Welcome back to our podcast HTN Let’s Talk, sponsored by Spirit Health!
For the latest episode, we interviewed Pritesh Mistry, policy fellow for digital technologies at The King’s Fund. We discussed digital priorities for the NHS, the opportunities for integrated care systems, challenges in interoperability and more.
To start off Pritesh spoke about his current role and career background.
Pritesh used to be a physicist and an engineer working on scientific apparatus, focusing on imaging cameras for space applications and life science applications. “I worked on imaging for very small things like cells, and I also did imaging for really big things like stars and galaxies – some of the stuff I worked on went in the Mars Rover and the Hubble Space Telescope,” he shared. “It sounds really exciting, but in reality I actually spent a lot of time in a darkroom testing cameras.”
Moving on, Pritesh worked within green energy for a while, on the development of renewables and buildings. About 10 years ago, he began working in the NHS, in innovation, research on entrepreneurship and transformation, “building collaborations across different stakeholders to get new things happening in the NHS.”
The King’s Fund
Pritesh works on the policy side of The King’s Fund, researching what is happening around digital technologies and how they are being used – or not used – in health and social care.
“We use that knowledge to comment on or provide feedback on policy initiatives that may be happening through NHS England or Department of Health and Social Care,” he explained. “How can they be improved upon? How can we make sure that they work for staff and for patients? We use the knowledge that we’ve gathered through the conversations we have – with staff, patients, carers – and try to make change, or improve how things are being funded or prioritised.”
In September 2022, The King’s Fund published a report on interoperability, examining “how interoperability is a 20-year challenge,” Pritesh said, “and what some of the solutions and ways forward might be.”
There is also a review underway on digital transformation in the NHS. “I was invited to the House of Commons to provide evidence to the Health and Social Care Select Committee,” Pritesh explained. “It was great to input some of our findings around interoperability, but also some of the conversations that we’ve been having in the system.”
The King’s Fund is “putting some final touches to some work around digital exclusion and inclusion,” he added, noting that although this topic is very important it can sometimes be oversimplified. “There’s a misconception that as soon as everyone is online, that’s the problem solved. I think actually it’s a lot more complex than that. We’ve been speaking to about a dozen members of the public to understand what their experience expectations are. We’ve also run a couple of workshops with NHS organisations, charities and local authorities, to try and understand what they are working on, and what we could do more of on the ground.”
From this work, it’s then a case of using findings to influence policy. “There’s a lot of talk about how the NHS might need to be more innovative and how it needs to use more tech. But what does that actually take, and what does that mean? How can tech actually change some of the structures and the systems that we have in the NHS, and how they work?”
Digital in NHS priorities and operational planning
Moving on to discuss the role of digital in the NHS priorities and operational planning for 2023/24, Pritesh said that it was good to see “levelling up of digital infrastructure and improving connectivity within that guidance. It’s not a headline grabber, but infrastructure and connectivity are really the backbone of reliable digitally enabled services. You need them in place if you want to build cutting edge tech on top.”
He commented on the importance of having a baseline capability in place, noting that this is fed into the What Good Looks Like framework. “It’s due to be updated this year, and that will then feed into digital maturity assessments,” Pritesh said, which will then help measure what digital progress looks like in provider organisations. “It’s really promising because it looks like it will also take into account aspects that are beyond technology. It’s not just about having electronic health records or WiFi in place, it’s about whether the digital transformation is well-led – not just digitising existing ways of working, but making sure we’re using them more effectively.”
He also highlighted the NHS App for its role in helping patients “get to the right service and access records, and improving prescriptions and hospital appointments booking. We’re seeing more and more capabilities being built into the NHS app, which is going to be great for for patients.”
Two aspects that Pritesh says are “less well-formed” within the NHS’s guidance for the months ahead are the roles of federated data platforms and the faster data flows initiative. On the first, he said: “The tender was released recently and it’s a national procurement, so it’s going to be a national tool that is made available. The intention is for the platform to help maximise capacity and reduce waiting lists – it’s an intelligent way of prioritising systems and workflows.” On the latter, Pritesh noted that there is less information available at present but ultimately it will come down to applying technology to reduce the reporting burden on staff. “It’s about having more automated data collection and reporting,” he commented. “That will help to reduce workload on staff and free up time, which hopefully should translate into more time for patients.”
Opportunities for an ICS from a digital perspective
Pritesh highlighted that it is anticipated that integrated care systems will receive funding to meet the minimum digital maturity requirements – mostly focusing on “basics around electronic health records and digitalisation of social care records. But it’s upon those that you can start building data led insights, prioritisation and intelligent waiting lists.”
This will provide ICSs with good opportunities to “bolster the baseline digital capability across the footprint. There’s a really good opportunity to start laying the foundations to make sure that the digital capability across the ICS is to a good level. It’s not just about being highly digitised in general practice, for example; you want a good level of digitisation across the patient journey.
“On top of that, you can start utilising some of the data-led aspects, you can build in population health management, you can improve population health data and analysis and start feeding that into your systems. Then you can make better decisions based on that information.” This can also lead to improvements such as risk management of populations and falls reduction, Pritesh added.
Coming back to the challenges around interoperability and how they can be tackled, Pritesh touched upon the report they released in September. “To be honest, it’s a huge issue and it’s been an issue for about 20 years.”
Going into this work, he said, The King’s Fund decided to look at interoperability across an ICS footprint, exploring how the components of a system work together. “We interviewed and ran workshops across the footprint – staff from hospitals, GPs, pharmacists, mental health trusts, ambulance trust, charities, local authorities, patients,” he explained.
They found that there was “no consensus” on interoperability. “What is it, what are the benefits? No-one could say ‘everyone agrees on this’. So one of the first things to be clear on is actually what we mean by interoperability, and what are the benefits we are trying to achieve? Without those, everyone is pulling in different directions and you don’t really make the progress that you might want to make.”
Interoperability is often seen as how technology gels together, he noted, and how information flows across technology. However, it’s not just about that. “We found that you need good working relationships. If people don’t want to share information and don’t want to work together, then it doesn’t matter how good the technology is, it won’t happen. You need people to want to share information as well as needing the technology to make it as easy as possible. Those two factors are of equal importance.”
You also need an enabling environment, Pritesh continued, acknowledging the importance of factors such as reliable funding, effective workflows and processes, and standards that people can understand. “We ended up moving away from some of the standard definitions of interoperability,” he said. “We would define it as how people, systems and processes talk and work together, across organisational structures and professions. It’s supported through technology. It’s a culture, it’s a way of working, and that needs to permeate how people in the system work; how professionals trust each other, how leaders work together to protect organisational capacity to share workforce.”
It’s also about making sure change management is there, and making sure that “when you procure technology, you don’t procure technology for an individual organisation,” Pritesh continued. “You need to think: ‘OK, how is this going to link in for GPs? What does it need to make sure it can be linked into pharmacists? What are the baseline features that we are trying to get across that ICS, and how do we make sure that every time we buy something or update something, it can be linked into all the other parts of the system?’”
How does an ICS foster innovation?
ICSs taking a directorial role and providing a vision from the top can support innovation, Pritesh observed. “But it’s about taking that top level of vision and direction and combing it with bottom-up inventiveness of staff – we need that to percolate through. We need to encourage providers to support their staff to explore and find alternatives, to have opportunities to look at technology. They need to be able to play with tech and think about how it might work for them.”
ICSs could also help with protecting time and supporting staff with access to education, skills and opportunities to play with the tech, Pritesh noted. “It’s about convening people. I regularly say that the one of the under-utilised superpowers of the NHS is the knowledge and the expertise of the people, the staff. Being able to create a peer group of innovators across the ICS to be able to support each other, to navigate technologies being deployed and being optimised, is an amazing opportunity that doesn’t really happen in the way that it could.”
It’s also about linking innovators to an industry network, he added; whilst staff often have great knowledge of workflows, patients and challenges, they may not know much about the technologies or the potential there. “It’s about bringing groups of innovators in alongside a network of industry and tech people, and marrying the two to create solutions. This could really add benefit to an ICS and how innovation is fostered in an ICS.”
Ultimately, Pritesh said, “It’s something about creating this as a normal thing to be doing. Starting small, normalising change, working with little projects, continue to improve services and creating a culture that recognises that changes are important and needs to happen. Standing still is actually going backwards; it’s key that we embrace change and we become used to change happening.”
Elements to be successful for innovators breaking into the NHS
“There isn’t a magic formula,” Pritesh said with regards to how innovators can break into the NHS. “We’ve seen some things work well, we’ve seen other things that don’t work so well in different areas.”
Trying to copy and paste solutions rarely works on the national level; more than anything, he said, innovators need to be able to show that their technology addresses real problems faced by staff and patients.
“You need to be aligned with national priorities – look at things like the digital plan for health and social care, or the NHS long-term plan, and understand where priorities lay and what each part of the system should be doing when you’re targeting your solution. Whether it’s at an ICS level, hospital level or social care level; what is it your solution is aiming to do? What problem is it actually solving?”
Pritesh also commented the necessity to have the right evidence base in place, and to ensure that you are aligned with the relevant guidelines, in addition to ensuring support for implementation and optimisation.
“It’s rare that you can either drop a technology in place and just leave it,” he said. “Often you need to support staff to understand how technology can be used, how the workflows need to be changed; you need to upskill staff to be able to use and optimise the technology as well. Then it’s about cultivating some of those staff members you are working with to become champions, to change ways of working and about pivoting solutions to fit the problem as well. Then you need to think about cultivating some of those staff you’re working with to be champions, to change ways of working and pivoting solutions to fit the problem as well.”
Many thanks to Pritesh for sharing his time and thoughts.