Healthcare through the crisis: Accelerating digital transformation at the NHS
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Healthcare through the crisis: Accelerating digital transformation at the NHS

James Lawrence — September 2020

Since the start of the Covid-19 pandemic, healthcare providers around the world have faced some of the biggest challenges imaginable. Here, we discuss with digital leaders from the UK’s National Health Service (NHS) how this publicly owned organization has responded to those challenges, the key role ICT has played in helping them step up to the plate, and what shape the future is likely to take.

The panel:

• Cindy Fedell, executive chief digital and information officer, Bradford Teaching Hospitals and Airedale Hospital NHS Foundation Trusts

• Dr Paul Jones, chief digital and information officer, Leeds Teaching Hospitals NHS Trust

• Wendy Clark, chief digital and information officer, NHS Blood and Transplant

• Darren Curry, chief digital and data officer, NHS Business Services Authority

How have you been responding to the Covid-19 crisis and in what ways have you been deploying digital technology to help manage this?

Paul Jones, Leeds Teaching Hospitals: Leeds hospitals are a mix of the sublime and the ridiculous when it comes to information technology. We have world-leading digital pathology. We have some amazing research work involving virtual reality and brain tumors. And yet, in the hospitals, we have 1.4 million paper patient case notes.

Dr Paul Jones, chief digital and information officer, Leeds Teaching Hospitals NHS Trust
We already had our own electronic patient record, which is fantastic and delivers all sorts of benefits, but there’s still a lot of paper and when the Covid-19 crisis hit, all this paper flying around actually created a problem for infection control. So we decided to reduce it significantly, and that’s been a huge change for us. We’re still not paperless in any shape or form but where people are generating paperwork, we’re scanning and destroying that paper. That’s a really big change across the Trust. We had to make the decision quickly, and we effectively did two years of stakeholder management on a Friday afternoon.

I would have loved to have had a week, so we could have thought more about what steps were required, but we knew we needed to take the paper away immediately to reduce the infection risk — that was more important than anything. Moving forwards, we’ll be trying to have those kinds of conversations without the imperative of an epidemic.

We’ve also been trying to avoid as many patients coming into the hospital by working out how we do more remote consultations. We were already a pilot site for Attend Anywhere [which facilitates video consultations] so we could push that quite hard. Our pediatric team love it, but the rest of the hospital not so much, as it appears that most of our patients and clinicians are happier using the phone for consultations. There is a worry among some older patients around using video conferencing — it feels a bit scary to them and they think that as they already have a relationship with a medical professional, they could just have a phone call.

Therefore, we need to be careful not to let the technology drive clinical behaviors. We need to engage with the clinicians, let them know what’s available, make sure they’re trained and they can use it, but there’s also an element of saying, ‘It only works in certain scenarios, so use it there.’ And just because telephones have been around for 100 years doesn’t mean they’re a bad thing.

Wendy Clark, NHS Blood and Transplant: We’ve been working on two convalescent plasma trials, which is all about taking blood rich in Covid-19 antibodies from people who have recovered from Covid-19, and giving it to people who are ill, to see how that works alongside other treatments to help them recover.

Wendy Clark, chief digital and information officer, NHS Blood and Transplant
There has been a huge amount of digital technology required to enable those trials: it has involved us setting up new collection facilities, on-boarding hundreds of new staff, setting up new ways for donors to register and contact us, working with other agencies like NHS Digital and Public Health England to get data about who has been ill and who has had tests so that we can proactively contact them. That will continue to be a priority for us now, probably until next year.

Meanwhile, there are projects that would have required people on the frontline to get really heavily involved in that we’ve had to slow down. For example, we were about to deploy a mobile solution to all our people working on blood collection that we had to pause. But for everything that we’ve paused, we’ve accelerated something else — and at a pace we’ve never been able to work at before.

To do that, we’ve had to change the mindset to: ‘We can actually do this because we simply have to. And not in three months but in three weeks.’ That sort of change comes from everybody seeing the importance of what they’re building and wanting to be part of it.

 Darren Curry, NHS Business Services Authority: In the very early days of the pandemic, we stood up the text messaging service for vulnerable people, informing 1.3 million of them that they needed to isolate for 12 weeks. The question was how to identify who’s vulnerable, and we supported that piece of work using existing data. Working with NHS Digital, we were able to identify people, and then to communicate with them via mobile devices in a matter of minutes to advise them to isolate. Without the technology we had in place, we would have been relying on letters in the post to inform people and provide them with regular updates.

This kind of agility and flexibility, to be able to react quickly to the changing environment, is a big priority for us, as the speed at which we’ve had to do things has massively increased.

Another example is that we’ve had a lot of our people working from home, of course, and we were able to switch to that quickly because we were already on our journey to cloud rather than having to worry about providing additional physical infrastructure to facilitate this.

• For more on the response to the pandemic, see how chief digital and information officer Cindy Fedell helped to set up a new hospital from scratch in just 10 days.

Aside from the Covid-19 crisis, what’s top of your strategic agenda right now and what’s the role of technology in supporting this?

Cindy Fedell, Bradford Teaching Hospitals and Airedale Hospital: We’re spending a lot of time thinking about digital exclusion, which has been exacerbated by the effects of the pandemic. Bradford is a good example: we cover an area that is both affluent and poor, and that equates to a life-expectancy difference of about 12 years. This, essentially, comes down not so much to direct access to healthcare, but more around social determinants of health — people who might not be employed, well-educated or have internet access at home.

Cindy Fedell, executive chief digital and information officer, Bradford Teaching Hospitals and Airedale Hospital NHS Foundation Trusts
Not having internet at home is a big problem for them: it means they’re probably not looking up medical information for themselves. It means they can’t access tools such as NHS websites that show how to carry out some self-treatment or how to seek help or have confidence in doing this. So often they turn up in the accident and emergency department quite ill, and long past the point where other communities would have sought assistance.

Solving this problem has traditionally been more in the domain of local or city councils, but we need to operate more as an integrated system because if everybody thinks somebody else should be doing this, you’ll never make any progress. There are some areas with really interesting initiatives, such as iPad loan schemes, and we’ve been talking to some of the big telecoms providers to see what we can do around just getting more people online.

Wendy Clark: Our area of blood is a ‘supply and demand’ business, so at any one point we’re working on whether we have enough of the different blood types to meet the demand that we’re getting from hospitals. There’s currently a shortage of certain types, such as RO which primarily comes from people of black African and black Caribbean backgrounds, and so we’re constantly working on how we engage with these people in a more effective way to encourage them to donate blood regularly.

There’s a big digital element to that, such as the way people engage with us, how they book appointments, receive questionnaires about whether or not they’re eligible to give blood, and so on. A lot of that means ensuring all our digital products are inclusive, and not in some way putting off different people in different parts of the community from engaging with us.

Paul Jones: As part of our strategic agenda, we’ll be looking at putting our electronic patient records in the cloud. I’m not a particularly big fan of ‘cloud first’ as a mantra. It’s like walking into a garden center and being handed a spade because they’re ‘a spade-first organization’ — it’s putting the answer before the question.

Having said that, our records are sitting on an infrastructure inside the Trust, which isn’t particularly robust or well archived. So the way for us to get it onto a resilient, scalable platform is to put patient records in the cloud. That’s one of our key goals for this year, but it’s a real challenge. It’s a classic ‘changing the engine on the plane in mid-flight’ scenario.

Darren Curry: A lot of our services support frontline services [for the NHS’s 1.2 million employees]. So the priority for us is to make those services as efficient as possible and increase their quality, which enables care to be delivered more effectively.

Darren Curry, chief digital and data officer, NHS Business Services Authority
We’re currently delivering a couple of big national platforms. First, we’re replacing the NHS Jobs platform with an enhanced, easier system for recruitment, which is a huge undertaking. And as the organization responsible for processing and reimbursing the £35 billion ($46bn) of medicines dispensed by UK pharmacies, we’re focused on making those services as efficient and accurate as possible.

Over the next two years, a key strategy will be about leveraging the data we collect through those services, to deliver wider efficiencies and actionable insight to the broader NHS family. For example, with NHS Jobs, we’re looking to add value through the insight that we gain from the analysis of aggregated application datasets.

How are you leveraging stakeholder and partner relationships to help achieve your strategic goals — and how has this changed as a result of the Covid-19 crisis?

Cindy Fedell: As a digital leader, it’s about making sure we are always at the table, listening in so we avoid the situation of ‘Design something and then talk to the tech people.’ The aim is to talk with them up front as that may result in a whole different design and a whole different solution.

Since Covid-19 hit, we all see addressing the ‘digital divide’ as a collective challenge now. Organizational boundaries are being blurred in order to tackle it, but it’s also about changing the supplier landscape. When I was appointed CIO of the NHS Nightingale hospital in Yorkshire and the Humber region, suppliers were telling us they could give us all kinds of equipment — mobile phones, a telecoms mast, whatever we needed — saying they’d sort out the contract later. So that thinking has shifted and, as an NHS organization, we have to respond appropriately.

Many talk about needing to hold suppliers to account, whereas now is the time to get into the ‘suppliers as partner’ space — if we don’t work with them as partners, they’re not going to work with us as partners.

We’re trying to elevate that partnership thinking across all our organizations — not just with suppliers but in our work with universities, the academic health science centers, and others — to get the digital agenda broadly embedded in programs.

Wendy Clark: Since the coronavirus pandemic started, we’ve had a whole bunch of people offering to do pro bono work for us. For example, we’ve just gone live with a new capability for blood donor registrations that has been rapidly created in partnership with a couple of supplier organizations. If we’d done it in our usual way, we would have started by going through government procurement to find a partner, which would have taken longer than the work itself. It makes me ask, if we could work with industry in a more innovative way going forward, where could we actually make progress faster?

Darren Curry: What we’ve seen is a lot more collaboration, right across the system. Various NHS agencies — NHSX, NHS Digital, NHS England and Improvement, the Department of Health and Social Care, and ourselves — all coming together with that common purpose and working collaboratively, which didn’t happen enough previously. I think we’ll see a lot more of that going forward which has also brought to the fore the benefits of collaborating on technology platforms and services.

Relationships are very important here: it’s about keeping promises — deliver on the things that you can do, be honest with the things that you can’t, and do it in an open and transparent way. There’ll always be bumps in the road, but if you’ve got a common purpose on why you’re doing something, then that’ll keep it on track.

Looking to the future, what kind of digital transformations are you expecting to deliver — and what are you hoping to keep hold of from those brought about during the Covid-19 pandemic?

Wendy Clark: I don’t think the IT function has ever been so popular in our organization. We’re constantly getting praised for our ability to deliver, and now we all absolutely expect to be able to operate at this faster pace going forwards. So the need for open systems to enable fast delivery is one of the biggest things we should drive out of the crisis.

That also shines a light on what happens when you haven’t invested in some of your technologies. It’s very obvious that those are the ones you can’t do much to enhance, and the business can now see that. So, hopefully, we’ll get more traction for investing in products through their life cycle, rather than make investments and sit back and wait for them to wither on the vine. 

“Bradford NHS Commend Centre”
Command Centre, Bradford Teaching Hospitals NHS

There’s so much that we can do just with some of the basic technologies that we haven’t been exploiting fully yet, such as mobile and virtual working. There’s also lots more to do with creating things like open services with APIs, so that we can consume them in better ways and build apps around them. Those may not be really exciting but they’re things that a lot of people haven’t done yet around the NHS.

I also hope that a whole bunch of people want to come and work for us because they will have seen what digital and tech folk across the NHS have done.

Darren Curry: Going forward, I’m excited about leveraging big data sets for prediction and prevention. As the cost of storage and compute [power] are plummeting, and with the use of machine learning and AI — and the arrival of quantum computing in the next couple of years — we will be able to interrogate data at a level that we’ve never seen before. 

This presents a fantastic opportunity for population health management, through prediction based on earlier life events, and to reduce the amount of time spent in ill health — which increases quality of life but also reduces the cost and burden on the NHS. But it all has to be done in the right way, with ethics at the forefront of any data analysis, of course.

We also have to be careful about continuing at the rapid pace we’ve been setting recently. I’ve seen a lot of discretionary effort from people, with individuals pulling 12- or 14-hour shifts, or longer, to get services out the door. That’s not sustainable. It’s as if we spent the first couple of miles of a marathon sprinting to achieve what we needed to achieve, but now we need to move back to a marathon pace or we’re not going to make it to the end of the race.

Paul Jones: I think a lot of the changes instigated during the pandemic will stick. For example, we’ve been given £600 million ($786m) to build a new children’s hospital and a new wing of the Leeds General Infirmary in the next five years, which are going to change the skyline in the city.

But although they’re big hospitals, they’re a smaller footprint than the ones they’re replacing — so one of the things we’re looking at is how we do remote working within a new hospital. How do we encourage people to not be in the hospital as often? Because of Covid-19, we made that leap in our thinking much more quickly than we expected to.

We also need to consider how we support our clinical teams in thinking about new ways of using the hospital for care, and how technology can support this. So, for me, it’s not a technology-first idea, it’s clinical and patient-centered but trying to show the clinical teams what the art of the possible is right now. 

Cindy Fedell: I think people see the value that digital can bring a lot more now and are much more open to tech-enabled change than previously. So the next few months are going to be really critical to us; it is our time to both embed some of the changes we’ve already made and use that as a platform to do more.

First published September 2020
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