Last time we spoke to Paul Jones, back in May 2020, the Chief Digital Information Officer at Leeds Teaching Hospitals NHS Trust told HTN about the challenges he and his teams were facing during the early months of the COVID-19 pandemic.
But so much has happened in the seven months since our previous chat, including Paul’s appointment to the additional role of Chief Information Officer for the West Yorkshire and Harrogate Health and Care Partnership Digital Programme, that we decided to catch up again just before the festive break.
Find out what fresh tech hurdles Paul has been navigating and how he sees 2021 panning out for digital health in the NHS.
What digital programmes have you been working on since we last spoke?
We’ve had continuing sets of changes to support the management of COVID-19 patients, so we’ve updated our electronic patient record to support this. We continued with our paper-lite project, removing paper from the hospital, and building on that. We’ve also completed lots of work to improve our infrastructure, creating a more robust environment to support the whole Trust.
We’ve kicked off a number of specific projects too, including the replacement of our service desk, which is currently provided by a third party. We’re bringing the service desk in-house, which involves a huge amount of work — we’re going to create the tools, put a new team together and provide a whole new service desk for the Trust.
We have 18,000 staff in the Trust and that’s the front door for many of them and — hand on heart — it’s been a pretty poor service for them for a few years. We’re aiming to make the service significantly better and provide a sense of staff being listened to, responded to and improve on the first-time fix. [Those] IT mistakes and issues that you get across a large organisation…we’re hoping to deal with them more quickly. I think that’s really important. We’re hoping to get that live by April.
We’ve done a lot of work around a new data platform for the Trust. COVID-19 reporting has made it clearer that there are issues with data management and reporting and how we get insight from our information.
Our insight and information teams have been incredible over the COVID-19 period — a new ‘sitrep’ comes in almost every day from the centre and they’ve had to turn themselves into a seven-days-a-week function. I don’t think the tools and technology particularly helped them, but they’re doing a great job despite what we’ve given them. We also need to start putting data into the hands of our staff and managers across the Trust, so they don’t need to look at data though us, they can look themselves and make decisions on real-time data they can trust.
We have a whole piece of work on what we call the ‘data platform’ — we’re going to have a data lake and something we call a ‘common workbench’. Depending on how you want to use data, you get access to different things. I think that will be quite transformative for us as a Trust, a real leap forward, so we’ve been doing the preliminary work on what that would look like and how much it’s going to cost.
Is there anything else in the pipeline?
We’ve delivered our Enterprise Imaging solution, which went live across the whole Trust in November 2020. It went incredibly well – given that we had to turn off the old one late on a Friday night and then by Saturday evening everything was running smoothly again – an absolutely cracking job.
And because we didn’t already have enough to do, Leeds is now a lead provider for vaccines, so we’ve taken responsibility for the West Yorkshire region’s IT systems that are reporting across the vaccination programme. We’ve been supporting various places within the integrated care system (ICS) to help them set up, report and deal with the various national systems, or lack of national systems depending on how you want to look at it. So it’s been pretty busy really — and that’s not everything!
What have been your biggest challenges over the past few months?
The challenges are resources, funding and priorities; what’s a priority today might not quite be a priority tomorrow for a busy hospital. We’ve recently had a situation where we put systems in place to support swabbing patients over five days for COVID-19, so we could start tracking nosocomial infections. Just as we were launching that we were asked to change the timescales. Because things are changing at an operational level quite quickly, sometimes it’s hard to know the priorities.
And it’s not just money. Clearly money is part of it — if we had more money we could do more things. There’s a book from the 1970s called ‘The Mythical Man-Month’, written by Fred Brooks, formerly of IBM [which covers the issues around adding more people to software projects]. This book describes the situation we have: we have certain people who need to do certain tasks, so giving me more money or more people doesn’t help because I need critical people to do certain things. So we’re looking to grow that capability — but that takes time.
Funding and resource has been a challenge but what we’ve done is put some processes in place to make that more transparent. Historically it was a bit opaque, ‘why has my piece of work been done and theirs hasn’t?’, ‘who made that decision?’, so now we have a daily meeting every morning with our [three] chief clinical information officers, the deputy chief clinical information officer and one of the assistant directors of operations. We discuss the priorities and the outcome is shared with the operations teams so that they know what decisions have been made.
[For example], with a fixed number of laptops to distribute out across the Trust to support remote working, how could I decide whether head and neck was more important than oncology or respiratory? How do I make that decision as the IT guy? We put in place a transparent process and now when people don’t get their laptops they’re disappointed but at least they know why. And that actually makes people…I wouldn’t say happier…but they understand.
Another new challenge we’ve had this year has simply been the relentless nature of the situation since March. Our teams have been under pressure. I say to them ‘this is going to be a marathon, not a sprint — I know you can’t get away but you need to take some holidays, take a break, turn your phone off, turn your laptop off. Whatever it is for you that supports your resilience, you need to make sure you’re doing those things.’
I need everyone on their ‘A-game’ when they’re here in work and if people are doing 60-70 hours a week, week after week, they’re not going to be. We’ve tried to put as much effort as we can into staff wellbeing and engagement, particularly when staff are remote for the first time in their careers.
Making sure managers are reaching out, making sure people are doing the more social things, and making sure people have contact on a regular basis. We’re in a fortunate position in the hospital, unlike other organisations, where you can come into the office. We are open, we just need to manage that social distancing and the various protocols.
I’ve done more on wellbeing and engagement than in any other part of my career: explaining the importance in the current climate and also trying to set an example by take some leave myself.
One of my hobbies is cycling and during the first lockdown I stopped because I was frightened of getting injured and having to phone up my boss and say ‘I know we’re in the middle of a major national crisis but I’ve fallen off my bike’.
In hindsight this was a mistake because my resilience was harmed — I didn’t get out into the countryside, didn’t get that fresh air. Since I realised I’d made that mistake, I’ve made sure I do get out when I can. Whatever is the thing that helps you reset, have that personal resilience and manage your own personal health — whether it’s cycling, reading a book, eating a biscuit — do the things that matter to you.
I think that’s been the challenge I’ve never had to face in quite the same way before as a manager and a leader. I’m conscious I’ve got 450 staff that have just been under the cosh and nobody wants to let the side down. That sense of duty brings you to work when actually your sense of duty should say ‘turn the phone off, take that week’s holiday, come back refreshed and we’ll be able to keep you from getting ill and run-down’.
Tell us about your new additional role as Chief Information Officer for the West Yorkshire and Harrogate Health and Care Partnership Digital Programme.
Leeds is such a pivotal part of the West Yorkshire ICS that I thought I should throw my hat in the ring, and I was fortunate enough that they asked me to take the role on.
If we just look at the digital side of the ICS there’s the obvious stuff around shared care records and digital inclusion. And then also the area I’m less familiar with, but hoping to get more familiar with – the support provided to primary care. This group tend to be smaller organisations, so the ICS helps them do some things they wouldn’t otherwise be able to do.
For instance, the procurement of the video conferencing service that GPs use and also the e-triage service — the front door to many practices. These things are hard for a small primary care group to do but we can do that and support them as the ICS.
I’m actually just looking at the digital strategy we’ve got for the West Yorkshire and Harrogate partnership and looking at simplifying and reviewing this to make sure we’re ambitious in what we can do as a region – but also pragmatic. We’re dealing with people who are busy, there’s a national emergency, there’s vaccines and there’s flu coming, so let’s not pretend everyone is going to spend half their time delivering services for the good of the region.
One of the things I think has been lacking a little bit — not to be critical, just my perspective — is a really clear line of sight between digital initiatives and improvement in patient care. Can I see a really direct line of sight between digital to patient? Sometimes I can’t. So I’d like to fix that. And that might just be about understanding a bit more about how those things operate, it might be a slight tweak, or just about getting the right commitments or plans in place. But I think we need that transparency — we need visibility about how we improve patient care.
I think that’s motivational for people. You don’t work in health because you like doing lots of tech stuff, you’re working in health because you want to improve people’s lives. I think being able to create that really clear line of sight is what I’m hoping to bring to the regional role.
Looking ahead across 2021, how has the pandemic changed your plans?
The biggest change is probably the paper-lite space. We always had plans for removing paper but never quite worked out how we’d get the stakeholder engagement to do it. It’s a big cultural change. Although we knew how we could technically do it, trying to get all of the consultants and senior staff on board was going to be a mammoth task. But I think the team basically did it one Friday afternoon…because of COVID-19.
Obviously, the other change was with remote working — nobody worked remotely at Leeds Teaching Hospitals before. I was chatting to one of my colleagues and he says he still feels guilty when he’s at home, he still feels like he’s doing something wrong. He’s worked at the Trust for 26 years and every day for 26 years he’s been sat at his desk at 6am in the morning. He’s slowly getting used to it, I think.
We went from 80 people connecting remotely to the Trust, to 1,300 people a day connecting. The team bumped it up to 1,000 [capacity] instantly — how they did that I’ve no idea and I didn’t ask where they got the equipment from. Since then, we’ve used some of the funding that came in to increase capacity again, so as many people who want to work remotely can now do so.
We started hitting some challenges on our internet bandwidth so we’re increasing that now as well, putting in place the infrastructure to cope with such a significant amount of remote working and the use of Microsoft Teams, Office 365 and the NHS mail. We’re pushing a lot more data through than we ever did, and our networking teams have been fantastic.
Mass remote working was a huge change from an IT perspective, as we just weren’t set up to run the Trust like that. In 2019, I joined from a global business where video conferencing was the way board meetings were run and yet I found myself expected to get from St James’s [University Hospital] at one side of town to the LGI (Leeds General Infirmary) at the other side. There was no notion of video conferencing from one site to another. [So] those changes have been amazing. I get reminded by colleagues that they’ve fundamentally changed the way clinical meetings are held [too].
It’s interesting which bits we will hang onto and which bits will go back to the old ways, and I don’t think a lot of it will go back. I [do] hope a little bit goes back — I miss my colleagues and I’d like to have that meeting on a Monday lunchtime, where someone brings fruit or a birthday cake in and we can have a bit of a chat. It is different and helps you build those relationships. But I don’t think it’ll be a complete return.
To find out more about the digital technology programmes at West Yorkshire and Harrogate Health and Care Partnership, visit wyhpartnership.co.uk/our-priorities/digital.
About Leeds Teaching Hospitals NHS Trust
Leeds Teaching Hospitals NHS Trust is one of the largest teaching hospitals in Europe, a regional and national centre for specialist treatment, a world renowned biomedical research facility, a leading clinical trials research unit and also the local hospital for the Leeds community.
The Leeds Teaching Hospitals NHS Trust incorporates the Leeds General Infirmary, St James’s Hospital, Leeds Children’s Hospital, Wharfedale Hospital, Leeds Dental Institute and Seacroft Hospital.