Interview Series: James Freed, CIO, Health Education England  

In our latest interview we asked James Freed, Chief Information Officer, Health Education England a few questions. 

Could you tell me about yourself, your role and organisation?

I’m the chief information officer for Health Education England which is an arm’s length body of the Department for Health and Social Care. Our job in the NHS is to make sure the right skills are in the right place at the right time and in the right numbers.

In order to undertake that, some of those responsibilities are direct. For instance, we directly manage and support the rotation of every single junior doctor in the NHS. We conduct an influential role around workforce planning, counting how many people we have in health and social care and how many we are likely to need in the future based on various different modelling approaches. We also deal with workforce transformation, where we support largely at the ICS level conversations about how the workforce is likely to change over time, and how we are going to be able to help ICS think about its short and longer term gaps, whether that be through direct supply, whether that be through creating new roles, new service models, upskilling or leadership, and we have a 5 point model called ‘the Star’.

My other role is running a programme called ‘building a digital ready workforce’ through which we hope to educate all those working in health and social care to become digitally ready – that is what BDRW is all about.

Could you tell me about your presentation today and its key themes?

I was on a panel this morning which was talking about digital literacy and what the mandate for digital literacy is for the NHS.

Digital literacy for me is just one element of digital readiness. Health and social care is an industry which has seen growing demand, and it is growing faster than what we can afford to pay for it. If we continue down the same track that we are currently on we will have a growing productivity gap – the only viable option will be to find new innovative approaches that use less effort. So how do we increase our productivity? ‘Digital’ is one way of speeding productivity up.

We know that digital opportunity is growing, Moore’s Law still applies, the processing power of computer chips is still doublingevery 2 years and we see the same exponential growth in the knowledge and data world. In short, our limitation is not what tech can do, it is how we are able to use it.

If we imagine a graph with two lines; the first being an exponential increase in tech over time, the second is a line much flatter with a slight curve at the end – we can call this second curve ‘human adaptability’ – the premise of BDRW is how you push that lineupwards, how we can make ourselves more adaptable and thus create more from the opportunities that tech and data afford us.

Being digitally ready is a combination of being digitally able and digitally willing, and each of those can be divided down further.Being digitally willing is partly feeling like you can make a change, but to be fully digitally willing, your organisation has to ‘let you’ – when an organisation stifles opportunity, you do not achieve a high yield of productivity and so we need to find a different cultural paradigm for health and social care – for instance, how do we experiment safely? Being digitally able on the other hand is partly the skills and knowledge an individual has as well as an organisational responsibility to give people the right tools to innovate; if you do not give people the right tool set in their work, they cannot undertake change themselves.

What has been your biggest achievement over the past 12 months?

In the last 2 years, there has been a step change in the recognition of the role of people, skills and workforce in the success of digitallyenabled change. The Secretary of State, towards the end of last year, expressly referenced that the programme for creating a digitally ready workforce was one of his 10 key exemplars, and I was then and still am, very proud of the programme. Another big achievement for me and my team was going live with our in-house Trainee Information System in Health Education England last year. We made a decision to go in-house rather than use external suppliers, which for me was a big step.

What are you working on at the moment and what is coming in the next 12 months?

Lots of things! In the digital literacy world, our theory of change is based on the progress we observe in patients when they become‘activated’. If you measure a patient’s confidence, their knowledge and skill base around managing their own long term condition, you can translate that into a single measure known as patient activation. A 1-point difference on a 100-point patient activation scale results in a 2% reduction in attendance at A & E for that condition – it is a significant impact, and our theory of change is that if we canmeasure digital readiness through a similar set of questions around confidence, knowledge and skill, we can nudge people up the scale in order to get people more digitally ready and both willing and able to innovate.

We are trialling a self-assessment tool right now and also trialling a nudge process, something called digital championships which is supporting organisations to upskill their staff.

Also, in the next 12 months we are expecting to launch a prototype sign-posting tool as well to help more digitally ready staff solve the problems they have or gain confidence to try out a new innovation.

From a leadership perspective, I would expect to see a trial or a move towards board development sessions in digital leadership; but as a word of caution, I would expect the progression to a mature board-level development offer to take time, it is not something that will happen overnight. We have already developed a prototype, a workshop if you will, so I would expect to see that being used. We have also determined eight dimensions of digital leadership, which have been documented and published.

Is there anything further that you wish to tell our readership?

There is another dimension to digital readiness I’ve not spoken about that is around developing us as informaticians to be better. We, unlike clinicians; doctors, nurses, and certain other professions that go beyond healthcare; law, communications or finance, we do not have a profession.

We do not have a bar, and so in the next 12 months I would hope to see a bar – a clear and practical measure of ‘good enough’ – and I would hope it to be applicable at a number of different levels. I’d like to see that bar applied to chief information officers and IT directorsin the first instance. I’d like to see that bar be expected ofinformaticians by employers as well, and I’d like to see an accreditation process  and training model around that bar develop.

NHSx has invested heavily in the creation of a gold standard training course for CIOs and CCIOs – The NHS Digital Academy. Itis a great offer and there are other options which are starting to become available such as the recently announced BCS / CHIME collaboration. What we need to move to is an environment where it is expected that CIOs are held to account to reach the level that they need to reach.

What advice would you give to somebody working in healthcare?

People are more important than technology! Stay curious, keep learning and accept as much help as you can!