We talked with Eleanor Rollason (Partner) and Chris Tack (Principal Consultant) from Channel 3 Consulting, about how NHS organisations and integrated care systems can better deliver value through digital.
Eleanor brings over 30 years of experience in clinical, operational and advisory roles in healthcare. Having started her NHS career as a podiatrist she completed the NHS Management Training Scheme in 2000 before working in commissioning and provider organisations at board level. Eleanor then embarked on a healthcare consultancy career with 10 years at EY, and joined Channel 3 in 2007, where she has led ambitious, transformational digital programmes.
With over 17 years of experience as an NHS physiotherapist, Chris brings a wealth of clinical expertise and insight into healthcare technology implementation. As a lead reviewer for regulator NICE he helped shape national guidelines and recommendations that have impacted patient care across the UK. Chris also was part of the clinical informatics leadership team for the EPR implementation at Guy’s and St Thomas’ NHS Foundation Trust and was selected as one of the first Topol Fellows at NHS England, a prestigious role focused on driving advances in digital health. Chris’ deep NHS background combined with his passion for improving care through technology make him a transformational leader.
In the face of funding challenges, how should organisations be spending their digital pound?
Eleanor: We are in an unsustainable position across health and care services – demand is increasing and there are not enough staff or enough money to respond. Digital is a big part of the way forward, but the significant investment in digital to date has not yet had the impact it should.
Digital provides the opportunity for health and care services to work differently, benefitting patients, staff and taxpayers, and a lot of that can come from getting value out of investments that have already been made. As a rule of thumb, financially you need to expect at least £3 return on investment for that digital pound. You deliver that by focusing on how the system is used to deliver better ways of working and caring, not just on getting the tech right. Digital transformation is ultimately about cultural change.
Chris: When times are hard, the health and social care organisations across an integrated care system – ICS – often don’t consider digital a priority, when really it should be seen as core investment to deliver tangible benefits.
We spend a lot of time with organisations on their business case. They often take a narrow view of potential benefits, limiting expected gains to those directly related to the specific solution. But the reality is that digital technologies provide value far beyond their immediate use case. Their integration unlocks adjacent opportunities across operations, creating a ripple effect of efficiencies and improvements to deliver enterprise-wide impact.
Eleanor: The environment is going to become even more politically challenging over the next 12-18 months with an election looming and money tighter than ever, so delivering value through digital shouldn’t be optional. As taxpayers, we need our NHS to be embracing digital to improve our experiences and outcomes as patients, and as a critical enabler in delivering cost-efficient, productive healthcare services.
Chris: There is a lot of talk about the impact that AI will have on medicine, but it depends on getting the basics right – having electronic patient record (EPR) systems in place, producing consistent, standardised data that is analysed and used, having clinicians with the skills and confidence to work with AI-powered technology and having the expertise to rebuild patient care around digital tools and information. Throwing expensive tech at problems will not work unless all the foundations are in place, and hospitals and clinics might already have a technology that could help. It is easy to spend digital money poorly.
Eleanor: We’ve got to remove legacy systems, too. If you look at banking and travel, when they introduced digital services they started to phase out access in the high street. If they had continued they’d be running two services in parallel and increasing costs. To move people towards the digital solution, you have to change the model and remove the legacy processes.
What are the benefits of digital investment in healthcare?
Eleanor: When digital solutions are implemented well they improve patient safety, clinical outcomes, patient experience, workforce productivity and job satisfaction. They also drive further improvement as the data generated can identify further areas where ways of working can be optimised.
Take EPRs as an example. The work we’re doing with a client across two NHS hospitals forecasts cash-releasing benefits of up to £30 million over 10 years. There are non-cash-releasing benefits alongside that through things like reduction in length-of-stay and saving clinician time, which we estimate at £70 million.
Digital unquestionably saves lives. It might be through real-time monitoring of a patient on a ward to identify signs of deterioration, such as sepsis, or monitoring a patient in their own home, enabling them to be safely discharged from hospital while still being supported.
It is also the key requirement for integrating services, such as hospitals, primary care and social care.
How do we have to approach service design to enable organisations and systems to derive these benefits?
Eleanor: To drive these benefits, the impacts on workforce and estates cannot be underestimated. That’s where the financial and operational efficiencies will be delivered. Implementing digital well and transforming care will involve the workforce working in an entirely different way, so there’s going to be an impact on training, roles and responsibilities.
Taking virtual care as an example. In a traditional setting, community nurses visit patients in their homes. Now that same nurse can look after a few hundred patients from looking at data on a dashboard. They can still make visits, but by viewing the data and making phone calls to assess need they will be visiting fewer patients and focusing their efforts on those with more complex and urgent needs. That is not how that nurse will have been trained.
I think digital will also help with recruitment and retention of nurses. We have lots of people who are leaving the NHS because of low job satisfaction. I believe digital is well-placed to help us hold onto the workforce, because we can provide a different working experience and work life balance by reducing admin and repetition and freeing up more time to care.
From an estates’ perspective, we’re used to outpatient suites with banks of chairs where people have to sit and wait their turn. With use of video – and indeed telephone – as well as remote monitoring of body functions with tech such as wearables, the need for outpatient visits is drastically reduced. This saves patient and clinician time and allows buildings to be repurposed.
There are the clinical benefits too. I was a diabetes specialist podiatrist – I used to ask my patients how they were getting on with monitoring their diabetes and often they weren’t monitoring it very well, if at all. Now, with digital tools, I’d be able to see it all, and more importantly so would the patient. They would know exactly what behaviours affected their feet. This reduces the risk of amputations.
Chris: It’s worth noting that the financial, clinical and operational benefits are interweaved, not separate. For example, workforce benefits are directly related to costs associated with reducing spending with staff agencies, or enabling people to make better use of their full range of skills.
Eleanor: When we meet organisations, we often hear that the technology has been implemented but it’s become more of a chore or a barrier than a help. Something that used to take two minutes now takes 10 because of the way the system is configured or because the processes around it haven’t been redesigned. That’s the bit we focus on – redesigning the system to ensure the technology benefits patients and staff.
How should organisations tackle the management of risk with these types of programmes?
Chris: Health and social care have a lot of complexity, and therefore risk. This means preparation is essential. For example, implementing an EPR means intensive testing before go-live, a massive training programme and lots of communicating with staff and patients. We make sure that the staff who will be using the system are involved at every stage – they are the ones who know how the tech will be used in busy departments when staff are under pressure, so their insights about how to prepare and run the system are gold dust. You have to listen and act on what you learn – that is how these big systems can be introduced safely.
Eleanor: Having a service model that isn’t digitally enabled carries risks in itself. It’s not like you are moving from a risk-free environment into a risky environment by becoming digital. On the contrary, good digital systems will greatly enhance patient safety long-term.
Who do you think holds the responsibility for driving the value out of successful digital transformation?
Eleanor: I feel passionately about the fact that digital is everybody’s responsibility, from ward to board. When we talk to organisations, we often find that people will point you to the CIO, but they can’t do it all in isolation. It has to be aligned with other aspects such as clinical, workforce, estates. People should be expecting to be working in a digitally-enabled environment, and to be cared for in a digitally-enabled environment too.
How do ICSs and organisations drive more from digital?
Eleanor: First, understand what you’ve got. Do some baselining to see what investment you’ve already made and whether it has delivered what you wanted. This will identify duplication, waste and inefficiencies, which is a great place to start.
Then you need to look at how well you are using what you’ve got. Is there more that you can and should be achieving from the investment you have already made? How can you join things up to have an even bigger impact?
From there, you need to think about your future investment strategy. What else do you really need? It might be that by investing in something slightly different, you can rationalise the technology that you’ve already got. It’s about making wise investments.
Chris: You need to spend time and money with the people on the ground on how you implement solutions. That includes the patients. Having that user-led, clinically-led design is what delivers impact and outcomes.
