Digital Health Roundtable: Challenges and opportunities of digital transformation in the health sector

After more than 18 months of the pandemic, what comes next for the UK’s health sector organisations?

It’s no secret that front-line workers and decision-makers face immense pressures. You only need to open a newspaper and read the headlines. Yet without digital technology, the situation we find ourselves in in the wake of Covid-19 would be far worse.

Digital acceleration sat at the heart of the health sector’s response to the pandemic. So much so that our recent study with the Centre for Economics and Business Research (Cebr) found that Covid-19 might have accelerated the rate of digital transformation in the health sector by over four years.

In our previous roundtable - in partnership with Digital Health - we looked at the state of transformation 12 months on from the start of the pandemic. It was an insightful and productive reflection on the impact of Covid-19 on the new everyday of healthcare.

In October 2021, we hosted a second roundtable to discuss the challenges that digital acceleration has raised. What innovation has worked and needs to be taken forward? What hasn’t worked and should be left behind? How do we sustain momentum?

I was thrilled to join the conversation and hear about the exceptional ways in which the NHS has been investing and adapting to prepare itself for the future. Once again, the Contributing Editor, Claire Read, skilfully steered the ship as the roundtable moderator.

Here’s what I learned and took away from the discussion.

The nature of the pandemic meant that organisations were forced to carry out digital transformation quickly. According to some participants, there were some downsides to this.

Adrian Byrne, Director of IM&T at University Hospital Southampton NHS FT, said: “One of the challenges in rolling things out quickly like that is that you don't tend to deal with the integration side of it particularly well. So, there's a legacy there regarding how we go back.

“Things have a habit of sticking in the NHS, unfortunately, and (if) you've rolled things out in a suboptimal way, then they stick for years. So, we've got that challenge and now we've got increased demand.”

As well as the challenge of integration, there’s also the issue of rapid digital transformation not necessarily suiting everybody. As Dr Tanya Pankhurst, Consultant Nephrologist & CCIO at University Hospitals Birmingham NHS FT, pointed out:

“The trouble with rapidly putting in digital solutions without your user base being involved is that you don't reach the patients that really need you lots of the time. So, I think the digital solutions that have been developed during Covid-19 tend to suit people who are already very well connected (with) their healthcare.”

Paul Bradley, CCIO, Hertfordshire Partnership University NHS FT, also pointed out that rapid digital transformation may have exacerbated digital inequality in certain areas. “Unfortunately, people with severe mental illness often live in digital poverty. So, the difficulties with getting basic devices, getting data and being able to access services online are exacerbated for that group.”

Digital inequality quickly became an important theme of the discussion on a national, regional, and socio-economic level. Prof Daniel Ray, Chief Technology Officer, Birmingham Women’s and Children’s NHS FT, commented on some of the complexities involved in addressing it:

“Giving a device to one family may be a really good idea. To others, it may not be a good idea. It may end up being sold for something else. Creating hubs for people to come to is (something else) that's been proposed to sustain some of this, but that's another quite important dimension - inequality of access.”

The danger is that those without that all-important access to digital technology could be left behind altogether, which could even become a determinant for poor health outcomes. Paul Bradley offered one suggestion for how to potentially tackle this problem:

“Making technology available – (through) recycling of old gadgets and gizmos and so forth - so that digital poverty can be addressed (could be a solution). There are lots of charitable works that go on in big organisations and maybe this is just one that’d be worth committing to (over the) long term.”

That’s not to say that acceleration is bad news. The panel agreed that it had created lots of different possibilities when it comes to ways of working and healthcare outcomes. The danger is more about returning to the way things were before because of a lack of long-term buy-in from end-users.

Graham Walsh, CCIO, Calderdale and Huddersfield NHS FT, said, “I'm sure we're not the only trust that has seen people wanting to see everything back to how they did it before - because like with many digital things that you do - without that engagement piece - people will revert back because it's not embedded into what they want to do.”

Some of our attendees were already well bought into new digital ways of working, recognising its potential to create new, exciting possibilities.

One attendee joined four different antenatal clinics in two hospitals from home one morning. “I think that's probably a first, but it does show what's doable.”

Ultimately, it comes down to what works best for people. In the words of Paul Bradley, CCIO, Hertfordshire Partnership University NHS FT, “If you can get a quicker and easier virtual appointment, (then) you don't have to leave your home.

“And the same is true for groups with mental illness in some cases, so people with OCD and (hoarders) who struggle to get out of the house, people with autism that struggle to get to unfamiliar and hostile environments as they might see hospitals, those of us who work in the community possibly still do. So, there's something (to be said) about those positives.”

The conversation then turned to the most important element of digital transformation – how it helps frontline workers and patients. Virtual appointments, improved data - all this has the potential to revolutionise our health services when deployed correctly.

For Michael Lumb, technology has not only benefitted his work, but also made appointments more convenient for the people that he sees.

“I was doing a lot of the consultations over the weekend, which fitted very well because it meant that people didn't have to take any time off if they were going into work - they didn't have to organise childcare (and) they didn't have to park.”

If electronic records are effective, they could save our frontline workers time to focus on crucial, sometimes lifesaving tasks. According to Michael, for this to truly work, clinicians and system designers need to create clear, navigable ways to access information together.

“They've got to design systems that mean we can navigate them, (giving) us something like a glass cockpit in a modern aircraft. It pushes information out rather than you having to go and find it.”

It’s a point that was echoed by Dr Tamara Everington. “It’s (the responsibility) of our managerial staff to deliver solutions, which feed the data reporting requirements we've got. And (it’s on) our backend solutions to join the whole system up so we can move forward together.”

In the words, of Adrian Byrne, “We know we've still got quite a tough job in terms of going forward and delivering that strategy. Digital maturity is quite low.”

And Graham Walsh captured the need to put people at the heart of digital transformation, stating: “We've got loads of fancy tech, but what we need to do is make sure we teach people how to use it the right way - at least for documentation, for coding (and) for informatics.”

Most attendees expressed a desire to move past the idea of ‘digital health’. Instead, they want to focus on providing the best healthcare solutions, regardless of whether that’s in person or using digital technology.

“Digital shouldn't be something separate,” said Dr Chris Mulgrew, Consultant Nephrologist & CCIO at Royal Devon & Exeter NHS FT. “It needs to be part of the DNA, part of everything that happens. Digital must be at the table from the very beginning to say that this needs to be part of the planning.”

Dr Tamara Everington, CCIO at Hampshire Hospitals NHS FT, hopes that we will reach a day soon where digital health isn’t even a term.

“What we are talking about is delivery of the best in health and social care, which is underpinned by the right infrastructure, hardware and software to support the people working at the frontline in delivering clinical care. And I think if we get to that place, then we will have delivered our ultimate goal.”

Our roundtable showed there are lots of reasons for optimism about the potential of digital technology in the health service. While complex challenges remain, digital acceleration has shown that there are exciting opportunities to be grasped when it comes to enhancing patient care and ushering in more efficient ways of working for NHS staff.

Thanks to all those who took part in our roundtable:

• Moderator: Claire Read, freelance writer and editor, Digital Health magazine
• Paul Bradley, CCIO - Hertfordshire Partnership University NHS FT
• Adrian Byrne, Director of IM&T - University Hospital Southampton NHS FT
• Tamara Everington, CCIO - Hampshire Hospitals NHS FT
• Dr Jim Forrer, CCIO and GP - NHS Devon CCG Steve Gray, CIO - University Hospitals Bristol and Weston NHS FT
• Michael Lumb, Clinical Advisor, Digital Child Health and Maternity Programme – NHSX
• Martin McFadyen, Head of Public Sector - Virgin Media Business
• Dr Chris Mulgrew, Consultant Nephrologist & CCIO - Royal Devon & Exeter NHS FT
• Dr Tanya Pankhurst, Consultant Nephrologist & CCIO - University Hospitals Birmingham NHS FT
• Prof Daniel Ray, Chief Technology Officer - Birmingham Women’s and Children’s NHS FT
• Luke Readman, Digital Transformation Director - NHS England (London)
• Lee Rickles, Yorkshire & Humber Care Record Programme Director & CIO Humber Teaching NHS FT
• Graham Walsh, CCIO - Calderdale and Huddersfield NHS FT
• Russell Tilsed, Senior Director – Public Sector, 8x8