HTN caught up with Will Monaghan, group chief digital information officer at University Hospitals of Leicester (UHL) and University Hospitals of Northamptonshire (UHN), to chat around some of the group’s recent projects, ongoing priorities, and work on AI.
“I’ve been at UHL and UHN since August 2024, and before that I was CDIO at University Hospitals of Derby and Burton,” Will told us. “And before that, I was director of operations at NHS England and led the merger between NHSX, NHS Digital, and NHSE.”
Innovation at UHL and UHN
Over the last couple of months, a lot of his focus has been on working with Nervecentre, Will shared, “because we’re going live with their first patient administration system, which is the hardest bit of the EPR journey to get right because it’s the backbone of everything else in the EPR”. The go-live for that is set for 6 June at UHL, he continued, “so we’ve been doing all of our trial loads, our testing, and all of that’s going really well – we just had three weeks of user acceptance testing, and whilst it’s rare that you get people being excited about adopting new technology because of how busy they are, what we found from that testing was that people couldn’t wait for it to be introduced.” A separate go-live is also scheduled at UHN for 21 May, according to Will, “where we’re going live with the patient safety bundle, covering e-observations and the emergency department”.
Will’s team has also been implementing a strategy called “One Digital”, he told us, “which is talking about how we’re bringing the teams together from across UHL and UHN, because it’s our belief that if we can leverage the scale that we get from being two big acute providers, we’ll be able to do far more.” As part of that, “we’re looking at trying to reset the culture around the fact that digital should be there for users, rather than users should be there for digital – trying to strengthen the clinical and operational voice in our decision making, and being really clear about our strategy around digital,” he added.
Work is also ongoing around the Federated Data Platform (FDP), Will continued, “and UHL will be the first organisation to implement that as our data warehouse, whilst at UHN we’re incubating a number of the national products, building a productivity app on top of the FDP which will help all of our general managers to understand what’s happening in their services, to help bring the data together, and that is really exciting.” The team is also building new products looking at things like scheduling for diagnostics, and developing a Canonical Data Model with the FDP to “try to work out the way we structure data in the FDP”, he said, “and it’s great for UHL to be the first place where that’s being built”.
Whilst Will notes “some scepticism” from the wider community around the FDP, he shared: “We’ve found it to be a valuable tool, and we’ve seen massive productivity gains in the things that we’ve implemented so far, so we think that if we can get it right, that data piece can be a huge opportunity for all of our teams across UHL and UHN.”
At the same time as welcoming these projects where UHL and UHN have been at the forefront of innovation, “it’s important to recognise that you can’t just be first and innovative all the time if everything else doesn’t work,” Will considers, “because there’s no point me saying to our clinicians that AI is going to solve all of their problems if when they’re coming in in the morning their computer takes 20 minutes to log on and then they have 7 different systems to log in to in order to run their outpatient clinic.” Alongside trying to ensure that UHL and UHN are “at the forefront of things like the FDP”, that means recognising “we’ve got an obligation to our colleagues which means getting the right devices to them, supporting them with the right network uptime and infrastructure, and some of those things which might seem really fundamental,” he reflected.
UHL and UHN’s collaboration on trustworthy and responsible AI
Will also talked about UHL and UHN’s involvement with The Trustworthy and Responsible AI Network (TRAIN), where he discussed the importance of ensuring responsibility and trustworthiness in upcoming AI projects. “We want to be really clear with our colleagues that as we do this work around developing AI, we’re going to do it in a way that they can trust in,” he said, “because I think we go through this adoption curve with AI, where we get really excited and then we get really nervous, and I think the nervousness is right, because there are a lot of potential issues there, and we want to be sure that when we are implementing we’re doing it to the highest possible standards.”
Being able to join TRAIN was “so exciting”, Will shared, “because that’s kind of a kite mark of the quality of the governance and the research that we’re putting into all of our AI adoption.” Membership also reinforces that UHL and UHN are “serious about technology adoption,” he went on, “and we’ve got an emerging track record now of being at the forefront of things like the Nervecentre build and the FDP, of our partnership with Palantir, and if you’re a supplier of AI into the NHS, you want to do that with the place that takes it the most seriously, has the best track record, and wants to do it in a way that is safe and responsible. So it’s a signal not only to our colleagues and patients, but also to the supplier community, that if you want to develop innovative AI products then UHL and UHN is the place in the NHS to do that.”
On a day-to-day basis, membership means that every piece of AI that the group introduces has “a really really high bar around understanding the research and the bias that’s in there,” Will told us, “and it also means we need to be sure we’re partnering with the right people and that we’re keeping those standards high”. At the moment, his team is working on three projects in particular, including trialling Ambient AI scribes, where Will highlighted the group’s approach to “working with four different partners and doing an evaluation to see what the strengths and weaknesses are before picking the right one for us.” They’re also working with HeyGen, he continued, “because one of the great things about Leicester and Northamptonshire is the diversity of the population we serve, and that solution means we can generate all of our videos and then have them translated simultaneously into multiple different languages.”
There are also three things that the group is developing for the first time, according to Will. “We’re developing a co-pilot for discharge summaries, so if you’re a doctor in training or a resident doctor in one of our organisations, our goal is to free up as much of your time as possible – if you’re working on a ward where four people are discharged per day, you’re probably spending an hour-and-a-half writing discharge summaries, and if we can surface all of the information for that in one place, we can probably get that down to 15-20 minutes.” A clinical coding bot is in the works, with support from NHS England and Microsoft; and the team are also building a proof of concept around “using a combination of technologies – scanning, optical character recognition and AI – to see how quickly we could remove all of the paper from our organisation,” he said.
“It’s been a fun partnership with TRAIN,” Will reflected, “because it gives us a framework when it comes to deploying AI, and I think lots of people are looking for what the right way is to do that – we’d encourage other NHS organisations to get in touch about joining that, as well, because there’s something about doing this safely and responsibly that will really matter, and it will help us collectively to improve public trust.”
Highlighting work around data at UHL and UHN
When it comes to data, UHL and UHN are similar to a lot of organisations, Will considered, in that “productivity is a challenge, and next year’s financial assessment is creating significant issues.” One of the areas of focus for the group, however, is on using data at a population scale, he told us, “working with partners across Leicestershire ICS and Northamptonshire ICS to identify opportunities for people to avoid coming to the highest possible cost of care setting, which is the emergency department, and how we can intervene sooner.”
What’s “great” about that kind of work is that it’s “not new or revolutionary”, Will continued, “because lots of places have been doing amazing stuff – Frimley have been doing it really well for years, and across East Midlands Acute Providers we’re part of a partnership with Nottingham, who have also been very successful, so we’ve got an opportunity to learn from them. It’s not always about being the trailblazers – we’re also recognising we’re not going to have every single solution, and therefore if there are other people who have that, we’ll just copy that with pride!”
Monitoring progress toward UHL and UHN’s digital strategy
When it comes to monitoring progress toward UHL and UHN’s digital strategy, Will shared how the trusts have just refreshed their strategy, calling it “Our One Digital Approach”. Within that, there’s a focus on changing culture, he said, “because I don’t think this is unique to us, but for us it’s been about doing what was technically possible and implementing products that maybe weren’t what our users would choose, so we’re trying to ensure that the loudest voices in our decision making process are our clinicians and operational teams – those people that use the tech most often.”
Will also noted three areas of focus which, if it were possible, would all be undertaken in sequence, but which “given the challenges we collectively face across the NHS we’re going to have to do in parallel”. The first of those is “fixing the basics – making sure you’ve got a device that’s fit for purpose, that the network stays up, that when people need help that they get that help quickly and it’s not a frustrating process, that people don’t have 17 different passwords.”
The second thing, according to Will, is “taking advantage of digital transformation that we know adds value – in our case across UHL and UHN we don’t have a full enterprise EPR yet, so that foundation stone of digital maturity is the second thing that we’re focusing on and ensuring we get the benefits that other NHS providers have seen from that.”
And the third thing is around emerging tech, he continued, “so how we’re using things like AI to make it easier and safer to deliver care – as a digital and data team, our role isn’t to spend lots of money or to have the best tech – our role is to make it as easy as possible for our colleagues and clinicians to do their job, and as easy as possible for patients to interact with us.”
Considering what the role of the CDIO will look like in 5-10 years’ time
Considering the future of the CDIO role and what that might look like in 5-10 years’ time, Will said: “I think as digital professionals we’ve historically probably made it harder and less fun to be a clinician in the NHS, and as a collection of CDIOs we’ve got an opportunity to redress that balance and make it easier and safer for people to deliver care again.”
Taking away the admin burden in relaying all of the information around care provided on to digital systems, and having that become “just a part of what delivering care looks like”, would go a long way, he considered. “So instead of having to record when a patient is sent to theatre, having that automatically done in the EPR; instead of having to write a letter at the end of every clinical appointment, having that done by Ambient scribe; or instead of having to log into seven different systems to get your discharge summary, having something that can surface all of the information you need about that patient; that will allow people to do the jobs that they were trained to do. That will mean moving away from this role as data clerks, which I think has been a big part of what it means to be a clinician in the NHS over the last five years.”
His dream for the CDIO role is “that it becomes less about the technology and more about enabling people to do the jobs that they were employed to do,” Will shared. “If we can do that by making it way easier to be a finance professional in the NHS; if we can do that by making it way easier to be a nurse, a consultant, or a resident doctor in the NHS; that for me is the most exciting thing.”
We’re also getting to a point where “people are starting to realise that an EPR deployment isn’t the end of the story,” said Will, “and actually what we’re going to need, collectively, is products that we can continue to iterate, continue to innovate with, and in the same way that we give teams across our organisations the power to redesign pathways and look for opportunities to improve quality of care or save money; there’s no reason we can’t empower teams to innovate and iterate on the products themselves, and configure those in a way that supports them performing their roles.” The CDIO role can become “about actually empowering people, rather than about just delivering and maintaining a tech stack,” he concluded.
Overcoming barriers to digital
Considering what barrier to digital he’d like to overcome at UHL and UHN, Will shared: “Over the next few years, it’s likely that we’re going to deploy a lot of technology into our organisations, and if I had a magic wand, I would do my best to make sure that every single one of the 30,000 colleagues we serve was confident to use that technology.”
In some ways, “the easy bit is for us to deploy the technology,” he went on, “but the hard bit is to do the transformation off the back of that – having our colleagues be confident in the technology and the systems that they’re using, and how to get the best out of them, is key.”
There’s no way that a CDIO or any one person on a board is going to be the answer, Will told us, “but if we can get technology into the hands of people that are closest to the problem and need to use it every day, I just get so excited for what that might mean and the changes we could bring across UHL and UHN, and also the wider NHS.”
We’d like to thank Will for his time, and for sharing these insights with us.
