Interview, NP

Interview: “To be able to predict and understand where we’ll get the best impact for people is gold” Deborah El-Sayed, director of transformation and CDIO at BNSSG ICB

We recently had the opportunity to interview Deborah El-Sayed, director of transformation and chief digital information officer at Bristol, North Somerset and South Gloucestershire (BNSSG) ICB. We asked Deborah some questions about her role, current and past projects, and her insights from a career which has spanned local, regional and national levels. 

We started our interview by asking Deborah to tell us a little bit about her role and her career to date. 

“As well my role as chief digital and information officer for Bristol, North Somerset and South Gloucestershire ICB, I’m also the executive director of transformation, so that means I’ve got a dual portfolio,” Deborah said. 

“In my CDIO role, I’ve got the digital portfolio, which sits around delivering the digital strategy, convening and drawing together all of the things that we need right across the system to deliver the four objectives that ICBs have been given. We’re considering how we pull all that together and wrap it around the person to be able to achieve better health outcomes, because you can’t do that just from one provider, one hospital organisation, one bit of general practice.” 

In addition, Deborah continued, she oversees the business intelligence and data agenda. “I feel really positive about the transformation agenda, because it gives me an opportunity to try and ensure that digital is embedded – because there is no real transformation now without elements of data and digital being enshrined in it. I’m not saying it’s perfect, like many places BNSSG still has situations where we’re delivering programmes and somebody comes along afterwards and wants a digital element adding rather than including it from the beginning. But we have developed a transformation gateway process which enables us to start to think about considering data and digital when we design, from the outset. 

“I think it’s really useful having this joint role, and being on the ICB board – being able to bring those things together to make sure that as an ICB board at the most senior level we think about digital and data as an integral part of what we do.” 

In terms of her background, Deborah studied computer science and began working in the NHS 32 years ago, in disability and mental health services. She described how she has worked on a range of projects including developing the first wired home for technology-enabled care in the late 1990s, and working on a telehealth project with NHS Direct to help reduce hospital admissions for COPD. 

“That was a quarter of a century ago, and we are still just implementing virtual wards and thinking it’s a really new thing,” she commented. “Now, technology has changed, the public’s ability to use technology has changed, the unit cost of tech has gone down - some of those barriers that were in the way just aren’t there anymore. But I think it still shows we’ve got a long way to go, and there’s still some acceleration that we need to drive forward to be able to make the best use of technology and data, to deliver the best outcomes for people. 

“We’ve also got to think about how technology can enable us to create new models of care, tend to the person at the centre and empower them to be able to do as much as possible for themselves, and wrap the clinical and professional safety around them. I think there’s a long way to go yet before we even start using the technology that we have in our everyday lives, never mind using the capabilities that are being developed. I’ve been part of some really great service changes, but there’s so much more to do. I feel both excited and slightly impatient around making those changes.” 

Key programmes and insights 

We next asked Deborah if she could tell us a little bit about some of the key projects she had worked on in her career to date. 

“I feel privileged because I’ve worked with some amazing people over the years – I’ve learnt loads from those people, and we’ve done some things that really have made a difference,” Deborah replied. She noted that she was part of the original design team for what is now the e-RS programme, originally ‘Choose and Book’. She was also responsible for 111 online, and for implementing PACS nationally. “When you look back, it’s nice to see things that will be different as a result of your contribution – amongst many other people. 

Deborah noted that her career went from local to regional to national, and she has now come back to local working. “I feel more connected to the population, the people,” she acknowledged. “It wasn’t planned that way, but I’m really glad I’ve been able to do that. At all those different spaces you get a different understanding, and you can take that knowledge and learning into a different setting. Connecting with the population again, I’m struck by how much we still have to do to embed digital into everybody’s day to day. 

“It is changing, though. In terms of our board, I’m noticing the fact that I’m not the only person that is talking about it now – the other chief execs are also talking about digital and looking to see how it can be used as an enabler to help improve care, productivity of care, sustainability, and ultimately the impact it has on the person.” 

On current projects at BNSSG, Deborah said:  “We’ve just developed our traffic control capability, which we’ve been doing in partnership across our system. The idea is that we’re giving people the information to make better decisions. With that, we can start to see how many people we have in each ED department; I can see how busy our general practices are in different areas of our patch, I can see our community data going live, or how busy 111 is. You can actually start to see the whole system. 

“From an urgent care perspective, it is a connected piece. It’s not just what happens inside that piece, or that part the system, it’s about how these things work together to actually deliver the outcome for the person and ensure that we don’t have ambulances queuing and an overloaded A&E department, that we have enough capacity to be able to think about how we discharge people home.” 

The ICB is gaining new data each month with new releases going live, Deborah explained. “Our dynamic population health project is starting to look at how we develop a trajectory to better understand our situation. If we stay at the level that we’re at now, what happens to the health of our population? For example, we’ve been talking about dental care for children. If we invest in that care now, we will improve the population’s health in 10-15 years time. It’s about starting to understand, through data, how we can visualise the best place for us to invest our scarce resources to deliver the best outcomes for the population. We’re using machine learning and some automation too. To be able to predict and understand where we’ll get the best impact for people is gold.” 

What about the use of AI and machine learning at the ICB? “We’re in the early stages of it – what we’re trying to do now is to understand the connections between things. For example, when primary care gets busy, how many people then go to A&E? How many people go to 111? So we can start using our historic data to help us understand the patterns, then we can build better predictive algorithms to understand what is likely to happen next. There’s no leap to ‘it’s all magically AI’, there’s a bit more work we need to do to make sure that we understand the data and what the data is telling us, so that we can learn from that data and build that capability.” 

Deborah added: “We’re also upskilling some of our teams on things like robotic process automation, helping people to understand what processes you can automate to make them more efficient. We’re trying to use technology and the advantages that data and technology give us to help scale up our non-frontline care workforce as well, so the whole thing becomes more efficient. We’re on a journey with machine learning and predictive analytics -  it’s not just about finding the answer, it’s about embedding it in how we work and how we make our decisions.” 

The other thing that Deborah said she feels “really passionate” about is the technology-enabled care agenda. “In 1999, when we were putting these wired homes in, that enabled people in the third age of live to live much more independently, without needing to come into hospital. I think there’s something really exciting in this space; we’re working with our local authorities and our virtual wards, to help us think about how a new model of care can he wrapped around a person for the future, so that going into hospital becomes an unusual thing that people only do when it’s absolutely needed. Rather than waiting for a heart attack to happen, we’re monitoring the effects and we’re preventing things from going wrong for that person, and allowing them to be a much more equal partner in their care.” 

Ultimately, Deborah said, “It’s about how we start to drive up the health of our populations and ourselves, by connecting into some of that data and technology that we use in our day-to-day lives. We need to make sure it’s embedded much more into the health and care system, so that people feel that they are still getting the same service, but not having to be in a hospital bed to be able to get that service and that wrap around.” 

Human-centred design and hopes for the future 

What does Deborah feel most proud of from her work with NHS England? 

“I think the thing I’m proudest of is starting to embed human-centred design in things, and having taken that from the centre and embedded it in our processes around transformation,” she replied. “Human-centred design and design principles sit in everything we do. We’re one of the few ICBs, for example, to have an insights team, and to have a process that involves human-centred design. I’d love to hear about other areas where they’re really embracing this – it’s so important to design your digital processes around the problem you are trying to solve. It’s not a singular project that I feel the most pride for, it’s a methodology and a way of developing both transformation and digitally-enabled transformation. We don’t give enough airtime to human-centred design, and we don’t always have the time to do it well. I was talking to one of my transformation colleagues today, and one of her phrases was, ‘we can’t afford not to do it well’. We have to spend time really understanding what the design needs to be.” 

Finally, we asked Deborah what she was most excited about for the future of digital health, both for BNSSG and for the wider NHS. 

“I’m excited for the opportunities that working as a system gives us to build upon the skills and capabilities that we have within our provider organisations, that enables us to do more by connecting all of these things up,” she said. “I’m really excited about giving our professional staff the ability for digital and data to release time for them to care, and to make those professions a great place to be for the future. I’m also really excited about the opportunity that technology brings, and I’m really hopeful that the colleagues who are now at the centre really understand that this is not just about hospitals anymore. This is about how we embed digital and data capabilities into the design of every service and every service transformation. I’m excited and hopeful about that.” 

Many thanks to Deborah for joining us.