Interview, NP

“I’m excited for the level of patient empowerment that I expect to see in the next three to five years” Adam Lavington, director of digital transformation at Herts and West Essex ICB

For our latest interview, we chatted to Hertfordshire and West Essex ICS’s director of digital transformation Adam Lavington. Adam shared the key digital lessons he has learned throughout his career, the ICB’s digital priorities, his hopes for the future, and more.

Hi Adam, can you introduce yourself and tell us about your career to date?

I’ve been in IT for 20 years – I started from the service desk many moons ago. I’ve been a desktop engineer, a network engineer, and a project manager. I’ve got a degree in computer science, and I went on to do a masters in project management. I have held management roles for IT operations teams including infrastructure and systems, and now I’m the director of digital transformation for Hertfordshire and West Essex ICS.

I’ve worked in other industries, not just healthcare; I started in the private sector, working in John Lewis for a few years before moving into the railways, then I worked for local authorities in the North East for about seven years. After that I joined healthcare. My healthcare background was mostly in mental health at first and then I moved into primary care IT within CCGs. However, discounting the COVID pandemic digital response, the last five years have centred on digital strategy, currently from an ICS perspective.

In terms of my current role, the primary objective has been to produce a joined-up, shared digital strategy for the ICS as well as costed investment plan. The next step is to deliver on that strategy and get the maximum benefit for patients that we can out of the funding that we receive.

Key lessons on digital

A main lesson is the importance of identifying the benefits that you can measure straight away. Before you start your project, make sure you understand the outcomes that you are trying to achieve. If someone can’t explain a proposal to you in simple terms, without aids such as slides, they don’t understand it well enough yet and you shouldn’t proceed with it.

You need to make sure you understand what your benefits are from the outset and understand how you’re going to measure them too. Within health and social care, the main motivation isn’t to make a financial saving; although that is obviously still a driver, it is around improved patient outcomes. As we aim for improved outcomes in health and social care, these qualitative benefits are sometimes difficult to measure. How do you know if something has achieved the benefit for the patient or resident that you were expecting? It’s not quite as clear as a straightforward as a financial saving. Take shared care records as an example. The benefit could be the fact that a clinician has looked at a shared care record and they haven’t ordered a blood test, because due to the shared care record they have seen a test was recently ordered at a different touchpoint. While there is a financial benefit there, there’s also a benefit in terms of speed and turnaround for that patient, and also time saved with regards to potential duplication of work.

Another key lesson is around stakeholders. You’ve got to have good patient and stakeholder engagement. People tend to listen to their own peer groups more than they do to techy people – it’s easier to sell something clinician-to-clinician than it is techy-to-clinician. So support from health and social care professionals with any digital project is essential.

IT isn’t cheap and you have to accept that if you want something done well you have to pay for it. You must retain the right skills. You’re better off paying more and getting a better outcome, as opposed to trying to cut corners by not having the right people and resources in.

In terms of the operational pre go live side of things, it’s very much a case of test, test and test again before you go live.

Also, you can never invest enough in cybersecurity, in any case you must have the mindset that it’s not a case of if rather when, and the more invested will be returned by the reduced impact of any attack and that’s definitely a key lesson.

Priorities for digital at the ICS

Our strategy is broken down into five themes. There’s collaboration – we are focusing on collaboration across the system so there will be some tough decisions to make there, with regards to coordinating our care approach as a system. That’s about pooling budgets and looking at resources as a system and a shared vision for digital transformation.

The next priority is around large strategic digital platforms; electronic health records, anything around the removal of paper to ensure those providing care have the information they need when and where they need it

Direct care enablers is another priority. This is all about prevention, along with things that enable people to live full and healthy lives in their home environment . This involves remote monitoring, falls prevention technology, sensor tech that can alert carers and help identify trends which may indicate a resident needs help or an intervention; not only to help that patient or resident have a better quality of life and stay at their home longer, but equally helping ease pressure on hospitals by ensuring beds are occupied by those in the most critical need.

Innovation is a big priority for us. We want to further explore artificial intelligence and robotic process automation; eventually we will probably move into precision medicine tech so that we can target medications on the individual. That’s a little way ahead, but it’s the sort of thing we’ll be thinking about.

The final priority is around digital skills and inclusion. There’s no point having all this tech if people don’t know how to use it, or the people you are trying to reach the most are the ones that you are excluding by putting the tech in place. The classic example would be ensuring that we aren’t making it harder for our older population who haven’t grown up with technology. Also, there are certain communities in our region that have worse outcomes due to inequalities; in Harlow, for example, some inequalities would be of more of a concern than other areas in terms of digital inclusion, so this is something we plan to address.

So they are our five priorities, the things that we want to focus on as an ICB. Then there are the priorities that NHS England wants us to prioritise as well. Some of those things cross over, but some of them are more localised.

Population health

Population health is a big buzzword at the minute, and we recognise that health and social care have got masses of data that we probably aren’t using or using as much as we should do. We have procured a data platform which is currently in delivery, and that will have various data feeds including national datasets and system datasets.

However, the national federated data platform is out to procurement right now. So we’re in a space where we are trying to use our data in new ways as an organisation, but at the same time, we’re keeping a close eye on the national platform because we don’t want to spend a lot of money on something as an organisation that nationally may be provided anyway. We don’t want to double up, we want best use of our resources.

Elective recovery and waitlist management 

There is an elective hub planned for Hertfordshire and West Essex which will be shared between the three acutes in our system. The clinical model for that has been worked out; how the technology is going to work is the next challenge to tackle. That’s because we’ve got three different acutes running different patient record systems and interoperability, and safely sharing information is a major challenge for us.

In this area there’s also a big push on virtual wards happening. That focuses on creating bed capacity and increasing capacity for elective care, as well as discharging patient to their homes where they want to be as soon as we can, whilst ensuring that their treatment is not compromised.

To support our elective recovery we are investing in preventative technology and alternative pathways; one example is a project called Handover at Home/Hospital at Home. This is where community services have access to the ambulance calls so that they can pick off lower category patients and signpost them to a difference service, which is faster for the patient and doesn’t require an ambulance visit. Another aspect of this is where ambulance crews have access to alternative services rather than needing to convey a patient to hospital; where it is assessed by a clinician as safe to do so, they can direct to an alternative service and free up bed capacity for critical and elective patients.

The other thing we are looking at is the care coordination solution, which is about maximising the scheduling of theatre capacity and management of patients. `if someone drops out at the last minute, you’ve got a list of patients to take their place. You can quickly offer a patient that slot and avoid non-attendances.

Main challenges

Interoperability and safety sharing more information is the main challenge.

Paper removal across the system is another one; we’ve got some hospitals that still have a significant amount of paper flowing through their trust.

The challenge around funding needs to be highlighted, too. There’s so much going on and it’s difficult to coordinate it all together, to know what your next funding stream is going to be. The funding has got to flow and it’s got to keep flowing. There’s a lot of pressure on services and we must invest to save and be more efficient. We’ve seen so much investment some on the back of the pandemic and this has had a massive impact on digital transformation; however the next 12-18 months are going to be challenging, and we need to be smart in terms of how we spend investment in digital.

As a system, we’re a complex one. Our patient flows are not as straightforward as some systems and our patients often move to trusts outside our system– for example, we have strong patient flow into the Royal Free, which isn’t part of our ICS. Therefore when we think about transformation and convergence, quite often the first question is ‘who are we converging with? Where does the patient go?’ It emphasises that interoperability challenge, because we’re not always converging with another trust within our system.

On another note, the primary care recovery plan has recently been released and there are a lot of challenges around that. I think we’re all well aware of the pressure within access to primary care services. However, the recovery plan is about empowering patients, modernising the way general practice works, building capacity and cutting bureaucracy, and there’s national funding coming to help with that. I think there are a lot of things in primary care that could be automated, like admin tasks, to free up time. We’re talking to several RPA suppliers who have done this and examining case studies from other providers who are strong in the automation space for primary care.

It’s a case of building blocks, really. We must remove paper records before you can properly share care information, and that requires new systems that are compliant with interoperability standards.

Achievements and hopes 

Ultimately, there are a lot of exciting things happening with technology. We’re doing some really good work in diagnostics at the moment as well with our new pathology service.

The main digital project I’d say we are most proud of is the shared care record. We’re seeing massive benefits from that. We’ve got lots of datasets linked up and we’re getting loads of positive feedback from health and social care professionals which is fantastic.

Another project that has recently gone live is our electronic consent solution which has been deployed across two of our acutes with the third planned soon. As a result the process around pre-op assessments has become much more efficient; previously there might have been multiple different phases of that process, but now it’s been reduced to one or two stages as a maximum, depending on the complexity of the patient. Patients are given access to electronic access to information in relation to their surgery in advance and where safe and appropriate have the capability to consent online.

I’m excited for the level of patient empowerment that I expect to see in the next three to five years. We’re seeing a push from the national teams regarding integration between the NHS App and trust patient portals. Our three acute hospitals have recently had approval for funding for patient empowerment portals, and there has been an increased number of patients who signed up to the NHS App during COVID. Soon, as well as booking your primary care appointments, ordering your repeat prescriptions and looking at your medical history, patients will be able to see outpatient letters, manage secondary care appointments online and receive questions and surveys to facilitate two-way communication between patients and NHS trusts. This is a massive step in making it more of a partnership between patients and secondary care providers.

For patients, in the next few years, I think healthcare will begin to feel much more accessible and convenient. It’s like the banking sector – how often do you have to physically go into a bank to complete a transaction now? Even 10 years ago, you would have been queueing up to pay a cheque in; today it is much more convenient and at your fingertips. While health and social care is obviously very different, I think we’ll see similarities in that you’ll be able to manage your day-to-day healthcare transactions online, in a way that is easy and convenient to patients and residents. However, to ensure we are not increasing inequalities, our policy is digital-first, not digital-only.

Many thanks to Adam for taking the time to share his thoughts.