Interview, NP

Interview: Paul Rice, CDIO, Bradford Teaching Hospitals NHS FT and Airedale NHS FT

Our latest interview features Paul Rice, chief digital information officer for Bradford Teaching Hospitals NHS Foundation Trust and Airedale NHS Foundation Trust. Paul talked to us about his experiences working in the digital landscape, the benefits and challenges of a developing and retaining a digital workforce and the importance of championing a digitally positive NHS.

Hi Paul, can you tell us about your role and how you got to where you are?

I’ve been in the role for two years, having previously held the role of regional director of digital transformation for NHS England in the North East of Yorkshire. Prior to that, I was the head of technology strategy nationally where I was responsible for supporting the creation of the Global Digital Exemplar programme and Digital Maturity Assessment.

The journey to digital has been by accident rather than by design; it became clear about 10 years ago that digital was becoming more prevalent and people were increasingly using aspects of digital technology as part of service improvement and transformation programmes. I had worked with organisations across Yorkshire who were using technology in innovative ways in health and care, and I’d seen how technology was making a difference to our lives more broadly and thinking ‘where can we make this work for the provision of health?’

I participated in the first cohort of the Digital Academy and went on to do a Masters in Digital Health Leadership at Imperial. Going forward, I am very interested in the digital talent pipeline and would like to see the next generation grow and develop within career structures with more cohesion than I experienced.

How do you think your background has influenced the work you do today?

I think the main influence has been the way in which I view the opportunity of technology through the lens of service and quality improvement, transformation and so on.

Arguably, for a while we’ve had the challenge of thinking about tech first and ‘what can we do with it?’ second. From my background, I approach that with the philosophy of asking how services currently operate, how they can be improved, is there a way in which digital technology can play a part in that?

The opportunity of having worked in service delivery in the NHS at a national, regional and now local level, is that you’ve got the benefit of understanding the perspective of the rest of your colleagues – their interests, their requirements and the pressures and challenges they may be facing. I have the benefit of having been in their shoes at some point in my career, which means I can empathise a great deal with them and the systemic challenges they face on a day-to-day basis.

The role of chief digital information officer

The scope of responsibility is quite broad and varied; I’m a full member of the board for both trusts, which entails a host of corporate responsibilities. I would emphasise the fact that there is a requirement to understand the perspective of the medical director, director of finance, and other senior colleagues roles in order to bring to the board a level of insight and strategic priorities.

It’s wide-ranging; I’m involved in clinical informatics, data intelligence and insight, programme management resources and some large projects such as ensuring we are exploring our Electronic Patient Record as far as possible, how e can best use it, or how we can use other critical tools alongside it.

In terms of what’s exciting about my role, I think fundamentally, it’s about the fact that digital really accelerated its prominence in peoples’ thinking through the course of the pandemic, and here is the opportunity for us to positively build and capitalise on that. It’s about taking the best opportunity to improve services through what digital offers – time saving, patient safety and quality, or a completely different relationship to how people relate to their own health and care and sharing that more widely.

It’s 2023; how are we going to use these technologies in a way that is consistent with work and engaging other aspects of ours lives? Can we understand our current practice better by taking lots of data points and experiences and looking into how these can inform and influence how we deliver care differently going forward? There is a lot of scope for us to use data in the NHS much more potently and comprehensively, including broader determinants of health and lived experience, than we have done previously.

Reflections on past and current roles

The clearest thing about a national portfolio is that you’re trying to make a change or influence people’s behaviour across the whole country all at once, or at least over a period of time. When you’re working in a local organisation, your relationship with your immediate team is much more visceral. These people look to you for leadership in the sense of how they do their jobs to the best of their ability, and how they can thrive in their roles.

Experiences are much more tangible in a local organisation, whereas in a national role you know there are influences that will take , in some cases, years to come to fruition. In one regard it’s about scale – in national roles you’re trying to focus on two or three things that will make the biggest difference. In a local organisation you’re juggling two or three hundred things and trying to make sure these are all dealt with effectively.

I think one of the biggest differences is the level of expectation placed on you from a national perspective; locally, there tends to be more of an understanding that things take time, and that it’s about the combined efforts of teams and people over a period of time that yield those results.

Partnership working in digital health

One of my mottos is ‘let’s make some new mistakes’ – I don’t think there’s any excuse for not connecting with other people who have journeyed this way before and trying to understand what their experiences were, what they achieved and what could have been done better. You will never get that if you remain insular in an organisation, if you don’t look up and out.

The nature of the issues we’re trying to address are very complex and they are not all within the scope of my team or organisation to resolve. As such, it is very important that the basic building blocks of those partnerships are within the hospital itself. We need to have that relationship with clinical and operational colleagues to align our interests and purposes in order to get a job done. When it comes to relationships, you want to look at whole person care, wider relationships with communities, local authorities, our colleagues who provide organised primary care, mental health services and so on. We have some knowledge, expertise and insight but we don’t have a monopoly on them.

If we’re thinking about talent, and I want to foster next generation talent – I need to do that in partnership with the further education colleges, universities and schools. I need broad range of experts who possess the knowledge to help me, and who I can support in turn. I live and work with an incredibly diverse range of colleagues and experiences. Getting their insights into the design and delivery of digitally enabled services means they are so much more likely to be fit for purpose and used as intended.

Instinctively, I don’t think I would ever not work in a partnership way. It’s becoming more and more critical, as there are very few things you can solve by yourself. In the past, I would say that structures and responsibilities have sometimes been set up so that a partnership way of working have not always been encouraged; I think what distinguishes the health tech community is that we’re instinctively open and sharing. We’re happy to bring some of our greatest work and biggest mistakes into the light for other colleagues to learn from and engage with.

Challenges around the digital workforce

I am delighted to be supporting the work NHS England are doing around the National Digital Workforce plan; it’s important for us to advertise the broad range of professions and roles the NHS has to offer. I think it’s important that the digital profession, in all its diversity and richness, is something that we promote, whether that’s in schools, universities, colleges and other routes into these rich and varied career paths.

I think there’s a big challenge in terms of career structures. They need to be more purposeful and guided rather than accidental. At the moment we are challenged because there are small numbers of people with particular high-value skills, and it can be hard not to rely on the contractor market to procure that talent.

I would prefer over time for that not to be the case. I use another motto which is ‘build, share, buy’ – can we build that talent within the organisation and sustain that talent? Can we share that talent? Can we buy that talent for a limited period? It’s about ensuring that this relationship is structured in a way that means some skills are transferred between the private market talent and our own workforce, so that when those people rotate out of my workforce, we are not left with a huge hole. We need to retain that learning.

Building workforce digital skills

The skills needed are varied and many. If I’m constructing a team to get a piece of work done, it’s as important to have someone with an understanding of the marketplace, who has got honed procurement skills, as it is to have someone who is very comfortable with quality improvement or programme management. I appreciate the fact we have reorganised nationally to put digital into the Transformation Directorate; it is important to say that there are still data and IT professionals and they need to be appreciated, nurtured and developed as much as the change management, communication teams and so on.

Another area to consider is how the clinical workforce engages and relates to any of those skills. In terms of apprenticeships and formal programmes of work, I would like to see nursing and medical curricula feature more awareness and appreciation of the role of digital and data in the careers that people are going to have.

Looking at general leadership programmes for executive positions in the NHS, it should be as important that you have an understanding of basic opportunities and principles of digital and data, as you do with respect to your colleagues working in finance or HR. No-one in 2023 should be saying, “I don’t do digital or data”, if you aspire to lead at every level in an organisation and/or do the ‘top job’.

Hopes for the future

I’d hope that we stop using the phrase ‘digital health’, and that digital  just became synonymous with the provision of health and care, so that people expect it as a part of how we use the best modern resources from any discipline. For example, the best architecture and buildings should be just as important as the best uses and implementations of technology. I would like for us to make that term redundant in the future. I know it’s not going to happen overnight, but I would hope that in the future people will be talking about health and care rather than within the context of ‘the role of digital in health and care.’ It would just be second nature and expected.

Many thanks again to Paul Rice for sharing his insight with us, feel free to check out our other interviews on our website.