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Interview: Ross Fullerton, Chief Digital and Information Officer at BOB ICS

For our Digital ICS event, we spoke to Ross Fullerton, Chief Digital and Information Officer at Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS).

Ross kindly joined us to discuss his experiences in digital work with relation to his ICS, some of the challenges he has faced, and his learnings as a digital leader.

Can you tell us a bit about your current role and background?

As Chief Digital and Information Officer, I essentially have two halves to my role. Half of it focuses on the things that the integrated care board (ICB) does, which means I’m directly responsible for all the digital and IT for primary care, including all the GPs and related primary care networks. That also includes the corporate technology used within the organisations and all the associated data and analytics that are increasingly important in managing a health and care system.

The other half, and arguably the most complex part, is then coordinating digital delivery across health and care – across all the NHS trusts, local authority, voluntary sector and third parties, as well as the ICB. I try to bring all those different groups together to maximise the potential to deliver better patient care and improve the health of our populations through use of digital.

As for my background, I spent the last year looking after the digital capability for health and care within Buckinghamshire, before the ICS formed. Prior to that, I had four years at London Ambulance Service. I was CIO for two years, leading on the digital capability for the 999 service and working across the emergency service; it was very fragile and often paper-based when I joined so I spent my time there making sure it was much more digitised and resilient by the time I left. The second two years were spent looking at the transformation of London’s emergency healthcare systems, exploring how we worked with the Mayor of London, with the 32 boroughs and all of the UEC system. I was there during the COVID-19 pandemic, so I learnt a lot in exceptionally challenging circumstances.

That’s my only other health and care experience – I’ve worked across lots of other industries including energy, retail, defence, security and management consulting. I think there are a lot of transferable skills you can bring into health.

What digital projects are you currently working on in your ICS?

We’re working on a range of things. We’re quite new and formative as an ICS; we’re focusing on integration and interoperability, thinking about how we can get access to each other’s data to improve care, planning and research. That’s the main thing that we are working on at the moment.

Alongside that, we’re working to ensure that we’ve got a clear foundation of digital capabilities. We’ve got some really strong digital centres of expertise in some of our trusts, but we’ve also got some trusts that rely predominantly on paper to operate day-to-day. So we need to get everyone working at the same level. So that includes common projects like electronic patient records, but it’s also about digitising the diagnostics pathways and working with areas like the cancer networks, to digitise those in a joined-up way.

We’re focused on virtual wards and virtual care, to try and increase the level of support we can provide our patients with to be treated safely at home, to care for them in a way that’s better for them and also protect our capacity.

There’s a lot of work on analytics and how we can understand all the vast sources of data that we have, to better understand population health, to target interventions and to embed the use of that everywhere. We’ve got some pockets that are really strong and that are leading the way, but again we’ve got areas that don’t use it at all. So it’s about looking for ways to share the good practice.

In terms of social care and how we digitise that, the social care agenda is something that we are increasingly getting involved in with the ICS forming and resulting in much tighter links with social care. We’ve been successful in receiving some of the funding for digitising adult social care so we’ll be using that to work with our care homes, for example, to increase what they do digitally and start to share that data in a more joined-up way.

What are the some of the key challenges that you’ve faced? Can you discuss how you’ve tackled them?

The first challenge is the concept of what it means to work as a system. I think there can be a little bit of a misconception that ICS CIOs are the more senior CIOs across the system who are going to instruct everyone else. That’s far from how I see my role. My role is primarily about bringing together some genuine experts from those different organisations, and starting to get them to think about how we can integrate the way we work to deliver better outcomes. It’s about looking increasingly beyond the organisational boundaries and looking at things differently across that system context.

In reality, for much of our population, they don’t just receive their care needs from one organisation. They may have a social care aspect to their life, a mental health aspect, varying degrees of physical health aspects; they’re engaged with the doctor, possibly the pharmacy, they might go to the optician. We’ve historically treated all of those things as siloes, so getting people to think about that differently and open up to the possibilities can be a challenge. People are often up for tackling it, but don’t always know where to start or what they’ve got permission to do.

I think the second challenge is what you prioritise across all of that work. I could probably write a thousand things to do, but which are the two or three that we can deliver that would genuinely make a big impact on our population? Each part of the system has its own needs and its own challenges, but as a system we need to focus on what we can really work on together that will make a difference.

That leads onto the third challenge, which is the formation of the ICS and preventing that from becoming just another layer that people have to engage with and interact with. How do we make it something that makes everyone’s lives easier? How can it stop us doing things multiple times that we can perhaps do once? Working through that can be a challenge.

Finally, I would say that navigating the national priorities can be a challenge. The priorities change a lot, the funding landscape changes, and you need to really focus on how you can deliver those priorities locally, meeting the needs of your population in the system you’re working in.

What is your main learning as a digital leader?

It’s all about the people.

That could be about building your teams, either with direct employees or virtual teams; if you invest in them and you engage them in what we are trying to achieve and why, then that is the most critical thing to success. If you can unlock the capacity of all those people to deliver what we need to do, it’s much more powerful than any one of us can do on our own.

It’s also critical that we understand the change we are looking to enact across the system – if we’re trying to improve how a budget is spent and delivered, we need to look to the patients and their lived experiences. We need to ask ourselves how we can understand that and how we can support our healthcare professionals in delivering that. How do we create an environment where that change can happen? It all comes back to the people.

The other learning is that nobody can keep up with the pace of change in digital healthcare. There are new innovations and ways of working, seemingly every day. The expectation on us as a set of professionals is that we know everything and we are on top of it all. I think step one is recognising that that is impossible, and then asking yourself how you can handle that. For me, it’s about having the right people around me so that we can share knowledge, but it’s also about looking at the outside world. I look outside of my organisation, outside of health and care in the UK – there’s an awful lot of innovation happening beyond our health and care bubble that we can learn from.

What would digital success look like in your ICS in three years’ time?

There would be seamless access to data that can be used for a variety of purposes, and our population would be happy with us using that data. That’s the key thing. That access would be for professionals delivering health and care, but also for researchers who can develop new medicines, new ways of caring for people, and support health and care to evolve even more quickly than it has done in the past.

Additionally, I wouldn’t say we’ll be entirely paperless in three years, but I’d like to see an awful lot less of it!

The final thing would be that citizens would have much richer access and control over how they engage with health and care on a day-to-day basis. Many of us have seen the NHS App take off through COVID, but what you can do through the app right now is quite limited. The population should be able to use it to manage their health and care needs over the next two to three years, we should absolutely have achieved that in that time frame.

If you could give advice to somebody looking to get into a digital healthcare role, what would it be?

There are loads of opportunities out there. I don’t think anybody in a digital healthcare environment has a fully staffed team. So if you are already working in health and you’d like to get into digital, go and talk to your digital colleagues and ask if there’s a project you can get involved in or some work you can shadow to get some practical hands-on experience. Whether you’re clinical, administrative, or another function, I’m sure that your digital colleagues would love to have your insight from your current area.

Health and care tends to put up barriers by using language that nobody else uses, so I would say don’t get put off by those barriers if you’re not working in the health and care environment already. It has its own language and you’ll learn it, so don’t feel deflated if it seems a bit inaccessible – get in, have a go, and learn as you’re going.

My final thought is for anyone developing their career in this space – remember to continue to look outside of the health world. There’s a huge amount that can be learned and it can be directly translatable. We need to look beyond our bubble, and that will help people develop careers that will make them a really amazing set of digital healthcare professionals.