Panel 1 | Health Care 4.0 - A Vision For Smart And Connected Healthcare
Speakers: Matthew Hamilton, Director, South London Partnership | Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board | Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University | Paul Kirkbright, Head of Knowledge Exchange and Partnerships, South London Partnership & BIG South London | Tracy Monday, Global Solutions Executive, Verizon | Dr Rishi Das Gupta, Chief Executive Officer, Health Innovation Network South London
Matthew Hamilton, Director, South London Partnership
Covering the five boroughs of Croydon, Sutton, Merton, Richmond and Kingston, we’ve got this morning’s panel members. Sandra, can we start with you?
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
Hi, I’m Sandra Dudley-McEvoy, I’m a Professor in Communications and Director of the REACT Innovation Centre here at LSBU, which is the research and innovation centre that looks to mix with large companies, startups and researchers across a couple of universities.
We look at the impact of 5G on innovation across health tech, manufacturing and energy sustainability, which is all integrated now as we can’t have one without the other and that’s why I’m on the panel today.
Tracy Monday, Global Solutions Executive, Verizon
Hi, I’m Tracy Monday, I come from Verizon as their Global Solutions Executive and we’re one of the partners who have invested in the REACT centre we’ve got our technology team as an overnight technology provider.
We say there is no reason for dead weight, you need to know everything you’ve got and you need to get that information. As technology is becoming a lot more digitized, there’s more data and there’s more data security required, data solitude, data management, and so you’ve got to have the right infrastructure. So we came in to provide these structures to LSBU.
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
Afternoon, everyone. I’m Martin Ellis, I’m Chief Digital Information Officer for South West London Integrated Care Board. An integrated care board has responsibility for the budget and delivery of healthcare services across South West London.
I’m pleased to be here at LSBU on the Croydon campus. The creation of the Croydon campus is a result of the One Croydon Alliance, which I was involved in setting up when I was a Director at Croydon CCG, personally, my daughter is a third-year nurse here, so really proud to be here and I look forward to talking to you all.
Dr Rishi Das Gupta, Chief Executive Officer, Health Innovation Network South London
Hi, I’m Rishi Das Gupta. I’m the Chief Executive of the Health Innovation Network, and my passion is around how we use technology smartly and sensibly to try and improve health overall.
I always start by asking or talking about connected healthcare or connected health, because I think the two are slightly different and I know that South London in general, South Western in particular and this site are all quite core to that. So I’m happy to be on the panel today.
Matthew Hamilton, Director, South London Partnership
So Rishi, if we start with you. From your perspective, what would you say are the biggest opportunities for smart and connected healthcare to address system-wide challenges?
Dr Rishi Das Gupta, Chief Executive Officer, Health Innovation Network South London
I think that we’re seeing a real convergence of consumer healthcare in traditionally provided healthcare, and so we’re seeing people, I say people rather than patients, taking a lot more control over their health, and the desire from all of us in healthcare to enable that change to happen.
That means that people are generating a lot more information about what their healthcare is, they’re taking on more responsibility about booking appointments, thinking about what’s going next for them in their interactions with healthcare and doing a lot more of that through digital channels.
I’m not sure that we have been as fast to adopt that approach in that mechanism as some other industries, but we’ve now got some of the equipment and some of the critical infrastructure like Martin was talking about, how that can happen, and therefore how innovators can build on that to try and empower patients in that space. Whether that’s care in people’s homes, where they are at the time, using a mixture of perhaps consumer-level devices, or also some specific medical devices.
The key points that I’ll stress are convergence, consumer healthcare and traditional health. The fact that now within the NHS and healthcare delivery environment, we are thinking about how to integrate with things outside of our control, and the improvement in our internal infrastructure to allow that to happen. The first things that are coming are around linking data that people are generating with what is in the health record.
Matthew Hamilton, Director, South London Partnership
Thanks, Rishi. So Martin, how can digital technologies be leveraged to bridge the gap between healthcare and social care systems?
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
As Rishi said, there is this convergence across personal devices, healthcare and social care. How many in the room have the NHS app on their phone? Isn’t that amazing. That was something that was rumbling along, and then COVID came and we actually needed it, and it’s become really important to us now, it is the front door to the NHS digitally.
There’s an ambition to take that a lot further. In South West London, 62% of people use the NHS app, and you can use it, I do, to get repeat prescriptions from your GP, book GP appointments, and answer questions to get through to 111. You can now, access your appointments in hospitals, you can look to change appointments, you can do that, but the service has got to be able to cope with that.
Technology is one thing, but we need to change the way we work to make technology work. While we have the technology, we need to rework services to match that. There’s a big future in how the NHS app enables access for people and a big shift in the dynamic of how health and care are delivered going forward.
It has been treating three objectives, analogue digital healthcare, moving away from reactive to preventative care and trying to deliver more support to people in their homes, rather than bringing people to the hospital. Technology, and we’ve seen it through COVID, these big changes can address that, so there’s a massive opportunity in that space.
Matthew Hamilton, Director, South London Partnership
Was it just a system change in terms of people’s opinions? COVID happened, the NHS app was always there but people suddenly started using something that works well, or is it actually a case of people accessing that in a more comprehensive way, and actually the app keeping up to date and working well?
Was it always working well, or has it started to improve in the last few years? Because, I have to say, as an app it is really extensive.
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
We all needed a COVID pass and you needed the app to get that. There was a need for change and that brought a critical mass of people using the NHS app, and that meant we were able to do further developments, and we’re seeing the growing use of the NHS app. There certainly is a future for how we connect other things to that.
There’s this dynamic shift around a paternalistic healthcare model towards a partnership with people on how to sort of manage our care, and we need the technology support that the NHS app can do to help with that connection between clinicians, services and individuals.
Matthew Hamilton, Director, South London Partnership
Building on that, what are the steps and strategies that can help ensure the right viability and scalability of technology across both private and public healthcare?
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
In the NHS, we’ve got a lot of statutory organisations at various stages of maturity in their infrastructure, their technology, etc. So trying to get everyone levelled up to a consistent baseline on the IT systems that they have, is the first step. We’re working on that, and there’s been investment nationally over the past few years to do that and to make sure everyone is consistent.
But we’ve got to go beyond that, we’ve got to look at how we bring all that together. How do we integrate that? How do we bring the data together and use artificial intelligence to make sense of that data or to support how we get information in, and how we take information out? Getting the foundations right so that we can safely march forward with this new space is critical.
Matthew Hamilton, Director, South London Partnership
Thanks, Martin. Sandra, we’re in a fantastic higher education institution today. How do you feel that education institutions can collaborate with healthcare systems to integrate innovation? How can we ensure that partnership works most effectively?
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
I come from a technology background and we’ve always looked at the idea of technology. When you started with technology 20 years ago, research was about 10 years ahead of technology and its implementation. Now it’s six months.
Of course, NHS and healthcare workers are dealing with the day-to-day job, of looking after people. Universities are unique because we do research, but we also teach the next generation, whether they’re doctors, nurses, engineers, or computer scientists.
Efficiency in the health tech and health care system is not the removal of people, but the addition of different aspects of expertise to create a better system. It shouldn’t be that doctors are sitting there going, how the hell am I going to learn about AI? It should just be a doctor able to trust the AI that they see in front of them, and they should be able to work with my computer science colleagues and engineering colleagues to make sure they’re getting the right technology. At the end of the day, the patients have to be better.
We’ve come across in research that we’ve become more multidisciplinary. Every sector of work has to be the same, not everyone can be a master of all things. Therefore we’ve got to become more efficient in the way we work with each other, rather than trying to make someone a jack of all trades that will get us nowhere.
Universities are unique because we’re building that multi-disciplinary group of people coming out, but we also have outreach, which reaches out to young people who don’t quite know where they’re going in life.
Just this morning I was talking to someone about smart manufacturing and distributed smart manufacturing on hospital sites, about making things in the basement that goes up into the operating theatre. He was working with beetles, trying to use the brilliance that beetles have done to evolve with their little antenna, to make new products for surgery.
Just the thoughts of what young people can come in with a mechanical engineer or a young girl or boy coming in thinking ‘I’ll end up in a hospital environment because I’m a brilliant mechanical engineer’, and that’s where universities come in and why we work at a reactivation centre for big companies because they have resources to support us, to take those young people through.
If you don’t expose them at a young age, there’s no point in me turning around to an 18-year-old and saying, ‘You should do engineering, get about it.’. You have to start very young. If you started young with the idea of a multi-disciplinary nature, rather than trying to make people a Jack-of-all-trades, because that can’t work, they won’t know where they want to go.
But if you invest in multi-disciplinary work and you invest in multi-disciplinary kids, then you have much better outcomes. Universities have those research labs, and schools have them, that’s what’s important.
Matthew Hamilton, Director, South London Partnership
And to what extent are you seeing that cultural shift?
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
Massively, because people are now demanding more from their health. We used to say customers speak with their feet, actually, now they speak with their fingers. What they’re looking for is, ‘I know I’m healthy, I just need confirmation of that. But when I’m not well, what do I do, and how does it work around my hours?’. You’ve got a massive system that is trying to adapt to that in the healthcare sector, but we’re also doing a day-to-day job, which is hard, and you’ve got a new sector, where you’ve got estate managers, clinicians, patients, all working together.
This is the sort of bandwidth that I need to do my job properly. I need my WiFi, I need my monitor to work, I need this to connect to that. That all relies on really strong communication systems, and it’s not what it used to be, where you get an estate manager, and they only deal with what the building looked like now they need to be IT experts. They need to understand where’s the future of this, and what’s it going to look like in 10 years, or if I put something in, do I have to print that out?
With graduates coming through, they’re facing that all the time and young people coming through now are far more adaptive to new technologies, and they haven’t got loyalty like we used to have to a particular type of brand or technology. That’s a big game changer in education.
Matthew Hamilton, Director, South London Partnership
And how integrated would you say that smart, connected approaches are within some of the teaching?
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
You have to adapt. If you do research, you know what’s coming, and either you’re doing it or somebody else is doing it, so you’ve got to adapt that into the teaching. If you’re not, you’re not giving your students the best outcomes, but also the research projects are important, and we speak to clinicians, nurses and practitioners, about referring to invent some AI we want to develop with them.
It’s becoming much more hands-on, and because of the availability of image data, everyone wants to know the answer or what’s the magic. You’ve got far more access to data and being able to apply AI techniques, which brings big changes. For example, screening and being able to monitor people at home.
You’ve got a lot more innovators just inventing in their room with their computers and now their access to be able to sell what their capabilities are. It is a seller’s market in terms of graduates and being able to hire people. I look at it from my perspective, I’m looking for a researcher and it’s much harder than most because they’re going to the private sector.
Universities have a lot to do to catch up and make sure that we keep the innovation up, rather than just selling to universities or creating research. It’s not just inventing something, it’s a whole ecosystem around how you invent and how you do research, so we don’t want to lose that skill.
Matthew Hamilton, Director, South London Partnership
That gives us a nice segue to get a private sector perspective. How can private sector players like Verizon support the NHS in transitioning to smart, connected care models?
Tracy Monday, Global Solutions Executive, Verizon
We already do, we’ve already mentioned AI, collaboration, multi-disciplinary and engagement. Artificial Intelligence doesn’t take away from quality patient care, it just makes it more efficient.
You can use AI to watch patients in their beds and see if there’s an issue, then that can automatically alert a practitioner somewhere within that floor, or find the nearest one to go. AI is already doing automatic learning, in the same way, it will continue to update and learn. All that does is enable the resources you have to do the job they want, but it’s not taking away the amount of data you can collect through AI, IoT, variables, applications, everything that’s currently available through digitisation, you need the right infrastructure to make sure that data can stay.
We’re working within the REACT centre to bring other big manufacturers and technology companies to ensure that we talk about information and that security information we don’t know the information we just buy the road. We don’t buy the cars or the drivers, you guys buy cars, we make sure those cars and drivers will all go in the right direction and don’t turn into anything catastrophic.
Technology is driving that efficiency, and it will continue to drive efficiency and power, and in more ways, it helps us. One, we get to see the problems that you’re trying to solve by bringing in a new service or solution. For example, if you want to embed something, you need to be able to test it for the future with speed. This change has gone from years of leading technologies to using AI to build an app in under a minute.
We can’t constantly keep changing and we need to have that infrastructure and be able to collaborate. The way things are changing and the way research is coming out, we’re refining. We have a bench cap, 6 to 4% of businesses bought today have already got AI in their business, it’s not unless you improve productivity and efficiency. The same goes for the NHS, it can transform any mundane process or task that those people are doing, but to embrace technology, you can’t change the processes and their development.
Matthew Hamilton, Director, South London Partnership
So to a certain extent, is what you’re saying, that actually the data is there, it’s how we use it?
Tracy Monday, Global Solutions Executive, Verizon
In most cases, yes, the data is there. Data is being created and every set of data creates another set of data and creates more and more data. You can constantly mine that data, so using AI to do that more efficiently, to give you the results, to give the patients a better outcome.
It’s about how we use the technology to apply care outcomes. You haven’t got resources to constantly walk around wards stopping to talk to every bed and every person. So why don’t we use technology to do it for you? The data is growing massively, and I think it increases 22% year on year. You can use AI to take the data or actions, whether it’s the running of the building or it could tell you that you’ve got an MRI scan that’s about to fail because it can tell how it should be working when it’s performative.
Matthew Hamilton, Director, South London Partnership
We’ve talked a lot about looking forward, what would you all say the most exciting advancement is in smart and connected healthcare, looking forward?
This is where we want to hear about the new stuff coming down the track that’s going to be transformative or on the cusp of being transformative. Does anybody want to start with that?
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
Ambient AI is probably on the tip of everyone’s lips, particularly in healthcare, and that’s essentially where the technology will listen into a conversation, and that conversation will be summarised and injected into the patient record system, and it’s been trialled in Great Ormond Street, successfully in outpatients.
What it does is it starts to reduce the time that clinicians spend keying information into the EPR, at the moment, that’s about 25% of their time. If we can get that down to below 10% that means we’ve freed up almost a fifth of their time to do clinical work, and that’s important. That will give us better productivity for clinicians, but also make it a more enjoyable place to work. So ambient AI and generative AI will be starting to heat up in terms of health use.
There’s a broader opportunity to work more closely across health and social care. We were commissioned a few years back to create what’s called virtual wards, and that’s to try and support people to be independent at home after hospital admission, particularly by monitoring their vital signs in the home setting, and if something happens, then acting on that.
For many years local authorities have had people on telecare, which is called alarm pendants, etc and that’s changing to a digital solution as well. But you know that the 20,000 people on telecare in South West London are the people that health is worried about the most. We need to start to work closely and use the technology platforms so that we can collaborate to support people more collectively at home. There’s a big opportunity to do something like that across health and social care going forward.
Dr Rishi Das Gupta, Chief Executive Officer, Health Innovation Network South London
I think you’re right in terms of clinical, ambient is the thing that’s right on the tip of everyone’s tongue at the moment, and real excitement around ambient voice technologies. There are a few other areas though, that I would highlight.
There’s a no-brainer in terms of buildings and environment management and all the HVAC systems and trying to adopt new technologies in those that also speak to the green agenda and the Net Zero agenda. That’s definitely coming down the line.
There’s a big area around workforce management because we’re not talking about clinical risk in the same way we’re talking about a set of technologies and digital tools which have been proven in other industries. The ability to bring those into an industry which is largely about people and about managing large numbers of people delivering care is exciting, and there are a lot of opportunities there.
The third area is in non-clinical AI. A lot of the administrative tasks and how those are adopted, and again, some of the regulatory tests that we would apply are easier to overcome in non-clinical AI. Often the fact that you’re doing administration does lead to clinical risk, but they don’t completely disappear, I don’t want to give that impression. But that’s another exciting area.
All three of those areas are important, and all of them are underpinned by a data layer, which we’ve been developing a lot of in London, and the OneLondon Care Record. The approach that we’re taking there pulls together a lot of the data from clinical encounters in a way that we can then go back and say, ‘Well, actually, who is underserved by the current systems that we have, and how do we redesign systems to serve them better?’.
The two big data pools that I would highlight are the OneLondon Care Record, which we have here in London, and we’re hoping to get access for a lot of the universities and then the second bit around imaging data, which we’ve taken a lead in London about how we do that.
Matthew Hamilton, Director, South London Partnership
Thanks, Rishi, Other things that are making you excited in this environment?
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
Imaging is one of the most exciting opportunities, and imaging that’s not based on going into the hospital or for treatment, and having a big machine scanning you up and down. Non-Xray and non-ionizing systems have a huge place to play.
Connected to your phone, it’s incredible what we can do and what we can record, and the ability to access data and identify outliers in people before they have any sense of what’s happening to them, and the automation of that and driving that back to your GP surgery in an automated system. You can predict diabetes problems, heart problems, and heart failure issues.
I’ve seen what’s been developed in other countries, it’s incredible. What we’ve got to do is drive the infrastructure that enables that, and the testing of that and the language that will come that will be universal for us, to drive that around the workforce planning as well and what will it sound like? What will we call it? What will be the words that make sense to everybody? Because no matter what you call AI it doesn’t mean the same thing to everybody, and so we’ve got to get into that common language.
The ability for people to go back and trust the technology, that’s quite a game changer coming in, that they can start seeing the impact it has. But it’s not just the impact it has, you’ve got to trust what you’re seeing. Those are massively impacted by workforce planning, that’s a big thing.
No one would think when you talk about AI and you talk about technology changes, it’s the workforce that will make that difference. Everybody, when you talk about industry and efficiencies, it’s usually getting rid of stuff, but this is where we need more people to embrace this.
Tracy Monday, Global Solutions Executive, Verizon
I try not to get excited about technology innovation, I always remain a little bit cynical and ask myself, ‘So what?’. Technology has changed so fast, so how do we embrace that for the good and the stuff that we’re doing here and the stuff we do in care homes, how do we keep people at hospitals? How do we treat them better where they feel more comfortable?
That saves money, but it has an environmental impact on travel. How do we treat people more remotely, but don’t lose sight of the human element of that? Technology is great, and I’m excited about the way it’s allowing collaboration and communication.
People don’t have to travel distances to get treated, they don’t have to travel distances to see people and treat them, but they still give them time back to do what they’re supposed to do. The human element, as Sandra mentioned, is quite critical.
We don’t have enough people qualified to do what we need them to do. We need to make sure that we use the right technologies to make their life easier so they can do the job that they were brought to do. Nobody goes into healthcare because they think they’re going to earn a load of money, or they’re going to be the inventor of the next AI, they go in because they have a desire to help, and if it doesn’t help, why are we doing it?
Matthew Hamilton, Director, South London Partnership
Thank you. Does the audience have any specific questions?
Question from Slido:
How do you see patient digital education being delivered, and how do we ensure we’re not widening the health inequalities for those not able to engage with tech?
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
It’s a challenge, but we’ve been working with the voluntary sector across South West London to go and engage with those harder-to-reach communities, particularly around the NHS app; how to use the NHS app, how to get onto it and navigate around it. We’re investing further in that going forward.
It’s important that we don’t leave people behind. Technology is fantastic for most of us, but some people just aren’t there with it. We need to make sure that we help and support them to use technology, but they have an alternative to technology because not everyone will be able to use it.
Dr Rishi Das Gupta, Chief Executive Officer, Health Innovation Network South London
The reason is that there are two sides to the coin on this one. First, I think Martin’s right multi-channel will be the way forward for delivering patient information and education over time.
Digital is a really important component of that, and I suspect, does more good than harm. It broadens the number of people who can access information, increases the number of languages that are available, it’s easier to translate tools that are there, and also gives more access in different forms and different sizes of information.
It allows us to test whether or not people have absorbed information and lets us provide information at a time that’s convenient for them. The time that is least convenient for me to learn about a new medical condition is the panic moment just after I’ve been told that I’ve got a new medical condition, which is when we’ve traditionally done it. So I’m much more excited about it than thinking about the limitations.
The reason it sparks a momentary reaction in me is that the question implies that we’re doing it perfectly at the moment, and if we’re only doing it in places where we’re currently delivering healthcare, and we’re requiring people to travel there if you’ve got mobility issues, problems getting into the buildings, if English isn’t your first language and you’re speaking to somebody who’s explaining it in English, those challenges are huge.
The final bit of the puzzle is if the new ways of delivering information are at a lower cost than the current ways of delivering information, perhaps we can deliver an hour’s worth of training online, but at the same cost that I can pay for a healthcare support worker to do 10 minutes of work and I can deliver care in a cheaper way that frees up resources to target care to those underserved populations at the moment.
At one level, I recognise the importance of the question, and at the other level, I hope we can move beyond it to think, about what more we can do with the technologies that are available and monitor where we’re having an impact with it, so that we don’t leave people behind it, or we mop them up and not provide services to serve them better as well.
Tracy Monday, Global Solutions Executive, Verizon
The other thing that you can think of when you’re looking at how you can use these technologies is companies like ours. We commit to providing as part of our CSR programs, digitising skills for disadvantaged children all over the world. We’ve provided technology and training to a million disadvantaged people to date, and that’s part of that. You can work with industry partners, and part of the procurement requirements should be, what are you doing to help our local people digitise?
At the same time, if you take someone like my mother, she’s got WhatsApp, and I’ll send her a message, but she’ll phone me back. You need to understand how different people want to work with technology. Pretty much everybody has technology, but not everybody wants to use it in the same way. It’s being able to adapt your processes to deal with that, to make sure everybody’s inclusive.
I don’t know many people now who don’t have a smartphone of some sort or can’t use it, but not everybody can. Lean on companies like ours that are working with you to make sure that we’re committing back to the community.
Professor Sandra Dudley-McEvoy, Professor in Communications, Director of REACT Innovation Centre, London South Bank University
Technology is there, it’s obvious. But, for example, if you have a 75% target, and you get that target, it’s the 25% you should be worrying about. The biggest fear I’ve seen with people is it’s not the technology, it’s when it doesn’t work, what happens when it doesn’t work?
If an app doesn’t work, where’s the phone number to ring and get a voice at the other end of the phone that will answer me and tell me what I need? When you build that infrastructure, you have to build what-ifs, and they have to be cemented into that system. Everyone involved has to make a promise that it will work, that people who don’t fall through the hoop keep falling through the net and continue to become isolated, and where the AI will help, you will be able to identify the things that are going well. You’ll be able to identify the things that are not going well.
If someone’s not interacting with your system, they’re not on your AI target anyway, so you’ve got to maintain traditional methods, and that should be an obligation on anybody’s part. You keep traditional methods, someone should still be there to answer the phone until that day ends. I don’t think it will ever end, but you need that because if someone unplugs a big network cable somewhere, we’re all back on the phone tomorrow to try and meet our targets. We’ve got to make sure that’s embedded.
Martin Ellis, South West London Chief Digital Information Officer, South West London Integrated Care Board
I heard someone speak last week about the older population and how they engage technically. They all have smartphones, but they don’t use smartphones for apps, and they won’t respond to things necessarily on a smartphone, but they’re very high responders to email. It’s even the digital channels we’ve got to think about that we utilise and make sure we can cover those needs.
Paul Kirkbright, Head of Knowledge Exchange and Partnerships, South London Partnership & BIG South London
Thanks very much. I managed to avoid my last question, which is: are we finally seeing the back of fax machines? So that’s all good. Could I ask all of you just to put your hands together after a fantastic contribution from our great panellist?
