"How do we get the best from technology" Pritesh Mistry | Voices of Care
hello I'm sahal mza and welcome to voices of care the Health and Care podcast I'm delighted today uh to welcome my guest Brites mystery fellow at the Kings fun pesh welcome thank you for giving us your time hi thank you so much for inviting me voices of care the healthcare podcast it's a pleasure it's a exciting year for Kings fund news chief executive a busy year for Health and Social care yeah it's always bus and as you mentioned we now got Sarah at the helm so some exciting changes ahead I'm sure and your area of speciality I know you've worked within the NHS and the Royal College of General Practitioners in your career um the theme running through it for me is technology research Innovation so your area focus at the Kings f is very much around the technology piece yeah so my work tends to Encompass technology data and Innovation within Health and Social care uh so my background as you rightly say is is uh broadly technical so engineering and physics but a lot of the work that I now do is focusing on the enabling environment so culture leadership infrastructure so how do we get the best from technology so it's that sort of intersectionality between technology and the human absolutely yeah so the human factors the technology the culture and the environment are so important so we see a lot of amazing things with technology but that tends to happen in isolation and in pilots and when it hits the real world you don't often see that huge potential realized so what is it that we need to do to create the environment for that technology to get to have the benefits of patients in stad I think by the end of the podcast we're hoping with your wisdom we're going to shed a lot of light on that I'm going to start with a four-letter word if I me which is not often usual but the four-letter word I'm thinking about is data U because that's really a central theme running through all of these Technologies whether it's AI Etc and I want to specifically focus and get your view on the initiative of the Federated data platform it's a centerpiece for the NHS it it's a transformative technology potentially can you give us a little bit more context around that its roll out and uh actually where it sits in the policy uh Spectrum absolutely so the Federated data platform uh was procured at the end of 2023 um and I suppose it's trying to solve a historic problem with the NHS in that the digitalization the approach to the digitalization of the NHS is happened in silos so you'll have individual organizations or even departments digitalizing and as they digitalize the uh technology tends to be procured or purchased independently without consideration of how those systems may work together and so that's created uh systems so Technologies like software with the data captured in that which is in different formats and in different structures and they don't link up well together and so you might have information about a person in a hospital record in a GP record in a shared care record record um and in various other places as well and so the caregiver can't have a full view of what's happening to that individual where they've been and so what we end up having is is patients having to um tell the caregivers time and time again about what's happened to them and that can be as you might imagine quite difficult sometimes if if it's a a serious condition um also relies on the memory of the patient so the technology the Federated data platform is intended to pull all that information for an individual together in one place so the user the Health Care staff can access the information that's relevant for that person at that moment in time to be able to provide the best care possible and and it's been broadly welcomed um Matthew Taylor NHS confer welcomed it Dr Nicola burn who's obviously the National Data Guardian for Health and Social care says it will have a transformative effect and as you say it's there to drive um efficiency save money as well and think make care delivery more seamless it it's based on a couple of predicates though one of them is to have sufficient level of trust uh in terms of it's one's personal data what's being done about that and that's is a legitimate point that people have raised yeah so I mean there are a few dependencies let's call them there are both technical cultural and Trust factors that come into this uh focusing on the kind of the trust element uh um the NHS uh as a system has not uh been very forthright in engaging with patients and so we've seen a number of missteps when it comes to data care. data is the big one that was quite a few years ago more recently there was a GP dat data for planning and research purposes exactly uh and what we saw with those examples is the erosion of trust in the public and how data is used in the NHS in particular the GP data planning research purposes that showed an uptick so an increase in the number of people opting out of their data being used in the NHS and what that means is that people are less likely to have their data and representative data which has implications for unbiased systems so uh systems that are equally effective for all um being used in in the NHS and now um what we're seeing is that there has been um move to try and increase trust in the NHS so the Federated data platform is for direct care purposes so people can't opt out of their data being used for for that U application however it's not just a Federated data platform there are uh additional uh contracts that have been provided around privacy enhancing Technologies so that should improve the Privacy the security and enable uh tracking and and uh understanding which staff members accessing data and for what reason so that should improve uh trust in how dat is used and there's also uh approximately 2 million pound worth of funding that's been allocated at the end of 23 so 2023 all around patient engagement and uh public trust so that's going to deliver on the three commitments from the data saves life strategy so that includes things like transparency statement uh data packed and standards for public engagement which is fantastic to see I I I think that's absolutely necessary it's the right thing to be doing um unfortunately those commitments were due to be delivered in March last year so March 23 we're now in March 24 so that should have been delivered 12 months ago it's great to see that it's actually moving now and something is happening but alongside that 2 million the uh what's going to be covered has been expanded as well so my challenge with that would be yes absolutely necessary it shouldn't be a one thing or onetime thing it needs to be ongoing and we need to make it meaningful so not just kind taking off things but meaningful ongoing conversation with publics and the patient as we've seen in various different parts of the country like London like Manchester uh fley as well so amazing stuff happening but it needs to be supported no absolutely and I think that's a it's something that we'll keep a close watch on I'm sure uh and I think it's part of this broader piece where technology has really been a central element we've had the budget of course um March budget in 2024 significant increase in investment uh planned over 2025 26 over three years um but I want to take up the trust point that you've talked about um and broaden that because the tech technological transformation is vital the government have put a lot of money behind it it's been trailed in many policy areas um but we also need to understand the impact on the leadership within the NHS Etc uh and you've written before very eloquently around the disruptive impact of technology on leadership can you can you explain about that because I I I loved your analogy it's very rare I see um commentary that will quote Elvis uh and we need we can't go on with Suspicious Minds it's and the role of leadership and Trust both within the stakeholders that work within the NHS and the public can you just expand that's a really important Point yeah so um so the trust is super important and when we're engaging with the public it should obviously include the staff and the leaders then the leaders know how to support their staff and the staff know what patients and the public expect um and going back to what I was saying that the the NHS has been digitalizing in silos so you get um often what happens is that you then have technology that that is developed and delivered in a particular part of the system so for for example if you have GP practices that highly digitalized but hospitals aren't then you find that there's Ripples and there's impact that causes burden on staff and it causes more pressures in the system that has knock on implications for staff and for patients and so your your hospital sends letters to your general practice you have general practice has to scan them in and that takes tear and time it's inefficient it it doesn't work well and this this is because parts of the system uh not working collaboratively and not working well together uh so going back to to what I was saying about digitalizing in silos what we're seeing is that When leaders step into that space and work collaboratively your systems that you're buying are purchased with the intention to work together so distributed because the funds are distributed across many different um aspects of the system that's that yeah the funds are distributed but also the the requirements for the technology are distributed so rather than saying this technology is absolutely what we need it's also thinking what's the tradeoffs if it's absolutely what we need but it's not going to join to the other parts of the system then actually it's going to cause other pressures so if we think about things like uh virtual WS for example um we're now moving into an era where the technology um it pushes against the boundaries so virtual Wards you'll find that the money comes into hospitals generally that means that your resources lie there they can increase their number of Staff they can deliver the care but then the patients will be in the home in the community that means there's potentially more work for community staff that money doesn't go to them but they're holding more risk and so where we've seen it working really well is actually those parts of the system communicating together with the leaders helping to bring parts of the system together moving towards a shared goal and in doing that it works out better for staff and for patients and there the sub theme within that in making sure systems speak to each other um interoperability you've talked about it's a bit of an Arcane subject um however that too is not just a technology issue it is also around relationships absolutely so if we think about technology as a sorry interoperability as a technology issue then you can tick off your computer systems and your data and your data formats and you soon get lost in technical uh jargon but what you find is it still doesn't mean the data or the information flows what we find is that people who want to share data will share data and will share information the technology needs to help but really it comes down to people trusting each other different professions from different departments and different organizations trusting each other having that uh agreement of information governance in place the technology helps that but if you know how other people are going to be using that information and it's going to be for the benefit of the patient it's going to be shared and that's also going to that has a big we've had the messenger review now for some time the importance of leadership so this plays into this and there's going to be some very important training and development that's going to be required in terms of this intersectionality of leadership and Technology absolutely so I think uh there's going to be substantial changes to leadership because of technology part of it is how people work together but also it's how do you uh share responsibilities how do you share the burden how do you share the risk when it's going to be distributed unequally across different organizations and different departments um and then is also how do you start creating more of a a holistic culture uh Department level organization level but when you've got staff that are potentially on site and offsite and different professions and new professions coming in it's all changing you've got underpinnings of digital so leaders need to be able to use digital and be familiar and confident with that to be able to engage with staff in a two-way conversation to create a good cohesive culture uh watch this space I think it'll be interesting um I want to just expand the conversation slight we've talked about the public and the importance of trust how data how technological interfaces are now going to impact Community Primary Care tertiary care acute acute care um there is been a large uh increase in registrations on the NHS app big increases in visits to the NHS website but there is of course an issue around digital inclusion uh the NHS have issued a framework on this point um there are significant numbers of people uh in our society that don't have the or either offline and find the challenge of interacting with the NHS quite significant and there are those people are not yet sufficiently digitally literate can we talk about how important as a golden thread in my view inclusion plays in this whole digital transformation absolutely so I think it's important to remember that Healthcare traditional Healthcare before digital was not perfect and now with the uh incorporation of digital it's improving but it's not one or the other it's both it's making Healthcare more accessible more impactful better outcomes a better experience for staff and for patients so digital inclusion is a is a key uh thread I completely agree we published some work in March 23 looking at talking to people talking to members of staff and trying to understand what's working what's not working and um I think there's a lot of misconceptions about the the the who was excluded and to be honest I think we need to take away some of those myths we need to stop thinking that there's particular groups and particular demographics we need to stop thinking that once everyone's online that will be solved because in reality anyone and everyone can be digitally excluded and by that I mean it's can be down to your personal circumstances so cost of living crisis increasing number of people unable to afford devices and data they're more at risk of being digitally excluded people who don't have skills and confidence will be digitally excluded but also we're talking about Healthcare as your health care changes you may have less physical uh dexterity for example less able to use devices and so as your health changes there's likelihood that you may become more digitally excluded and so what we need to ensure is that we've got services that are digitally enabled and tradition services that meet the needs of the public and so what our work showed is that there's three fundamentals there's your devices there's your internet data and then there's your skills and confidence and these are absolutely necessary to just be able to have be considered to start being digitally included but then it's not just those things it doesn't stop there it's also about how your services and your your digital tools are designed and this is where we need to start engaging with people so a lot of what we've heard is there are people who are very digitally capable they do their online banking one lady described her setup as something from Star Trek with multiple monitors and all sorts but she finds herself digitally excluded because the the tools and the services are not set up around how she needs them to be set up they're not set up co-developed and co-produced with her so what's absolutely necessary is those fundamentals but services that are co-developed co-produced with people in in in community settings and this means the NHS can't do it alone this includes a very important role for the voluntary sector that you talked about I think AB absolutely so the NHS can't do it alone nor should it there's a lot of good stuff happening out there there's a lot of communities that are around voluntary organizations and Charities so how can the NHS and we're seeing this in in parts and and they're doing so such good great work they're working with in part ship in collaboration with Charities and voluntary organizations to talk to people understand what their challenges are how they want to uh access services and then reconfiguring services to have your continued traditional Services uh midlevel where you've got volunteers and Tech in the in the public area and then you can use your Tech at home and that's your more high level Tech uh service and by having that optionality means that people can choose where they go they can help people to move up the digital ladder and we can continue to use services in the way that people expect and need I think the message for me there is that digital exclusion inclusion needs to be defined very carefully and going to keep a watching brief on it now you've talked about the voluntary sector we've talked about the NHS can't do this on its own we're very focused on the NHS here quite rightly we've had the budget for techn technological transformation Etc um there is a another segment of uh the healthcare landscape of course called the social care um and I just want to touch upon that briefly we just don't have the time to cover it entirely but I know that you I think your colleague Simon bodri have done some really fascinating work looking at the potential and already the um promise of Technology within a challenging social care environment um tell us a little bit about that I think you talked about there being a very wide potential uh for technology from whether it's going to be virtually assisted technology or helping with Hospital discharge yeah so um I'd say there's huge potential for technology in Social care unfortunately it doesn't have the attention and support that it needs uh so the current focus is around digitalizing social care so digital social care records and um Falls and prevention so preventing Falls and prevention um so there's a lot more work that needs to happen to support social care is uh a system as you rightly say so it's not just about the NHS it is about social care and how those parts of the system work well together um there's huge benefits that could be derived from technology and social care and people expect it as well um so it's about getting some of the digital Basics right unfortunately I would say that this uh similarities and challenges across the NHS and across social care so there's insufficient Workforce mhm um the workforce doesn't have the support and skills and education needed to be able to use the digital tools to the best ability uh there's a lack of digital infrastructure as well and you'll see this is commonality across the in the H review when they're looking at systems and the importance of having people are technically qualified in terms of data and Technology yeah absolutely and then some some of the evaluation I feel is incomplete and doesn't often look at uh the implications on social care so virtual War we mentioned already um when they're used in in some instances there's no evaluation on the impact on carers for example and there's a real risk that technology like virtual WS asks more of carers and that causes care burn out more burden on carers which then has knock on implications for the patients for the NHS and for social care as well and so we need to consider more holistically who's going to be impacted by the technology and how we make sure the technology works for all of those people something really interesting that came out of that uh Round Table was was around the potential for technology to do some of the stuff that we we often Overlook so technology is great it can do a lot but we and focus on the number of widgets but what we heard from one individual was the opportunity for technology to give her more control more Independence and we don't have metrics for control of their environment but they're so important to the human the humanity absolutely so there's a huge potential so she was speaking about how something very simple like a voice assistant can give her more control of her lighting and her blinds and all these other things that enables her to do that feels like she's much more in control of of what she has and what she can do and there's much more that technology can do but we just haven't really had the opportunity to do that yet but plenty of Promise within social care so much promise that that we should be pushing more towards absolutely um want to end now we've referenced Star Trek uh earlier um having grown up watching it space as the final frontier so here in technology we're going to have to touch upon Ai and large language models as the New Frontier maybe the final frontier um this has been trailed a lot in in mainstream media all over the place but in healthcare I mean the government have made a bet in the March budget of this year in terms of funding uh The Institute of public policy research produced a report looking at all of the public sector and talked about tens of bli I think it's 24 billion of savings that could happen across all government if AI rolled out Bring It Back Down to Earth which I think you have a brilliant uncanny habit of doing looking at these things helping us who are not experts talk a little to end today about the promise of AI but also some of the demands it's going to make in terms of how do we Define that and regulation uh so we could do a whole series of podcasts I'm sure we'll bring back to that I'm sure we will um so I think okay to start with what do we mean by Ai and it's very difficult to Define what we mean by AI it's an umbrella term it's been around from the ' 70s and what it means has changed substantially in that duration I would say it's like talking about um Vehicles what do you mean by Vehicles do you mean bikes do you mean cars do you mean airplanes they're all vehicles yeah but they do very different things and AI is has a parallel um so I suppose the way I would frame AI is thinking about human cognition and human capability so what is it that humans can do that technology hasn't been able to do and is now starting to be able to do um and so what we're seeing is there have been Leaps and Bounds in Ai and the capabilities to can do and that that gets us very excited about the potential for AI um and so I I think i' categorize it in four main buckets so there's AI that can uh partially do a task and the implications around that would be that it reduces workload on a member of Staff yeah so productivity is a potential potential productivity um and then there's the extension to that which is entirely doing a task so then that starts changing people's roles and responsibilities um and then you've got AI that can absolutely um make things easier so it changes your risk and it makes things more intelligible more easier to do so that means that that task could move from an expert to another healthc care professional or potentially even a patient themselves so things start moving around as suppose something that that is similar but isn't using AI is um online treeing so whereas you used to call and then you used to have to tell someone your information you now do that online so that task or that activity is moved to the patient doing it through a digital schol and the last thing is that AI can do things that we've never seen before yeah and that's where we talk about the more transformative Ai and by that I mean um so you can now get AI will analyze an ECG so your heart rate measures so the electronal pulses of your heart and from that it can start analyzing the risk of you having a stroke or a heart attack and so there's information that we have been looking at visually but AI can now look at the data within that and has a whole another level of interpretability within that um and so there's huge potential for AI but it does come down to the data which we' spoken about and the quality of the data and the representation of that data so the data needs to be representative of the people yes that is going to be used for if it's not then it might be biased you end up with potential for worsening care outcomes widening Health inequalities um and so yes there is huge potential but I think we're still quite early on that route and one of the key points that you I've drawn from what you said there is that there there is a potential there for more enhanced co-production with the patient but there will also be the gap of ensuring that the patient population has sufficient health information literacy so it goes back to the data it goes back I guess ultimately to that quintessential humanity and the trust that people are going to be required to have in what AI can do yeah so staff need to be able to trust the AI people need to be able to trust the AI and there's a lot of AI That's being developed and proof of Concepts which show the amazing things you can do but once you start looking more in depth you see that it works well for some people less well for others people won't trust that and that's going to be a negative so we need to do this properly we need to make sure that we can evaluate it effectively and that means changing how we evaluate tools it's not just about evaluating it now but having a longitudinal monitoring approach so how is it continually helping benefiting or not how do we go back and re-evaluate our tools as an ongoing basis um and going back to what you're saying it's it's there's a lot of focus on AI for the Health Care system which is great but we need to also move towards more of a patient- centered approach to AI so AI potentially as I mentioned can move tasks and one of the big benefits the large language models have is it can change information um not just just text based information but let's focus on that for a minute it can change text based information from very specific jargon heavy medicalized language to something that was much more approachable and understandable for a lay person and that empowers people it gets people more involved in their health more understanding in their health their well-being and empowers them to be able to do more to look after themselves but it can also you're not seeing a move on from large language models to multimodality so that's using different formats of information so voice uh animation video imagery a mixture of that with text as well and so now you can move away from relying on text to people who have no literacy uh very low literacy levels are unable to read but can look at an image and noce that something's going up which means that that's not necessarily a good thing and that can help them again on their health Journey we can start moving away from these traditional barriers of literacy numeracy health literacy that you need to keep building up and use Technologies to circumvent some of those to really Empower people so actually it's potentially is a fabulous tool done properly uh to democratize not only diagnosis but delivery of care absolutely on that very very positive and upbeat note I'm I'm sure we'll be inviting you back to unpack that more as more and more developments I'm sure it'll be high on your agenda uh in the work that you and the Kings fund are doing but on that note prti mystery thank you so much for your time and your wisdom today thank you pleasure if you've enjoyed this episode of voices of care please like follow or subscribe wherever you receive your podcasts and if you want to find out more about how we are transforming Health and Social care please visit newcross healthcare.com voices of care in the meantime I'm s murer thank you very much and look forward to seeing you on the next voices of care the healthcare podcast
2024-08-19 20:22
