We sat down for a chat with Ian Roddis, director of digital, data and technology at Buckinghamshire Healthcare NHS Trust, to discuss digital transformation, digital maturity and his experiences in digital in health.
Ian’s background, and how he became digital director
“I came into it totally by accident. I’m not one of those folks who has a career path in mind – it’s always been about doing good stuff, interesting stuff, benefitting people”, Ian said.
He has always worked in the public sector, from working in education at Coventry Polytechnic in the 90’s before moving on to Warwick University. At Warwick, Roddis’s programme involved printing out course materials for international students and posting them out, which turned into using email and building websites when the internet started coming in. “I like to say that I kind of surfed the ‘first wave’ of the web, which has then become digital,” he commented. “In terms of defining that, to quote Tom Loosemore’s definition of digital – it’s not ‘rebadged IT’, it’s the culture, processes, business models and technologies of the internet era to respond to people’s raised expectations.”
After Warwick, Ian moved on to the The Open University. With the concept of remote learning using internet technologies taking off, Ian was involved in building an intranet for 11,000 staff, and in developing a solution allowing more than a quarter of a million students to view their results and update their details. The growth of the virtual learning environment saw all of the Open University’s teaching transferred online, and Ian also became involved with the back-end engineering supporting the CRM processes that supported the online “£200M online sales channel” at open.ac.uk.
NHS Digital and work in the NHS to date
In 2017, Ian began to work for the NHS – NHS Digital at the time. “The NHS.uk website was becoming part of the online health world and increasingly being used to relieve pressure on frontline services by advising the public on conditions, medicines and local services. It was really interesting to be part of that and the rise in government of digital services, user-centred designs, service design and service standards. My colleagues and I, were in effect, trying to do the same for the NHS. We built the NHS digital service manual, and I did significant work on NHS.uk information architecture supporting millions of visitors to more easily find the information they needed to live healthier lives and find reassuring content for potential illnesses.”
He moved on in 2020, three weeks before COVID hit, to join Kettering General hospital (an acute trust) as Deputy CDIO and is now director of digital, data and technology at Buckinghamshire Healthcare NHS Trust.
“Buckingham is an integrated acute and community trust. With the frontline digitisation and digital agenda, we have various standards we’re looking to achieve, and like many trusts, we’re driven by that. We’re at an interesting point, now – we’re receiving significant regional and national support, but our digital maturity journey is also significant – we’re currently low – so we’re looking to use digital technologies to support cultural change which is sustainable. We’re working to bring on board that change management, ways of working which will use agile methods to both learn and iterate and be clinically led.
“We’re going to be doing some exciting work around patient flow, thinking about things like business process re-engineering (now an old-fashioned term!) and using data to help understand the life of the hospital, to manage that flow and have targeted interventions,” Ian shared. “We want to have dashboards so you don’t just see things on a ward basis, you see it on a hospital basis and then on a system basis. We’ve been doing some work on predicting what is going to be coming in the front door, looking at efficiency so we can reduce length of stay and maximising bed usage.”
Digital and frontline staff culture
Commenting on the culture around digital, Ian said, “Often IT has been seen as a back-office function, but as part of our quality improvement work we do walks to identify things that need fixing, and fix them. I think it’s important to note that people work for a hospital, but they see their ward as their tribe, their community, and we have to tap into that. Build on that commitment, and bring those tribes together with digital tools to make sure we work as one efficient organisation”
He described how during a ward visit in Kettering, Ian realised that it wasn’t easy to identify his team or to know why they were there. “I had the idea to create some blue waistcoats for us to wear which say ‘digital team’ on the back. It’s not about ‘doing IT to people’, it’s about walking around the hospital and being identifiable, asking people how you can help them. That on-the-ground stuff is really important to build that trust to help deliver a digital project, say an EPR; because how can you deliver an EPR if you can’t do the basics, if they don’t know you and you haven’t walked in their shoes?”
The importance of leadership
Ian went on to talk about the importance of leadership and having the whole team on board. “The NHS is full of brilliant people – I’ve got colleagues who have been here for 30 years! Something that surprised me when I joined the NHS was that investment in people is not significant. You’ll be trained in things like finance, but will there be budget for you to go on a training course and learn about things like agile working or modern digital practices? Infrequently. So when you tell your colleagues that they need to undertake a big change, there’s nervousness. I’m there to help them do their best, to lift the weight of decision-making. I’m absolutely not there to set them an impossible task and then berate them when they have failed to do mission impossible. So you have to take those folks with you, building trust, building on their skills and knowledge from the last 3o years as well as helping them see the exciting possibilities ahead.”
Ian also raised the importance of training. “I had one colleague tell me that it was the first formal training and qualification in Agile they had done in 12 years. She was really happy to have done it. It can be a difficult journey, but it can have massive benefits both to staff and obviously to patients.”
What is needed for digitising the frontline in the NHS?
On what is needed for digitising the frontline to be successful in the NHS, Ian said: “With regards to money, I think there’s something interesting about long-term strategic planning versus year-to-year budgeting. In COVID, there was a lot of short-term money, but an EPR business case is 10 years long. So some of the challenges are about funding, inevitably, and about being able to plan for at least two to three years which includes realising cash releasing and non-cash releasing benefits.”
He continued, “We’ll be using a lot of our internal staff to deliver this – the marketplace is challenging because many trusts are trying to do digitisation and there’s only so much external support, and they’re all in demand.
Ian explained how the trust places focus on “investing in internal teams and investing in talent, particularly early on in careers. We’ll be bringing on a couple of graduates through the NHS DDaT scheme, for example. We’re also going to appoint a number of apprenticeships for form developers, who can build forms in EPR.
“It’s a challenge bringing in the right resources to do digital transformation, and that’s why I’m so passionate about developing our internal teams. They care, they have the expert knowledge of our existing systems. My challenge is to help them move forward in terms of their skills and ways of thinking.”
Digitisation at ICB level
“From an ICB perspective, we have a digital team growing in experience of working with primary and secondary care providers,” Ian said. “We ’re now starting to build a permanent team around the ICB. As well as the in-hospital journey of digitisation, the ICB will mature as well, which I believe will bring benefits – perhaps procurement advantages, for example.”
At NHS Digital, Ian was a product lead for a number of squads which included a mixture of data, digital and technology professionals. He explained how the roles tended to be at a high level, which meant they cost a lot. “I think the ICB will give you the ability to build design squads, and user researchers that work across the ICB. No single trust could afford that, but I hope the shared services model will start to bring capabilities and skills, that can be afforded across the ICB. I think increasingly we will see ourselves working as a system,” he said.
Best practice in digitising the frontline
Ian shared some examples of best practice in frontline digitisation, touching firstly upon an example from Kettering, during COVID. He described how a trust in London put a shout out sharing their intention to build a virtual video appointment system in a matter of days. “They used the service manual that we built, in NHS Digital, and we built the next iteration of that in Kettering. It was a web-based platform that used a digital tool within it – it was small, but it was perfectly formed.”
Another example is System C Vitals eObs, an app for taking digital observations. “The trust started rolling it out before I joined, but we just finished maternity and paediatrics,” Ian shared. “That means the whole hospital is now having their observations recorded digitally. From a technology perspective, when doing the EPR, that gives us reassurance and it safeguards best practice. In maternity, for example, (I think) observations should be taken every four hours, but imagine waking a sleeping mum with a newborn? The technology helps enforce and support best practice. It helps record where the patients are, and rather than thinking of the ward as a single unit, think of the whole system. eObs also has a dashboard view, so from a central viewpoint you can check all patient scores and see if someone is deteriorating.”
Exciting things to come
As our final question, we asked Ian what he was most excited about in health tech. He said: “In the NHS, it’s all about health prevention, using devices and education to understand what ‘good’ should be. It’s about ensuring that pathways through health are frictionless, so your record goes with you, and you know your own health record. Technology like AI can lean into this – we may use it to flag things, to support clinician decision-making or to identify risk. How it all comes together is the exciting bit. Rather than that patient experiencing ‘little pockets’ of care, all of that is seamless. The patient is treated by one hospital and gets the results at the right time, they are educated about their treatment. And for the staff, it should be easy for them to raise an order, to see where they are and what they are doing. It’s about anticipating the patient needs, and the patient being fully informed of the journey they’re about to go on.”
Ian concluded: “I think if someone is going to come and work here, they need to bear in mind that it’s a service with lives at stake. Balancing that agile delivery with an appropriate view of risk is really important. I think people take the NHS for granted, and the number of people who have worked in it for 30 plus years. With such established structures, agile work and digital work can be challenging. With regards to the culture of the NHS and digital, I think you have to be willing to challenge the status quo. And when trusts get it, when CIOs get it, it really helps.”
Many thanks to Ian for taking the time to join us.
