HETT 2024: new government, a new focus for health tech?

The HETT Show has been a fixture in the UK's digital health calendar for several years now, and 2024 was no exception. We were delighted to have a stand at ExCeL for both days - it was our first conference as a team and we were delighted with how it went. We spoke with lots of clients old and new, and colleagues across the sector. Read on to find out who won the Liberty London Advent calendar and what we learned across the 2 days.

The new government is now well established with Wes Streeting as health secretary, alongside Peter Kyle at DSIT, overseeing all things health-tech. There is plenty of recurrent messaging in the media about the perilous state of the NHS. However there is little clarity among attendees about what this will actually mean in practice and where health care organisations and their industry partners should focus.

Some observers noted that NHS is in a state of indecision: waiting for direction from politicians and hoping to unlock the funding required to implement meaningful change. Others felt that the political pressure to improve care would likely be linked to specific top-down initiatives which will come with short-term tactical funding. The perennial challenge of short term funding will need to be addressed by the government if the systemic challenges of healthcare are to be met.

Now is the time to dust off your business cases and make sure you're organisationally ready for when the last minute funding rounds come in. Use this time to get stakeholders aligned inside and outside your organisation and line up delivery partners who you can trust to make it happen.

Amongst the many discussions at HETT we felt that three distinct themes emerged:

• maintaining momentum on existing programmes,

• accelerating new ideas and approaches,

• topics that aren't quite cutting through.

Maintaining momentum

There was continued discussion and apparent investment on two ongoing programmes / areas of investment: frontline digitisation and virtual wards.

In 2021 the frontline digitisation programme promised that every NHS trust would have an electronic patient record by Spring 2025 and claimed (we may be sceptical!) in November 2023 that 90% of trusts had already achieved that target. We heard from various integrated care systems that there remains pressure from NHS England to converge on a single EPR across multiple providers. Change at this scale is complex with concerns about affordability, the scale and complexity of change and whether it is being led clinically.

"An EPR isn't an IT project"

It was great to be reminded of the challenges involved in single or multi-site EPR implementations: whether converging on EPIC or Oracle Cerner (it tends to be these two in most EPR mega-convergence discussions) the non-negotiable requirement is integrated leadership and governance from clinical and operational teams. EPR implementations directed by a well-intended national team and led by CIOs rather than genuinely committed multi-disciplinary executive teams is destined to fail.

Continued digitisation of the healthcare records is an essential step - can you afford not to get it right? Our experts have hands-on experience of unlocking pan-system alignment through to detailed implementation in multi-trust EPR programmes.

The other programme that continues to receive investment and focus is Virtual Wards. As a centrally funded initiative, the virtual ward is becoming an increasingly well established model of care across the country. However the approach to virtual wards has been the mirror opposite of EPRs with local teams left to design services, experiment and procure locally relevant services and technology. Central teams have focussed on sharing best practice, collating statistics around service provision and facilitating service development.

The success of this model is yet to be fully understood, with NHS England commissioning a multi-year evaluation of these services. EPR implementation and scale-up of virtual wards are very different however it's great to see there is room for both approaches, and possibly learning to be shared across them:

• In what circumstances does a central mandate accelerate high quality outcomes?

• When should the NHS encourage innovation and create the conditions for ideas to flourish?

• At what scale should technology and service standards be defined and where should they be procured?

We expect some standardisation of operating models across organisations for virtual wards that define a clearer role for community services, primary care and social care emerging alongside acute-led services. The technology and service providers may also consolidate as the winners and losers of this new sector emerge.

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Accelerating new ideas

The hottest conversations were sparked by the Secure Data Environments panel. There was strong interest from research-oriented organisations like Arcturis who are excited at the potential for much faster access to high quality data which can in turn lead to improved development of treatments for diseases like cancer.

Hearing from a patient as part of the panel discussion was an unusual aspect of a show like HETT, but it was a masterstroke and highly informative. The need to continue high quality dialogue at national and local level was key to maintaining public support. This requires taking the time to build an understanding of the complexities and sensitivities of making health data available for research and to make public partners a central tenet of decision making.

The SDEs themselves are at different stages - some building on existing relationships, developments and teams, and others starting from scratch. We had excellent discussions on our stand with people interested in how we are working with Oxford University Hospitals and Telefonica Tech to create the Thames Valley & Surrey Secure Data Environment. The team based in Oxford are among the leaders whose success is generating a strong response from academic and industry partners. Our workforce planning approach aligned well with ongoing work from the BCS to develop and promote the SFIA framework which has been an invaluable tool that we have used for many years.

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The healthtech that isn't (yet) cutting through

Despite the marketing hype, the promise of artificial intelligence didn't have a big impact on discussions or the agenda. Lots of potential use cases emerged - for example improving clinical decision making in provision of hospice care - but the industry response wasn't really there.

The era of CoPilot in health is starting to emerge. The team at Buckinghamshire Council were on-stage at the GovTech show next door to HETT, with local authority CIO Tony Ellis showcasing the real-world benefits they're seeing from being a pioneer in the use of AI and CoPilot365. The NHS could learn from the approach local authorities have taken to rapidly scale use of CoPilot.

As we mentioned in our blog following Rewired at the NEC, health conference organisers haven't really got a grip on the links between health & social care. There was limited presence from social care providers, technology providers and on the agenda. Whether it's the social determinants of health outcomes or the vital role played in improving patient flow, this voice must be heard to address the challenges in the health sector.

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Reflections from the Starlight team

The team have shared their personal thoughts from the conference below:

Ross: "Running a stand changes the dynamic of the event - rather than getting to spend the day attending seminars and exploring what's on show, we spent most of our time at our stand meeting with the many people who stopped to say hello. It was a privilege to have so many discussions - including clients present and past, colleagues in other consulting firms wishing us well, motivated clinicians thinking about their future career and many others we hadn't met before."

Anoop: It was a pleasure reconnecting with familiar faces from my professional journey and seeing how they have shaped their digital paths over the years. It was equally exciting to hear about innovative ideas, such as an AI-powered NICE-assured GP assistant, a remote monitoring app aimed at disrupting social care backed by an incubator, and first-hand reviews from UCL’s Virtual Ward teams.

Darren: A great 2 days spent chatting with old friends and new colleagues. As it was our first time exhibiting, it was so important to share our vision with others around our transformative model that supports the shift towards integrated and high-quality healthcare by creating tailored solutions based on clients' individual requirements, both in the present and the future. Happy to say our approach was met with much agreement and enthusiasm. 

Feyzan: As an early adopter of several FemTech apps at different stages of my life, the lively panel discussion on Femtech was of particular interest. Much discussion centred around the funding behind these apps and the commercial models that ensue which prevent equitable access and don’t always have the best interests of the end user at heart. It is clear there is significant activity in this space but help is needed to guide start-ups through accelerators, alternative funding options and regulatory issues, all of which we are well placed to help with. 

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And finally... the big draw

A big feature of discussion was the draw for the Liberty Advent Calendar. This received a huge amount of interest ranging from curiosity through to someone who has an annual savings plan in place to buy one each year! We are delighted to announce that the winner is Dr Nilesh Bharakhada, a GP from London. Congratulations to Nilesh - we'll have it with him soon and now need to work out what to feature at our next event.

Thanks to everyone who came and spoke with us, entered the draw and shared your ideas. We look forward to seeing you all again soon.

Data saves lives: building a Secure Data Environment for R&D

Over the past few months, the collaboration between Telefónica Tech, Oxford University Hospital (OUH) and Starlight Consulting has proven to be an exceptional example of what can be achieved through dedicated teamwork and shared vision.

Since April 2024, our teams have been working closely to design, develop and deploy a state-of-the-art Secure Data Environment (SDE) for the Thames Valley and Surrey region. This partnership has been instrumental in supporting NHS England's initiative to enhance the security, accessibility and utility of healthcare data across the region. Together, we have successfully navigated the complex landscape of healthcare data, aligning our efforts to deliver a robust solution that meets the stringent requirements of the NHS.

In a remarkably short time, we have managed to prepare an appropriate solution and data architecture that form the backbone of this SDE. Our joint efforts have focused on ensuring that the system can handle data ingestion from a number of source systems and ingestion patterns, initially centred around cancer data requirements. The integration of various components, including the NHS England Opt-out, into this environment is a significant milestone, demonstrating our ability to address complex challenges with innovative solutions.

As we continue through the remainder of the project, the integration of the Trusted Research Environment (TRE), developed by OUH using Microsoft Azure TRE principles, with the SDE, represents another significant step forward. Over the coming weeks we will, together, ensure the core foundations and data within the SDE are readily integrated and accessible, providing researchers with a secure and controlled environment to conduct their vital work. This integration is a testament to the strength of our collaboration and our shared commitment to advancing healthcare using well governed and well architected technology.

Reflecting on our journey thus far, it is clear that the synergy, teamwork and incredibly close collaboration, between Telefónica Tech, OUH and Starlight Consulting has been pivotal to the success, so far, of this project. Our teams have demonstrated exceptional agility, expertise and dedication, enabling us to achieve remarkable progress in a short timeframe. As we continue to work together, we remain committed to delivering cutting-edge solutions that will have a lasting and positive impact on healthcare in the Thames Valley and Surrey region, ultimately benefiting patients and healthcare providers alike.

Rewired 24: values, energy and a missing ingredient

This week hundreds of people with an interest in digital health attended the excellent Rewired 24 conference at the NEC in Birmingham. Rewired is the highlight of the large-scale NHS digital and data conferences, attracting big name keynote speakers and an vibrant series of side events which this year included yoga, a running club, innovation events by The Hill and the opening of the Ramadan fast (Iftar) organised by Hassan Chaudhry.

We were delighted to attend the event alongside the team that Starlight is supporting at Oxford University Hospitals who are leading on the Thames Valley & Surrey Secure Data Environment (SDE) programme - more on that below.

Testing the values of the digital community

As the conference approached news broke of the despicable comments made by Frank Hester, owner of The Pheonix Partnership (TPP) whose systems are used in GP practices and NHS trusts up and down the country. TPP’s systems hold data related to tens of millions of patients and (alongside UnitedHealth Group owned EMIS) they are part of a duopoly that has a stranglehold on primary care IT.

The response to Frank Hester’s comments from many including event organisers Digital Health and Matthew Taylor of NHS Confederation was both rapid and widely welcomed - both put their values first and made their position absolutely clear. Given the long-standing title sponsorship TPP have for Rewired this will have been a difficult commercial decision for Jon Hoeksma and the team at digital health.

Over the next few days people shared links to the Reddit and Glassdoor websites dating back many years which set out further allegations that reinforce the perception that the culture at the top of TPP has been unacceptable for far too long. We need to reflect as a community on what could have been done earlier to call out and make a stand against this longstanding behaviour.

National (lack of) response

On day 2 of Rewired Jon Hoeksma from digital health chaired a fireside chat with Dr Vin Diwakar, NHS England’s National Director of Transformation. Vin is well regarded and spoke articulately about the plans to keep addressing the digitisation needs of the NHS. Jon probed Vin about his and NHS England’s views on the comments from Hester and received a hugely disappointing answer straight out of a media-training handbook.

It simply isn’t good enough for an NHS England board member to blandly state that there is no place for racism in the NHS and not be drawn any further on specifics. Diwakar continued to avoid the topic by saying it’s not right to comment on individual suppliers or contracts. Well, yes, it is appropriate and we expect him to do so. There were opportunities to outline options that NHSE could consider: whether it’s reviewing how ethical procurement rules are implemented, applying the fit-and-proper person test, requiring the implementation of Freedom to Speak Up or another approach. We need to do much much more and Diwakar had the opportunity to demonstrate leadership.

As the event drew to a close the wonderful Ayesha Rahim from Surrey & Borders Partnership NHS Trust and member of the Shuri Network joined with Digital Health to publish an open letter standing up to discrimination in digital health. This is a tangible demonstration of action being taken swiftly that has already received widespread support. Starlight has signed this letter and we encourage you and your organisation to sign up and to consider how you can support the community to tackle these behaviours.

Finding new energy

The health of the NHS makes headlines most days. The complexity and acuity of patients has increased since the pandemic, cared for by a workforce which has reached the end of its tether and has little spare capacity it is willing to bring to work. The economic climate is worsening and despite the huge amount of money being spent on health most organisations are preparing for some really tough times ahead trying to balance the books.

In this context the potential for digital, data and analytics to make the best use of finite clinical capacity continues to be in sharp focus. The Spring Budget announcement of £3.4bn additional funding for digital (albeit, as pointed out by Matthew Taylor, against an unknown baseline) in FY25 & 26 gives hope that funding can flow down to support the right change. We need to caution that digital innovations cannot solve the challenges of the NHS on their own, but they can make a difference.

Jess Morley gave the talk of the event with her energetic and articulate keynote speech that focussed on the difference between what we could do vs what we should do.  The shift from a 1:1 evidence-based model of care to a many:many algorithm-based model of care is barely understood yet in other parts of the conference demonstrations of LLMs generating discharge letters in seconds rather than taking 30 minutes sparked interest and a lively debate.

It’s easy to imagine how pressurised health service executives could be seduced by the potential to transform productivity using these tools - and if we can pull it off safely the potential prizes are huge. However there are huge gaps in our capability to adopt these changes  - as Morley points out the governance frameworks, legal basis and skillsets required to adopt these new technologies are not yet fit for purpose. The pace of AI development vastly outstrips the pace of legislation and too few professionals are equipped with the knowledge to navigate these changes. Getting this right will be fundamental to achieving equitable access and achieving the provision of health we are seeking.

We also saw real-world examples of how automation and data can help those with the most complex needs maintain continuity of care with access to their GP. Both Dr Minal Bakhai and Dr Dan Alton demonstrated how models such as John Hopkins ACG are now embedded in clinical workflows at point of contact into primary care. This is being used to make sure the patient receives the most appropriate model of care regardless of the channel/method used to access the NHS. With this support in place practices are able to allocate more time from the right clinician to support those with the most complex needs.

The brilliant EHR State of Mind by ZDoggMD featured in Dr Shanker Vijayadeva’s showcase of deploying robotic process automation (RPA) across primary care in London. There was great interest in the room from GPs who are deeply frustrated with the burdensome and inefficient processes they have to follow to perform numerous tasks every day. RPA can help, but also requires care.

RPA is only really needed where we have failed to provide IT systems that meet the needs of patients and clinicians. It provides a temporary sticking plaster but does nothing to addressing the underlying issue of poorly specified, designed and implemented systems that are in use across the NHS. RPA also introduces something else to maintain when underlying systems change - which is often after the RPA experts have moved on.

Research Saves Lives

Hilary Fanning, Professor Jim Davies and others spoke of how the Secure Data Environments for Research programme is creating high quality datasets that make it safer and easier for researchers to develop new practices, improve pathways and develop machine learning and AI models. The NHS is unique in having a single patient identifier - the NHS number - across the health records of over 60 million patients, creating a large dataset of global significance and value. But not all patient data is directly linked to the NHS number - linking these datasets will require SDEs to overcome the commercial, technical and capability gaps endemic in hundreds of IT systems across the NHS.

The voice that wasn't in the room

Throughout Rewired speakers discussed the imperative to move to a more preventative model of care and for closer working with partners across integrated care systems such as local authorities and the voluntary sector. But the digital health world feels as far away from the social care and prevention world as the rest of the NHS sometimes does. Where were the social care or voluntary sector speakers voices provided with a platform to share their perspective? It's an area full of potential that deserves more of our time and attention.

The social determinants of health often sit outside the direct remit of the NHS. From fuel poverty to social interactions, diet, exercise and education there are many opportunities for health and care organisations to work together to identify and implement positive interventions that have the potential to improve the quality and length of lives.

There have been huge investments in digitising social care records - what outcomes was this intended to support and are we being successful? What other interventions are required?

The provision of statutory services such as Continuing Care and other support packages is shared between local authorities and integrated care boards. The cost of these services is a huge pressure on already strained budgets, costing billions of pounds every year. Our friends, families and neighbours who depend upon these services to meet their ongoing and often complex care needs deserve high quality care delivered in the best way. How can partners work more closely to support these patients and where are the digital interventions that are most effective?

Tens of thousands of care appointments are missed every year when a carer visits someone's home, unaware that they been admitted into the care of the NHS. The follow-up often involves many hours of safeguarding work to track down the patient and ensure their whereabouts are appropriate. This is a simple data problem to solve that we somehow haven’t cracked at-scale yet.

From discharge support to promoting improved health, the voice of care needs to be heard at #rewired25 if digital, data and analytics teams are to continue playing a pivotal role in meeting the health and care needs of our population.