good do you think?

You could talk about nursing

or you could talk about the health care system in general.

I don't mind.

How good do you think

that you are signalling

the problems that you need to be solved the most?

Bad.

Okay.

We don't often.

All right.

We don't often understand them.

I think we don't spend the time understanding them.

So, I mean,

it's a point we're doing some work

as I said with documentation REPR.

And we've now come to the point

where we were deciding whether to deploy or not.

We realise we haven't done that work.

We haven't got to understand what the true pain points are.

Right.

What a problem we're trying to solve.

So lots of things

that made on assumptions,

sitting around the table,

talking about it,

but actually,

when we go out and see it in action,

that's where you get the truth.

So, yeah.

We definitely need to get better at that.

And again,

it's the upfront investment, isn't it?

You know,

the planning and building that in

so that process mapping can't be understated.

So, you want your, you know,

current state,

then what you're aiming for,

and then the steps in between.

And do you feel like there are individuals in the system

that are able to deliver that sort of process mapping?

So, that sort of exists,

or is it a bit of a thing that gets forgotten about?

Yeah.

Is it a genuine question?

No, you're right.

So, there are.

And I think this is a skill.

You know, you do need to remember that.

Yeah.

Especially in a system

as complex as the healthcare system.

Absolutely.

And you know,

I'm like, what's great?

Talk to you how I use a tech.

We don't talk about anything else around the periphery.

Yeah.

You know, that complexity.

Yeah.

So, it is a skill.

And I think it's something

we don't invest in very well.

I think where I've seen it work really well

is where you join up, like,

trend transformation,

quality improvement.

Okay.

That's the same sort of methodology.

Yeah.

You know, you define your problem,

you map it out,

and how do you fix it.

Yeah.

So, seeing really good results

where those two teams come together,

and actually we were just talking about it

on a panel I was just on,

and they shouldn't be two separate teams.

Like, it should be...

It's the same thing.

And, you know, we've talked very much

a lot in the past as digital leaders,

that actually shouldn't be digital transformation.

It's just transformation.

Yeah, it's improvement.

I completely agree with you.

Like, calling it digital transformation

is such a very misleading.

Yeah, absolutely.

It's just like improving stuff.

Controversially, a few years ago,

a question that will the CNIO role still be, you know,

will it have an, does it have an expiry date?

It does, because it will just be change.

It won't be digital change,

and it won't be a need for this isolated person

championing the digital,

because that will just be the norm.

Yeah, I do think that there's an element

that we have to try and shift all this into BAU.

Of course.

And make it everyone's business.

Yeah.

It's not just digital people.

Yeah.

Exactly, and it's not us doing it to you.

It's a partnership.

Right, so we've got a couple of minutes left.

What are you most excited about seeing at Rewide,

or you may have already seen?

I am most excited, I think, about the suppliers.

I like going around and seeing what's new.

The new shiny stuff.

Yeah, exactly.

And I like to say catching up,

the networking thing is so powerful.

Yeah.

These jobs that were in, tend to be quite lonely,

especially like this, the kind of leadership roles,

tend to be only one of you in a trust,

trying to deliver mountains, and not everyone gets it.

So, you know, it's nice having the networks,

that's always my favourite bit.

Okay, good.

And are you on any panels?

Or are you?

Yes.

So, I'm the chair of the advisory,

C&I-O advisory panel for digital health.

Okay.

So, us as chairs have just done a panel session,

and I'm also talking later about half of us

for about some work we're doing in East Midlands.

Perfect.

Well, Haley, thank you so much for coming on the show.

Thanks for having me.

And have a great rewrite.

Yes.

Thank you, Haley.

Yeah, perfect.

Right, so that was our Rewired Special,

and it was great to have you with us.

So, thank you very much for joining the three guests,

Alex, Hassan and Haley.

And we will be back again next week with another great show.

So, thank you very much for listening.