Seven hundred and 30 days later: #Rewired22

Digital Health Rewired was one of the last health and tech shows to go ahead before the UK locked down in the face of the Covid-19 pandemic. Two years later, #Rewired22 was back at the Business Design Centre, London, with a new commitment to a digital future. Jon Salmon reports.

Digital Health Rewired was the last health and tech show to go-ahead before Covid-19 hit (Highland Marketing analysis). Few people who were at the show that day thought it would be two, full years before they were back at this kind of event in person.

However, with the worst of the pandemic behind them, the keynote speakers and IT experts who attended #Rewired22, had a clear theme. Health tech needs to get out of “crisis mode”, sort out its priorities for the future, and get stuck into delivering on them.

On the second day of the event, Tim Ferris, the director of transformation at NHS England, was pretty clear about where his priorities lay (digitalhealth.net). He said he’d been “surprised” by the “patchy” level of digital maturity across the NHS and upset to discover that “19% of acute trusts don’t have an EPR.”

“That’s not ok in this day and age,” he said. “In 2022, it’s not ok to be personally witnessing mistakes being made on paper.” Ferris went on to indicate that he doesn’t just want EPRs to be rolled out at every trust. Wherever possible, he wants trusts to be using the same EPR, and the same instance of that EPR.

Hence the new emphasis on ‘convergence’ that was widely reported ahead of the event (Health Service Journal). Ferris also indicated that he wants to sort out the confusion brought about by having NHS England, NHSX and NHS Digital responsible for different aspects of IT policy, and to bring some order to their projects.

“It’s difficult to understand what the priorities of the centre of the NHS are, because they have so many initiatives,” he said. “Making sense of that cacophony of initiatives is a really important part of how we will make progress.”

Entropy, chaos, and progress

Simon Bolton, the interim chief executive NHS Digital, also had chaos on his mind; although he drew on the concept of entropy to make his points (digitalhealth.net). Jokily, he opened his keynote with an ice-breaker – asking his audience to stand up and remain standing if they could tell him the difference between NHSX and NHS Digital.

Most people sat down, but Bolton acknowledged that NHS IT leadership had become more, rather than less complex as NHSX and NHSD merged into the transformation directorate, the NHS’ general management changed around them, and integrated care systems came on stream.   

It took effort and energy, he said, to ensure that this state of entropy (which he characterised as a gradual decline into disorganisation) didn’t further slide into chaos.

Assuming he can get the digital side of the new directorate lined up and running hot instead, Bolton indicated that his prorities include better commercial deals, leadership and workforce. He emphasised that the NHS should be working with its suppliers to “leverage critical mass”; which is another aspect of the convergence policy.

However, he acknowledged that the quid pro quo would have to be greater central clarity on policy and standards and what suppliers will be expected to deliver.

Bolton also underlined the need for leadership, which for him included creating a great environment for the workforce; one in which people felt empowered and were able to make some mistakes; but one in which there were clear goals and ambitions, and work had high integrity.

He concluded: “We’ve got a massive journey in front of us. We are going to make mistakes, but we must empower people to do amazing things. We need to be ambitious and goal-orientated and really reach for the sky. Together we can all make a massive difference to citizens in this country and that for me is a hugely exciting place to be.”

Central direction, board engagement

Helen Thomas, the chief executive of Digital Health and Care Wales, which last year replaced the NHS Wales Informatics Service, was also interested in the relationship between a new central body and localities. Although her thinking was more sober and practical than Bolton’s.

She said the focus of Digital Health and Care Wales would be building the architecture for standards in areas such as cyber, data and interoperability. “We need to stay in the strategic space,” she said. “Local organisations need us to create the foundations of a framework from which they can innovate.”

However, she also acknowledged that there were wider challenges to doing this, such as finding sustainable funding models; keeping pace with demand; driving adoption; and recruiting and retaining talent.

The role of NHS trusts and health boards will be crucial in addressing these challenges. Another session, this time chaired by Saffron Cordery, the deputy chief executive of NHS Providers, explored C-suite experiences, as revealed by a project it has been running with Public Digital.

Alex Whitfield, chief executive at Hampshire Hospitals NHS Foundation Trust, said it has appointed a non-executive director with specific digital knowledge, and set up a digitisation committee to prioritise and oversee ideas.

At the same time, she said the IT and digital team has been put under the management of the chief medical officer and integrated with the quality improvement and transformation programme teams. This new approach has been “really transformational,” she said.

Liz Davenport, chief executive at Torbay and South Devon NHS Foundation Trust, agreed that boards have a key role in setting the right environment for digital change.

She said her trust has made significant strides in the past two years with a strategy geared to staff training; EPR development; improving the digital skills of patients; and ensuring the right technology is available in the right setting.

Building on the CCIO role

Digital Health Intelligence, the company behind Rewired, also runs networks for chief information officers, chief clinical information officers, and chief nursing information officers. Unsurprisingly, this made the future role of CCIOs and CNIOs a topic for debate on the show stages.

Dr Ayesha Rahim, deputy CMO and CCIO at Lancashire and South Cumbria NHS Foundation Trust, chaired a panel session at which panellists argued for a higher profile for these roles, including acknowledgement at board level.

Dr Gareth Thomas, deputy CCIO at the NHS England transformation directorate, felt there was also work to be done to highlight to undergraduates that clinical informatics is a viable career. He said: “We need to start to embed this from age 18 onwards so that they see it as an important valued career. It will take a generation or so, but we need to create a fix.”

Dr Simon Eccles, national CCIO, agreed with these points, but warned against the idea of creating a guild or embryonic royal college as a vehicle for greater recognition. Clinical informatics specialists needed to stay close to their organisations and colleagues, he argued.

Good news on data and AI: but don’t forget the public

Despite this focus on how NHS IT can emerge from the chaos of the pandemic and find a stable, confident basis on which to move forward, there was plenty of upbeat news to come out of #Rewired22.

Ferris may be alarmed by the “patchy” spread of EPRs, but a slew of trusts that took part in the global digital exemplar programme have just announced that they have achieved HIMSS Level 7; so there’s a model to build on.

Clive Kay, the chief executive of King’s College Hospital London NHS Foundation Trust, told the show that he couldn’t run his trust safely without an EPR, and that he was right behind the idea of neighbouring trusts using the same IT (digitalhealth.net).

King’s has just got the money for a joint Epic project with Guy’s and St Thomas’ NHS Foundation Trust, that has been dubbed ‘Apollo’; because it’s a “moonshot” project to “achieve something that is generally believed to be impossible”.

However, over on the smart health stage, Tom Scott and Paul Deffley from Alcidion argued that most trusts are going to benefit from a more modular approach. Alcidion offers a modern, modular EPR, built around a FHIR standards platform.

There was also a good deal of interest in openEHR at Rewired, and in getting beyond the roll-out of EPRs and getting into using their data in more creative ways. Chris Kelly, staff clinicians research scientist at Google, told the second day of the show that AI could improve accuracy and efficiency, enable new models of care, and personalise services.

Although David Newey, the deputy CIO of The Royal Marsden NHS Foundation Trust, noted that there is a need to build out bias and disadvantage. And national data guardian for health and social care Nicola Byrne reminded her audience that organisations using data “must ensure that they are able to demonstrate what they are doing with the information”, and that “it is actually trustworthy” (digitalhealth.net).

Reflecting on the two-years of the Covid pandemic, she said there was no doubt that it had demonstrated the importance of technology and of data to the NHS and public health; and got that across to the public. However, she warned: “It also showed that trust is context specific.

“The public got the importance of data for the use of research, for how it could be used to make the vaccine programme possible, but that doesn’t mean that from now on the public will simply trust everything the government or health and care want to do with data.”