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.