Data-led transformation in the NHS - partnering to optimise patient care

Is data the key to transforming healthcare systems and patient care?

What are the top priorities for digital transformation leaders in the NHS? How can Pharma and Medtech companies partner with the NHS to share data, transform services, and find smarter, faster way to improve patient care?

Prof. Phil Richardson (Chair and Chief Innovation Officer, Mtech Access) is joined by Stephen Slough (Chief Digital Information Officer, NHS Dorset) to explore how, through the catalyst of partnership, new technologies and data have the potential to transform healthcare.

We have reached a point where digital is so ubiquitous that, even in the NHS, what were previously seen as ‘digital’ transformation projects are now viewed as simply business transformation projects.

Add in advancements in artificial intelligence and ChatGPT-type services, along with the potential of big data, and it’s no surprise that digital is at the heart of transformation in the NHS.

In this episode, Phil and Stephen explore:

 - The digital landscape for NHS decision makers
 - How, when and where data can transform healthcare systems and patient care
 - How the NHS and industry can get access to and share our data to better plan products and services
 - What the top priorities are for digital leaders
 - How industry build strategic partnerships with Integrated Care Boards (ICBs) and other NHS leaders driving data-led transformation

This podcast was originally broadcast as a live webinar. Learn more at: https://mtechaccess.co.uk/data-led-transformation-nhs/

To learn more about our work with the NHS and how we support our Pharma and Medtech clients visit:  https://mtechaccess.co.uk/uk-nhs-insights/

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Transcript

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- [Announcer] Welcome to this Mtech Access webinar. At Mtech Access we provide health economics and outcomes research and market access services from strategy through to implementation. Our unique NHS relationships guide and validate everything we do in the UK. We work with over 80 NHS associates to bring our Pharmaceutical and Medtech clients authentic insights into the NHS. We can help you answer key questions related to the NHS from how to communicate with Integrated Care Systems, Places and Primary Care Networks, to how to capture pathways of care. Get in touch today to discuss your market access goals. First though, I hope you enjoy the webinar.- Welcome everyone to the NHS Whispers session. I'm Phil Richardson and today we'll be covering data-led transformation in the NHS and how perhaps we could partner to optimise patient care. We've got a great mix of audience here today between industry and the NHS, and I'd particularly like to welcome our NHS associates who play a key role in the work we do. For those that don't know us, Mtech Access is a specialist health economics outcomes and market access consultancy with a track record in expert delivery who provide specialist support to both Pharmaceutical and Medtech clients and work as a collaborative partner with the NHS. Today we focus on specifically the role of data-driven transformation, and I'm absolutely delighted to welcome our speaker Stephen Slough, who's the CDIO for Dorset ICB. Welcome, Stephen.- Hi Phil, thanks very much.- It's great to have you here today, particularly as digital is playing such a key role in the transformation in the NHS and the much broader conversation. But I think before we get stuck into that, it'd really be good to help our audience understand a little bit more about you, your current role and your responsibilities.- Yeah, sure. So I'm, as you mentioned, I'm the Chief Digital Information Officer for the Dorset ICB, which is the new construct, national construct from the NHS to look after 42 separate geographic areas around the country. And we're lucky to have in Dorset, the opportunity to have a digital representative in that board, able to be involved in the conversations and hopefully steer the direction of some of those conversations to make sure digital data technology and innovation is included from the outset rather than at the end of the conversation. So it's a great opportunity for the digital profession and a really good opportunity, I think, to help us start to work more, to link together how the NHS works with local authorities, with the voluntary sectors, with private sector companies, Medtech and Pharma being big parts of both of those. Yeah, and ultimately make a difference for our population. So yeah, it's an exciting role and an exciting time.- Great. It is good to hear and it builds on lots of the work you've done previously, which I'd love to get into a little bit more as we go through our conversation. Could you tell me a little bit more about your team and how it fits? Can you just expand on that a little bit? You talked about quite a complex range of stakeholders and it'd be good to understand how does that work, or maybe even a day in the life of Stephen Slough. What does that look like?- It starts pretty early with walking the dog, but that's probably not interesting to most people. Yeah, so it's a really, we have a really good collaborative approach in Dorset which is useful because lots of the conversations we need to have can be quite complicated and the challenges we face certainly are, same as everywhere else in the NHS, are quite tough. So being able to have those conversations are very useful. The team here at the ICB itself, so our digital team looks after the technology for this organisation and for primary care in Dorset, and we've got various other elements of it which then bring in specialties around providing digital access to patients at home through various different Medtech solutions. Our Dorset Intelligence and Insight Service, the DiiS platform, which is our data and intelligence platform, kind of comes through this team as well. But interestingly is hosted through two of our partner organisations. So it makes it a genuinely, what's the best way to put it, a genuinely system-involved and a product and programme which draws on the collaboration and fits in with the way we work with that collaborative approach. Other things like Automation IG are all involved and big parts of what we do too. And the conversations typically that I would have day by day are with our various different partners across the system, with challenges we're trying to address together around particular replacement of different platforms, approaches to how we work together, and of course conversations with partners and suppliers, or people who are prospective partners and suppliers, who want to come and work with us and help us with the challenges that we face. There's never a dull moment, I think it's probably fair to say.- And then on top of that, you're obviously dealing with anything, any crisis or challenge that emerges operationally. Did you get involved in any of any of that?- Yeah, absolutely we do. And we, if there are cyber incidents, which are on the increase, as you could imagine, we get involved in that. How we can support the platforms that we run from here and also across the system we get involved in supporting with all of those too.- So that does sound a lot. So the dog walk in the morning, so what's your dog called? I'm sure everybody will be interested in what kind of dog it is and what that's called.- Is is a small cockapoo, he is nine-years-old now, so we've got ahead of the cockapoo trend and he's called Oreo. So he is now famous I suppose.- He's now famous. So trend-setting on every level, including wellbeing walks first thing.- Absolutely, yeah.- Yeah. So you mentioned DiiS, and that's got some national interest, hasn't it? And I think it was very early, the work you and the team were doing were very early about integration. When people were talking about interoperability you were creating solutions to help decision-making. Do you want to just expand a little bit on that,'cause I think our listeners would be generally interested in how far you've got on that data journey.- Yeah, of course. So the DiiS, so the Intelligence and Insight Service platform we've created started a number of years ago and it's been a quite a creative journey I suppose, to get it to where it is. So we started it with our digital strategy in 2016 of having a way of bringing data together from all the different data sources that we have across the system to provide a way of looking at how effective and efficient we are at running and providing the services that we have. From that initial concept to where we are today has been a huge transformation really in ways of working together and then output in ways patients are treated. And, you know, if I look at that original ambition, the team that are delivering it, they have just totally smashed that out the park. It's gone way beyond where we thought and really excited about what might be starting to come next with our opportunities on that. And it really was interesting. It was quite hard to keep the momentum going and to keep the investment going to make it fundable, or to keep it funded, sorry, before the pandemic. But we'd worked really hard up until that point to get lots of really good data sets together, so when the pandemic hit the team were able to very quickly spin up in a single visual, the entire impact of COVID on the Dorset population in as near real-time as we needed to be able to operate it. And that was the game-changing moment for the product, if you like, that we've created internally. Because that was the piece that everybody kind of went, ah, that's what you meant when you were saying data would be able to be really useful to us. And we haven't looked back since then. I no longer need to try and find funding for it every year. The team is funded. Everything we're looking at in terms of our strategy moving forward mentions it because data-led is the way we should be going. So it's been a brilliant transformation and it is ingesting data from all of primary care, our acute hospitals, community mental health hospitals, local authorities. We're in conversations with the local police force, fire rescue service, and some private sector organisations as well. And that helps to create a really good picture that enables us to leverage proper population health management for Dorset.- And that is fantastic and obviously I can attest to it, having worked with you for a quite a long time.- Absolutely.- To then be a customer of the DiiS dashboard in my gold command role through COVID. It was absolutely used on a day by day basis by both gold, silver, and bronze commands, down to how many beds have we got, who's got oxygen? Where's ventilation, water? What staff sickness have we got that's COVID related? What does that mapping look like across the county so we can see where the hotspots are? So it was a massively useful tool and including getting some attention nationally, didn't it, with the national COVID team. So I think it's a great example, isn't it, of how you can actually drive transformative work and it's more than just about having data. And I'd like to explore a little bit about that with you if I can.- Yeah, it's definitely more than just about the data. The teams that we had, we have developed this internally, were spreadsheet warriors before, but they understood the data. If the data moved or changed in a certain way, they knew why, what the drivers were and what had caused it. So by then giving them access to more up-to-date tools than the spreadsheet, they can create visualisations, bringing in mapping and various other pieces like that which then unlock just a, what would've been a graph previously and turn it into something much more visually impactful. And you could drill down through that data to get to actionable insights for a small cohort of the population. So pseudonymized and nobody knows who these people are, but it can be re-IDed back into primary care. So if we find an area that needs action taken, GPs can be appropriately informed and alerted and can then take that action next time they see that patient or proactively get in touch with them. And we used it, didn't we, with the vaccination efforts'cause we created specific tool sets to support vaccination mapping and tracking in Dorset. And we were able to specifically target areas of the population where the uptake wasn't where it needed to be for the vulnerability of those patients. And also because we have some of the demographic data, we knew how to talk to those members of the public in the right way, that meant the message landed and was received and actually turned the direction of their decisions to not be vaccinated. So it's having the right impact.- So that's a great example of a strategic oversight saying, look, we've noticed a pattern here and we can actually now put into the GP's hands a list of names of people that might need some support, some help, some intervention. And I guess you, it also probably deals with the question in the opposite direction, which is a GP or a clinician saying to you, can you tell me who my hypertensives are? Who've got a mental health episode, who might have had an ED presentation, who might be of this socioeconomic group or race or something. So is that currently how it's being used or are clinicians using it in anger as it were to help solve tricky therapy problems?- Yes, they are. And a few of them are evangelists about it. Very definitely. And they're brought in wholeheartedly to it and engaged with the team to work out how they improve it further regularly. And there's a few particular areas where consultants from acute hospitals are very heavily involved in wanting to understand what the data is that previously would've been, you know, linear fashion or just in a list in a spreadsheet can now be visualised in a way that they can then go, well actually, can you get me some data on that as well, because that might change how I'm seeing this and it might change then what I do for those patients. If we have the data we can then, the analyst will create that for the consultants, sit with them and then go through it with them. And it has been part of the success of the DiiS in that from the outset, whilst we had to work out the technology to make it as scalable and workable as it is, all of the visualisations are clinically led or operationally led. We haven't sort of sat there in a bit of a analyst fest and gone, this would be good, let's create one of those. It's all been to answer a specific question or series of questions to help improve outcomes or help improve the way care is delivered. And that has some interesting knock on benefits as well.- So does that put you in a space where you can have a direct conversation with the clinicians in an evidence-based conversation as opposed to an opinion-based conversation?'Cause I see lots of conversations happening in health systems across the country where there's lots of very strong clinical opinion, but it's often not supported by patient-led evidence. It's supported by subsets which don't tell a whole story. So do you find that's changed the type of conversation you can have?- Yes, definitely. And it's maybe because we're able to present to the clinician information in which their previous approach and thought process on it wasn't available to them. So they were kind of almost not blind, and they have a lot of skill and intuition and experience of course. But if you then suddenly, you know, and they were basing that on what they knew from that experience, but all of a suddenly you're adding in this wider part of the situation that might challenge them to think in a slightly different way, which might change what they do because all of a sudden the evidence is there and it was, you know, it has been interesting the impact of using this tool, and indeed COVID in particular,'cause lots of attempts to trying to introduce new technology early on in the..., or before the pandemic, sorry, were met with a bit of scepticism of, well we've always done it this way, so we'll always do it this way, COVID landed and that didn't work anymore. And then new technology was all of a sudden the only way forward, particularly with remote consultations, for example. So the distrust and anxiety that existed before didn't matter anymore. It had to come in and had to be used. And that has played on then in the use of data in the way we use the DiiS.- So how do you then scale that to a system-led approach or how does it help you shape your digital transformation approach? Because I imagine there are now lots of individual clinical areas very excited by what they can do, what they can access, but primary care, which is a much broader church around all areas, some of which is handled in different settings, that in a DiiS for you becomes then a brilliant mechanism but also a fragmentation mechanism. So how do you balance the challenge to do everything and yet do something?- Well we haven't really slowed down the effort. Everybody sort of stepped up enormously, didn't they, when COVID hit and we haven't really stepped that back. So we are arguably suffering a little bit from the success of the DiiS and how well that went down and how much it's been used, because now everybody is starting to look to it. So our ICP strategy was published just before Christmas and we're actively working through how now we bring in the clinical and operational strategies to help us deliver that. And once those are clear, then how we develop our people, how we bring in data and how we will operate and commission will all come together to then achieve that ask from the ICP. But as I said, I think earlier on, every aspect of what we need to do in the future now looks to data because we want to be informed in what we do. We don't have the resources, be they people or financial, to just go and do some things if they're not going to change the outcomes for the patients and reduce waiting lists, improve or reduce waiting times in ED for example, handovers, those sorts of things. So everybody wants to have the insights about where we are and we then need to be able to adapt the DiiS 'cause it, it has not historically done this quite as much to then keep track of all the changes over time so that when we get to the desired state that was set out in the strategy or close to it, we can see actually if the impact that we intended has landed and if not, hopefully along the way we can start to inform and nudge in different directions. The challenge that brings is the demand on the team is considerable because we've kind of opened Pandora's box on data, and everybody wants some, which is great, it's fantastic, but we're going to have to prioritise, I think the things we look at and there's a number, you know, how do I get data science better embedded? How do we get our machine learning running on this to reduce some of the demands on the team? But those are future developments we're still thinking about.- So if you take those as important things to start now, so become a priority. It's a bit like what can, what do you need to start now that you will use later and there are things that you need to start now, which you need to use now. What's your basket of priorities look like now? What's in top of head? What are the things that you're putting your energy behind?- First one comes back to the people and the team. So they've been working incredibly hard for an extended period of time and they've got that super creative way about them now, but we need to get behind them, need to support their development further, make sure they've got the right opportunities they need to keep them interested, to keep them excited, to keep them inspired and, you know, stay with us rather than look to somewhere else. So the people is the first thing more generally cyber is then there, the amount of attack attempts we get as a small organisation in the NHS, let alone the broader piece across the system every day is crazy from all sorts of walks of life, and parts of the world trying to break in. So we have to make sure we've got that secure base then it's getting the more of the basics right, levelling up the infrastructure. I read an article from another consultancy earlier on today who are still saying this is a big part of what you, the NHS needs to focus on, getting that right.'Cause if you implement lots of fantastic new technologies and it still takes five minutes to log in the morning, people will be less interested in using the new solutions. And then I think for me, everything else hinges off data being the priority. If we agree that data is the prize operationally, let's say, that will drive the questions around, well what do I need to make sure I can get the best quality and depth and breadth of data into an analytics platform that draws out those better insights and is that we continue with the fragmented aged applications that we have or do we need to consider investment to improve the application so the quality of data that can be held is better. So that data in turn feeds through and creates greater insights and improved intelligence. That means the actions we take for the population then become smarter, more informed, and better rounded. So I think data then is the launch pad for all the other change that we're going to need to make and all the other transmission efforts that we all need to change technically.- And that's a huge undertaking when you have a, you know, many years of transactional data that's captured, some of which has questions about quality, some of which has questions about sequencing or timing. And some of it was fundamentally the wrong question was asked at the start. So everything that's been gathered, and I can't remember the last thing you told me, but gigaflops, petaflops or teraflops or something of information that may or may not be useful, that's quite a lot to sort out as well as some of the things you, I know we've talked about in the past around infrastructure getting just the fundamentals right, that nobody's interested in but are completely essential. I know you touched on cyber, but there's simple things aren't there, like hardware and software that you just need to basically keep the system running. But if we look back to the 1980s, which I realise is now 40 years ago, so lots of the audience might not be aware of what happened in the 1980s, but there was a focus at that time on single view of the customer, the customer relationship management, nirvana was if we thoroughly understand everybody well their wants and needs, we can best tailor our services to them. If I bring that to a patient-centered and probably a citizen-centered view actually,'cause ideally we are looking for people who don't need health interventions, we're looking for people to lead healthy and well lives. Is that a nirvana for you in the system to get a single view of the person? Is that something that you would have as an aspiration or perhaps based on what you've said so far, quite a long way along the journey to do that?- Yeah, it is absolutely, because that deeper level of understanding around people who are already ill should help us work out how they maybe ended up getting there. So people who are currently not ill could be advised in ways to help them adjust their lifestyle and their, their approach perhaps to exercise, eating, mental health, wellness, work life balance, all those sorts of things would have a positive impact on living healthier for longer. Which has got to be the aim, isn't it? So yeah, that, that is definitely the nirvana. So you are, when you are in a consultation with somebody, you are treating the whole person in front of you rather than the symptom that they've presented with. And whilst the DiiS can do that with a pseudonymized view and it becomes richer and more informed the more data sets we have, we've also got the Dorset Care Accord, which is a product we developed with a provider partner to pull together as many of the different clinical records that exist and the social care records that exist for our population. So you do start to get that identifiable complete picture about our patient. We haven't finished that journey, but it's a good, it's a good way along with new data being added that again, rounds off that view of the person that sat in front of me as a clinician. So whilst you might work in one of our organisations, you've got the opportunity to to log into this and get that more rounded view and that'll get better over time as well.- Yeah, no, no thanks. I think it's a big challenge whilst you're also trying to deal with the effect of the pandemic on all sorts of different things. And I think as we were talking broadly about transformation and you've talked about data, it'd be quite interesting just coming back to the, your conversation about the pandemic and the impact it had. Could you share a little bit about your perspectives and have they changed as a result? Because you are a very experienced digital leader and you, you've got an industry background and you've come into the NHS and you've continued to build, you know, measurable transformed systems and solutions and now for patient benefit as opposed to for other benefit. Did the pandemic, you talked about the technology and you talked about the impact that that had and some behaviours and some mindsets were reset rather quickly within weeks as I observed. What about your perspectives though, are you still on the same mission you were, you know, 10 years ago or are you different? Is there a new, is there a Steven Slough version two?- What happened to me? Well it was useful in many ways, which is an awful thing to say about a pandemic that's had a such terrible cost to individuals and organisations as well. But it has helped, it has catapulted technology and digital into the forefront of people's minds much more, some of the anxiety and perhaps almost reticence to use it has not entirely gone away and it's perhaps a little bit more healthy with its scepticism than just being a straight out, no. So yeah, it definitely has had an impact. But the challenge it presents for us is because we have done quite well as a profession meeting the demands that came our way during the pandemic, the expectations we now continue to deliver in that way, which brings different sorts of challenges'cause we have to get much smarter at prioritisation than we were before.- No, I can see that. It's quite interesting. It's almost a "Simpsons" moment isn't it? Where you've been saying we need to do this. No, we can't do it, we need to do this. No, we can't do it. We need to do it. No, we need to do it. Yes you can.- Right.- Okay, we're now going to have to do it. So, which is fair, but it is interesting to see that some of the core principles that you've certainly been advocating in the team, certainly all rally round continue through, and it's not just a knee-jerk response. And because I do see elements of some approaches are a rebadging of not quite the right way of doing it, but rebadging it or a wraparound. But I think the things you talk about, the core principle that sit within the, now let me understand who we're trying to drive benefit or let me understand how we bring the information together so it's useful for the decision makers. All those things that under, you know, let me make sure there's a platform that actually is robust and reliable and safe and all the things you always talk about it. It's good to see that that's continued and the pandemic itself has just allowed some of them to get a traction a bit more, which I think is only for the good.- Yeah. And, it's not quite as exciting as it to invest money in a technology that isn't seen and isn't really understood by people in terms of, you know, that basic core infrastructure foundational layer. But none of the fancy stuff works without it, none of the insights generating computing work will be possible. Analytical work will be possible without the infrastructure being right.- But you must have therapy groups, however you can join to talk about that sort of thing.- Yes, we all go and sit quietly rock together.- Which is excellent. If we just step back a bit then,'cause we touched on earlier about industry and the other thread of the conversation today around as well as data transformation is partnership. And you and I have definitely talked about it for many years, that individual organisations, individual groups, individual sectors can't solve these things on their own. It's a multidisciplinary solution with academia, industry, the NHS and wider partners coming together. If you think there's certainly conversations I'm having with Pharma, Medtech and academia is, we'd love to be involved. We've got our own data, we've got our own insight. We'd love to be involved. We're not quite sure how to do it or or where to even start. Are there any hints and tips to, and I'm really trying to avoid you suddenly getting a thousand phone calls after this session, saying 'Stephen I need to come talk to you'cause I've got a really great thing.' But something that could help make the connections smoother, make them more value-based, make them more useful. Are there some things based on your experience today that you could perhaps share with us?- Yeah, I think so. And I'd imagine everybody experiences the same, you know, the the cold caller attempts to come and sell you something, it's a bit tiresome mean you get lots of emails and lots of requests of, you know, we've got this brilliant thing, we'd love to come and sell it to you. And it's hard to get technology into the NHS from what I've seen. It's hard to get really new innovation in as well.'Cause there's quite rightly, there's quite a bit of regulation to ensure that what you bring in is safe, but it is possible. And if has somebody who's got a product, if you've done your research first of all of the people you're going to go and speak to and the environment that they're in and the organisation they're in and how they work and try to find out what some of the challenges are. So you are turning up with a way to help them solve the problems rather than bring them a product which you are trying to sell. So it's yeah, try yeah, try to understand what we are facing and as specifically in some cases and come with an answer and if your product doesn't match that it's almost a case, don't come because we don't have the capacity and the time really or the funding, and there'll just be lots of engagement. Oh that would be lovely if we could afford it. But we can't. So try to understand where we're at, I still now, the CCG ended last year, 1st of July the ICBs were created. I still get emails from people trying to sell stuff to the Clinical Commissioning Group, which hasn't existed. I just ignore them. They go straight in the bin,'cause they haven't bothered to look, they haven't tried to understand. I get emails coming to the ICB referencing us as a trust, which we're not, that goes in the bin, because they're not, they haven't done anything. They've just got a list of emails and fired them on out. So we want people that actually want to work with us who have something genuinely they know will help us because they understand the situation we're in and they come in and they then partner with us over what might be a longer period of time to get the product in and working or the solution in and working or the support there to help us rather than come in, sell something, bounce to the next one.- Yeah, I can see that. And I've also noticed more that that often the initial conversation needs to be more than one organisation coming to say this is how we can help rather than how a single organisation helps. Is that something you are also seeing?- It absolutely is. And that some people will bring absolute expertise in a transportation layer for data, for example, and somebody else will bring the technology that will feed that transportation layer, will get the data to where we need it to be in one of other applications or into the DiiS for analysis. So yeah, we're seeing quite a few partnerships now. Sometimes two, sometimes three or four major corporations. Sometimes partnering with a new entrant to the market or a new technology and using perhaps some of the larger brand names to help launch that in front of us.- So partnership, I think what I'm hearing from you and certainly what I've observed and the advice we are giving to organisations is it's a team, it's a team game, not a product game. And actually for some organisations and some quite big ones, that's quite a shift in culture for them to move from often products which go all the way to a global level without ever connecting horizontally into a solution base. And that sounds like the type of things that you would welcome organisations who are better informed, have some insight, have researched the situation and come with the this is how we think we might help. And it's solution orientation, isn't it, rather than our product orientation, a team-based solution orientation.- It is. And we've had some really good success with some of that. I mean, one, we were one of those partners supporting really with something one of our local authorities had done with a major telecoms company and some other technology providers really superbly led by them at the local authority. That was a world first in some of the work they were doing. And that sort of conglomeration of organisations almost brought together some very skilled people, very capable people that then developed products because of, and through that engagement was really good.- Now that is good. And it's great to see and it's not really rocket science is it? When you get the right people around the right conversation or the right purpose.- Yeah.- It does flow, doesn't it? The energy level does does really go up and it does flow.- It absolutely does, yeah.- What are things just, I need a definition from you. For many years there's been the conflation between IT, apps, tools, applications, digital, and it's used interchangeably between 'I need to buy another laptop', 'I need to download an app','I need to transform the NHS','I need to change how clinical services are delivered'. Can you give us a definition that we can then cut out of this conversation and then we can just share with people just to help everybody get organised. So when they're talking about digital to you, they mean the same digital that you mean?- Yes. We'll give that a go. Whether you can cut it out and use it or not, I don't know. But let's see. So IT, you know, perhaps informatics and those sort of more traditional names for what is now becoming digital, which is where we'd like to be, I think. So the IT bit is that rinse and repeat product-based, here's your new laptop, you need a new piece of software, here's your new piece of software, you need access to that, there's your access. It's the absolutely essential, necessary aspect that is the unloved bit that sits in the background. It's the help desk phone, it's the server that's got your data on. It's the switch that hooks everything together. You never see, but you rely on entirely. And that's critical. That's important. You can't really work without that. But it doesn't do that. It's really the old run, grow, transform idea. It's the run. That's what it does. The digital service then is very different to that. It's almost the other end of the scale. So it does all of those things'cause that's a big component part of making sure there's a landscape that will work, but it's got to make sure that the team and the organisation have the right skills to be able to harness and take advantage of new technology and new innovation in what's coming out. A digital service is then going to act as a catalyst really to be bringing about change to force, in some cases force the agenda for change required to bring about a different way of working. We should be clear, certainly in my view there are really very few pure IT or projects anymore. All projects that we are involved in are business transformation projects that will have an element of digital because there is almost no aspect of any of the service that's provided today that won't somehow at some point rely on at least one digital piece of technology. Even if that's just email. So the change about how people use the technology that we implement is a massive part, or should be a massive part of what digital is, rather than just what IT is. It's business transformation. We are reflecting a business process electronically. That's it at the end of it really, but we need to be working out how we make sure not only our first customer being clinicians are serviced and carers are serviced by technology, but also the public. How do we then engage the public? If we want to use more technology with the public, for the public to help them look after themselves outside of a care setting, then we need to upskill the public as well as our second customer if you like. And in that, anything that we are developing and deploying outside of the walls of a care setting where we're expecting the public to use it has to be co-designed with them. Well it should be if you want it to succeed. Otherwise you're going to get what a bunch of techies and clinicians think is the right answer. Which might perfectly suit the internal process, but be so complex and unworkable and unwieldy to the patient or member of the public who needs to use it, that it becomes unusable and the uptake won't be there. You got to balance the transformation on making big step change if that's possible with the regular and small step change. Because sometimes the little things you tweak might have a massive impact operationally, internally that then head on to improve how the public are serviced. So it's about, I think mindset change away from everything is just about the laptop that sat in front of you to understand that actually you're looking at everything you do and all the technology that's going to sit behind that, that might not be so easy to cut that out.- Yeah, yeah. No, well we're going to have to run a second episode now to possibly to cover the detail. But I think that was brilliant,'cause I think the some of the things that I took away from that is digital is a mindset, and I think that that's really powerful. I think digital is transformation and there are transformation projects rather than digital projects. So there's some IT projects, so replacing the wiring, the CAT cable, the routers the switches or something, there is a IT project, but digital is a transformation. And I just want to connect back to your earlier comments about working in partnership. The partnership conversation needs about the what difference it's going to make, which is the transformation question, not the how many, whatever it is, whatever the features are of whatever the thing is. And I think that's going to be really critical for Pharma companies who are moving into the combined prescription molecule and prescription digital solution and the composite of that. And also those working in a more broader Medtech space who are trying to bring in solutions. The real risk is there's a focus on implementing a product, whereas it's really clear. I think that it's a transformation space. It's a mindset and also it's an ecosystem which is patient or citizen inclusive. It's not a bunch of people sitting, you know, burning discs as they used to, to standardise on an implementation of product. So I think that was really helpful, because it ties nicely into the next thing I'd quite like to explore with you is, it is the research space. So we talked about the patient-centered piece, we've talked about new ways of working and transforming ways of working. Research, or research and innovation together are clearly a critical transformation lever too, which are enabled by digital and more recently the secure data environment, which is the trusted research environment that space, could you just bring that to life? Give me some sense of what that means and how it might fit into a broader industry conversation?- Yes, and the aim of it is really for those that haven't seen anything about it, is to really start to provide formal and structured engagement mechanisms with the NHS to access the data that it has. And it has a hell of a lot in an appropriate way with all the right ethics and regulations in place to secure both the researcher and the owners of the data to really unlock all the hidden gems, frankly, that are going to sit in that data that will help transform hopefully the way Pharma products, Medtech products, other software solutions for accessibility and equity maybe as well. So that you can have real world data to make sure you're going to do the right thing and in the right way that will have a benefit. And hopefully then over time be able to keep coming back to prove that it's had the impact that you'd set out to do. And they are, they're a great idea. If we can work on how to make it work with the technology that's important, we will be able to make that work. But the opportunity there is huge, and the opportunity for us to be able to link some of those secure data environments together over time so that you could almost do something across the whole population, again appropriately regulated with the right ethics and the right controls in place. It could be really exciting. Really interesting.- I think it's a brilliant, brilliant step forward and I'm aware of, you know, teams have tried to do some of this in isolation before and it is, it's tricky and as you mentioned at the start, it's very hard to engage the NHS with an appropriate level of information with the appropriate group at the appropriate time. And certainly we see a lot of people who believe they've got the evidence they need, but very quickly fall short of an, within an NHS conversation. So this should make the walls poorer, shouldn't they? Between industry, the NHS and the patient in a absolutely and ethically controlled, regulated way, as you've said. For things that will help patients and solve system challenges come together with less friction.- Yeah. And it could be really powerful if we're able to achieve it could be really, it could be exciting.- So you've already talked about quite a lot of things that sit in the broader ecosystem. There's conversations at the moment, population health management, there is big data, there's business intelligence, there's health economics, there's evaluation, there's the whole how we're going to improve care together. And most of the conversations tend to polarise to an area such as population health management and then that turns into a almost a database conversation. But the language you're using are different to that. And I know you and I have talked about, I think you coined it as the data galaxy at one point and I don't think it's chocolate related, but it's something, or maybe it was, but it's something that I think is a lot for people to get their head around, is it a thing, is it something we should think about? Is it something, a conversation we should be engaging in? Is it a clarion call to bring people together or is it just a conceptual thing that somebody's doodled and it's turned into a white paper and a LinkedIn blog?- Hmm, around the SDEs you mean?- Yeah, I was thinking that'cause all of the things we've talked about so far connects to that secure data environment, don't they?- They do, yeah. And I guess the, and the value of the information that's going to appear that we can share is it should really be a byproduct and certainly that's the approach that we've taken with the DiiS and our approach to that has enabled us to start to pull together data. You then start to show it to people. It starts to have an impact on how they then care for their patients or how they work with other partners in our system to improve care. It has the impact then that people see, well actually if I put more data in or better data in, I'm going to get more intelligence at a higher quality so I can make more informed decisions. It will have better outcomes for people. And so it becomes a kind of a self-improving but self-motivated, self-improving mechanism that levels up data quality and use of applications. It also comes back to that point of if we don't have the right applications to capture that data, it will start to drive that pressure for us to improve the quality application. So the data is captured more effectively, because of that we end up with a really good high quality data set we can use internally, which is what the DiiS helps us with, but also make that high quality data available to industry. It's very different in its approach to how some of the current national initiatives are going, which are based around performance data. The performance data won't give the level of insight, certainly won't give the opportunity for the research that this will because performance data is presented in a very almost pass or fail kind of way. And you won't necessarily drive the right internal response to improved data quality about performance.'Cause that's not interesting to clinicians particularly. But if it's driven around what they're trying to do with their patient, it will be and that will dramatically improve, hopefully care by the end of it. So to be able to answer the questions,'cause it should always come back to the patient to answer the question how do we keep people healthier for longer at a higher quality of life before they then need support from health and care services? Yeah, it's kind of got to come back to that. And once you've then got all those different parts of the system working together, you end up with those points of light back to the galaxy analogy, those points of light of data and you draw on them when you need to help improve the picture of the person sat in front of you or to help improve the sets of data that we can provide for research and getting some of those things right improves health, improves life expectancy, improves the motivation, the morale of people to be involved in the local economy and it sort of starts to spiral upwards. If we can get the data.- Thanks, that's really helpful'cause I think that starts to show what the end could be and the end is not far away if we can bring these things together sooner and if we can work together on it rather than individual, feels like that's a real goal worth attaining, isn't it? As opposed to a performance goal, which is a hmm, perhaps not the, it's just a completely different way of looking at the information, isn't it?- Yeah. Yes.- You've sort of sparked in my mind and it'll be a bit remiss of me not to ask you, whereas you are one of the NHS's leaders in the digital space, ChatGPT, what does that mean? And with four, version four coming out, and we had an internal conversation this morning between three and a half and four, which I would find very interesting, but couldn't find anywhere I could actually practically use it, but I just wanted just to get your tongue in cheek view as opposed to, you know, go to the strategy meeting with it view, but you know, what's your take?- Ah, it's fantastic. It's going to be, if we use it properly, it's just be insane in what it can unlock. And I think version four is in Bing, oh no product, is in some search engines already, others are available, but it's insane what it can do and what it could enable. If we could take its algorithms and its ability to mine, interpret and then respond about data, then if we could plug that into our data, you could then ask it almost conversationally for insights into the data that we have in real time. So you could start to not only, we could do simple things like schedule patients and chop and change schedules and things like that, you know, make a more informed decision. So if somebody's coming in for one appointment one week and another appointment next week, could you do two on the same day, to give them one journey or move it online or, you know, intelligently schedule. And that should be simple, but intelligent health related chatbots to help you with diagnosis of what you have. There are several of those sorts of things available now, but a more thoughtful and insightful mental health platform for people perhaps who are in crisis who need somebody to speak to could have a more conversational experience with one of those sorts of bots than with a person 24/7 whenever they needed to in complete confidence. Just, it would just go on and on.- Yeah, and the conversation with the patient as you've did that example also informing the data set, which will be then subsequently interrogated to fine tune the conversation. Yes, I think it's interesting. The team here did this morning run it against our NHS whispers webinars and finally had lot of really interesting insight that came out for it. So I'm not sure we're at a place where that we can share it yet, but even just on that sort of subset type question, which was feeding it in the process, you can see how it could, how it's another generational shift in how digital will drive transformation. I think that-- Absolutely.- Those things together.- That's good, so watch this space then really.- Definitely, yes.- Listening to all the things you've talked about and having had some experience myself in policymakers and how they can sometimes be slightly off the message we'd ideally like, this is your opportunity for your wishlist for the policymaker with the things you're trying to do that what you've achieved so far, the things you are looking forward to. What are the things that would help you, and I'm thinking in your executive role working to drive transformation across the Dorset population, but really as a role model for others. What what would your wish list look like?- So if I had something I needed to ask of the national colleagues and there's obviously, there's a lot of change going on for them. So they're in a difficult space at the moment. I guess it's to listen and then to include perhaps, because having worked in sort of central roles before in a previous company, they're quite tough. They could be quite thankless'cause you're there giving out these messages and these directions, but there is an opportunity isn't there, to not do that in isolation. If you listen, engage with people who are still at the frontline. If you have been at the frontline yourself, to get the real issues that we are facing, you can then come up with a policy change or an idea or an initiative that will make a difference and you'll get engagement from everybody that you need and who you want to do that work for you rather than coming up with something that you think will be good based on what you knew and then trying to force that out. It won't be as successful. So yeah, I think that would be, that would be the one thing if I could ask would be to listen and include.- Yeah, I think that sounds great and it's all reminds me of the wisdom of the crowd type conversation. The expert policy writer may, if they haven't addressed the wisdom that's available, then it's doomed not to work particularly well, is it? I think that's the situation. We've got a minute left and I wanted to just give you a quick snap question on pulling a dream team together. Your version of the Avengers to drive digital transformation in Dorset. I'm not asking you to name names, but who would you have on the team?- You'd need to have good representation, wouldn't you, from different places, but goes back to the previous answer. If you try and do it in isolation, you won't succeed. You'll be missing part of the puzzle. So you need to have the people we're doing this for, there needs to be population representation. We need representation from each of our partners in health and care. And you then need to bring in industry specific brain power to help close the gaps on the things we don't know because we don't have the capacity to know all of those things. Bring in the specialists on the subject, each time comes back to that partnership working we'll have a problem, we'll need some help. And it's the call then for people to bring their organisations and join up with us, sit on the same side of the table and look through the problem with us to come up with the answer that ultimately will make lives better.- Brilliant. Well that's a fantastic answer to my last question. It's been a brilliant conversation with you. Thank you very much. We've covered such a wide range of different topics. I think the whole thing around digital being transformation I think is a really strong takeaway message. I think the whole thing about data, but the right data and managed in a way, that it's improving continually to give better insight, I think is really strong and I think the key thing around partnership and that it is a, there is a dream team that can be around the table, lots around already. So some of our colleagues perhaps potentially listening into this seminar could provide a valuable contribution to that. So I think that's a very strong place to finish. I'd just like to thank you very much for your time. It's great to continue to work with you, and I've love to see the work that you've driven in Dorset. It's great to see how... the patient benefits are obvious and continue to emerge. So that is also brilliant. I'd also like to thank our audience for joining us today and for those listening online to this recording, we'd welcome you to continue sharing your comments and questions with us, and I'd like to wrap up again by thanking you, Steven, for today, and wish you well with your plans going forward.- Thank you, Phil, great to talk to you.- Thanks, bye.- [Narrator] Thank you for watching. If you'd like to find out more about our work with the NHS or how we could support your market access goals, please email info@mtechaccess.co.uk, or visit our website mtechaccess.co.uk.