Interview, NP

Interview: “No-one’s got a magic formula, but what we do have is learning” Cara Afzal, Health Innovation Manchester

For our latest interview, we spoke with Cara Afzal, programme director for data and digital at Health Innovation Manchester, about her journey and experiences with digital in healthcare.

We started by asking Cara how she got into digital and data and how this journey had brought her to where she is now.

“I started my journey working on large-scale digital transformation programmes at Health Innovation Manchester in 2015,” she said.

“My first digital project was part of a national AHSN (now known as the Health Innovation Network) programme to help CCGs understand atrial fibrillation prevalence and improve treatment for patients. Our mantra was to ‘detect, protect, and perfect’, and we worked with an industry partner to present data in a dashboard from across Greater Manchester to show the current status of atrial fibrillation prevalence, highlighting where there were gaps in detection and how the CCG could improve patient care.”

That ignited Cara’s interest around the power of what digital platforms can do in helping staff to better understand the extent of the problem they are trying to solve.

She explained. “Once we’d helped the CCG identify gaps in atrial fibrillation detection, I led a programme deploying devices that captured a medical-grade, single-lead ECG in just 30 seconds, detecting a normal or atrial fibrillation heart rhythm. This innovative project helped the CCG to clearly define the extent of the problem and identify cohorts of high-risk patients who then received treatment to reduce the likelihood of suffering a stroke.

This was one of many projects supported by the Health Innovation Network’s NHS Innovation Accelerator (NIA) scheme in 2015/16 that enabled products developed by frontline clinicians and entrepreneurs to demonstrate impact in one part of England before being rolled out on a wider scale. The scheme accelerated digital transformation into the NHS, and patients benefitted more quickly from proven digital innovations in healthcare locally and nationally. The scheme is still running today, with impact data being captured to evidence the benefits.”

In addition, Cara shared some of her other work, such as her involvement with the DataWell programme, which aimed to establish a federated shared record for Greater Manchester, which she says “did not come to fruition in its entirety but learning from this programme was a building block for the GM Care Record (GMCR).”

She also commented on advancements in this space: “During COVID, we saw the pace of digital change like never before and began to see the positive impact that digitalisation can make. I took on a post as an Associate Director for Digital Transformation at Manchester University NHS Foundation Trust (MFT) to better understand the acute sector’s “challenges of implementation on the coalface”. During her time at the trust, she was involved in the launch of the Hive EPR (powered by EPIC) which went live last year, supporting the roll out at four of the ten sites of MFT in what she describes as “an invaluable journey, where she was able to practice iterative techniques for implementing change and acquire real experience of working alongside frontline clinicians and managers on one of the largest digital transformation programmes carried out in the NHS.”

As well as the EPR programme, Cara also worked with a team on establishing a Frailty Virtual Ward. Cara had plenty of praise for the team at the trust, mentioning the “brilliant work being led by Dr Eleni Malloupa, a Complex Health Consultant, and Charlotte Wilkinson, Physician Associate in Complex Medicine”. She continued, “I’ve worked with some wonderful people who go above and beyond, and I’m blown away by the additional effort busy frontline clinical and management staff apply daily when doing additional digital change work on top of their day jobs. I think that keeps me motivated as well.”

She added that she also did a short stint as a Divisional Director, leading the Division of Medicine, Complex Health, and Outpatients’ Division. “I’ve done two quite big pieces of work that have given me a greater understanding of the challenges of implementing change in the acute sector and getting technologies into practice within the NHS. I’ve now got acute sector frontline experience, and I’ve come back to Health Innovation Manchester to share learning and progress work we do across the region.”

Key areas of interest and key learnings

Have you developed any specific interests in the realm of digital over the course of her career to date?

“Yes, my interest is in EPRs, shared care records, and patient access to their records because information has the power to transform care quality, delivery, and patient outcomes,” she replied.

She also has a keen interest in interoperability and making systems user-friendly for patients as well as staff. “We need to ensure the people can see their health records in a way that’s simple, so patients are empowered to take control of their care. I’m especially interested in change and adoption and effective implementation of technologies, using novel approaches to get the job done.”

We asked Cara whether she could share any of her learnings from her time spent working at the trust.

“The system is under immense pressure, as everyone knows. We’re asking staff to do much, much more with less time. It’s amazing what staff manage to achieve in the time that they have. We need to look at ways we can support staff to implement change. There is no one magic formula. Iteration is key and context is important. There will be unknowns, and therein lies the challenge. The most important thing I would say is having that bank of information in place so that you can avoid repeating mistakes.”

Future focus in digital healthcare

In terms of future outlook, Cara shared that her new role at Health Innovation Manchester is going to be focused on overseeing a large portfolio of digital programmes and projects across Greater Manchester, working with Dr Gareth Thomas the Digital Innovation Director, “looking at existing pathways, improving the way that we do healthcare, and working to unlock the full potential of digital data assets for the region”. The recent launch of Greater Manchester’s Health and Care Digital Transformation Strategy sets out the key areas of focus, covered by HTN here.

The GMCR is something Health Innovation Manchester was “instrumental” in setting up, Cara added. She highlighted that the digital team at Health Innovation Manchester will be “progressing this even further, enhancing the GMCR, care plan digitisation, and digital access to primary care, to mention a few. That’s something that I’m very much looking forward to working on with the team, to make sure these innovations are being used to the best effect.”

Finally, on top tips for digital transformation, Cara said:

“Transformation requires a lot of stamina and motivation. There will always be hurdles because in many instances it hasn’t been done before. We are treading uncharted waters and there isn’t always a precedent for what we’re attempting to do. This makes it exciting and challenging at the same time. Digital transformation requires iteration, and this can be difficult because it hasn’t been done before, and the context can be different. You will never be able to plan for every eventuality. What you need to do is adapt and iterate. Also, capture issues in a structured way within your programme and proactively address lessons learned. I cannot stress enough – capture your lessons learned during the cycle of the programmes, because if you don’t, you end up relying on memory, and we’re only human; we can’t remember everything! Those lessons will be an invaluable bank of information”.

“So, my top, top tip is to keep going, even when the going gets tough, and keep focused on the endpoint, the deployment, and active use in the real world. It is these experiences within digital health innovation which have kept me motivated and focused on the tangible difference we can make to the needs of our population.”

Many thanks to Cara for taking the time to join us.