“I think pharmaceuticals have had to become quite lean and mean… In the NHS, it is still hugely manual and the tech is trying to catch up.”~ Joanna Smith
In this episode, we dive deep into the world of healthcare technology with Joanna, a seasoned professional who has worked across various organisations. She shares her insights into the differences between the pharmaceutical industry and the NHS, shedding light on the challenges they face and the opportunities technology presents. Discover why embracing technology in healthcare is essential for improving patient care and operational efficiency, and learn about the exciting developments and innovations in the healthcare technology landscape that are transforming the way we receive medical care.
Digital Lighthouse is our industry expert mini-series on Softwire Techtalks; bringing you industry insights, opinions and news impacting the tech industry, from the people working within it. Follow us to never miss an episode on SoundCloud now: See all Digital Lighthouse episodes on SoundCloud
Zoe Cunningham: Hello and welcome to the Digital Lighthouse. I’m Zoe Cunningham. Today, I’m super excited to welcome Joanna Smith, who is currently the interim CIO at University Hospitals Sussex. Hello, Joanna, and welcome to the Digital Lighthouse.
Joanna Smith: Hi, Zoe. Thrilled to be here.
Zoe: Fantastic. Well, let’s kick off. What would be the most accurate way to describe your position, your role, and where you work now?
Joanna: I’m an interim CIO, and I’m also fractional. That means I’m not actually full-time, and this is because I’ve chosen to embark on a portfolio career as I’m now at the end of my career and I want a little bit more flexibility. I have a few clients, but my main client, the one that I work for 16 days a month at the moment, is the University Hospitals of Sussex. In that organization, I lead the IT teams, including data, coding, health records, and information governance – about 400-odd people in one of the largest trusts in the country.
Zoe: Wow, fantastic. For you, do you find that working for lots of different organizations, I guess, gives you new ideas, and you can share ideas between organisations?
Joanna: Yes, and I really enjoy people. I’m very much a people person. For me, I’m a “sum of the parts is definitely not as great as the sum of the whole.” It gives me an opportunity to stay up-to-date and current. I do also like being an operational leader, someone who’s actually delivering a service, which is why I tend to have one interim role, which is three or four days a week, and then some smaller advisory or consulting roles.
Zoe: It’s very different, isn’t it, to be in that kind of chunky, hands-on role versus just saying, “Oh, you should do this”?
Zoe: I really get that. What is it that you enjoy most about working in technology?
Joanna: I think it’s the fact that I see the benefit that technology can enable in a business. I’m not particularly thrilled with technology for the sake of technology. I’m actually probably quite a bad tech user. My IT teams tend to find me very intolerant of things that don’t work perfectly and aren’t really intuitive. For me, it’s the fact that I can see what tech can do for an organization, whether it’s efficiency or innovation; it just enables an organization to be even better.
Zoe: That’s actually a great perspective to have to be the user who says, “I’m only using this if it makes my life easier,” because actually, some of the worst technology implementations that I’ve seen come when the engineers using it are like, “Oh, but it’s simple. You just click here, click here, do this,” and everyone else is like, “What?”
Joanna: Exactly, exactly. I think that’s the point. I come from a business background, and I didn’t start my life in technology. I didn’t come through technology as a deep techie, so I’ve always been someone who’s been business-facing, understanding business problems, and then seeing how tech can help. If the answer’s a simple spreadsheet rather than a clever big system, the answer’s a simple spreadsheet, you know?
Zoe: Absolutely. You’ve worked in the pharmaceutical industry as well as the NHS. Can you share your thoughts on the main differences between and the similarities as well?
Joanna: Yes. The positive similarities are that they’re both very focused on ultimately caring for people and doing great things for people. One is about discovering new medications and treatments. The other is both that, as well as care, obviously. I think for me, the fundamental difference is – apologies in advance if this doesn’t sit well with everybody – I think pharmaceuticals have had to become quite lean and mean. It’s a highly competitive world. It isn’t one or two big guys, it’s hundreds of organizations, so they have to be uber-efficient, and they use technology to do that really well including understanding data as they process a drug through a life cycle. In the NHS, it is still hugely manual, and the tech is trying to catch up.
There is a bit of a culture of resistance to change, and it’s something that’s been there a long time. It’s not about an individual, or teams, or departments. Making change in the NHS is much harder because there isn’t the same ability to dictate the center, could but doesn’t mandate real extreme statements. The center does not say to 240 trusts, “You will use Dell” or, “You will use this one system.” They’ve all got different priorities, and the trusts are different mental health, tertiary, then primary care. It’s different. That makes it a lot harder to drive change at pace in a consistent way. Whereas a large global company can drive that from the top as a strategy in a relatively short number of years.
Zoe: That’s so interesting because obviously one of the great things about the NHS is that we don’t cut off the funding. The NHS is well-funded so that we can provide great care to people, but like you say, there is that commercial driver that comes when you have to adopt technology or your business is going to go out of existence. I can see that that’s going to create a very different working environment and a different rate of technological uptake.
Joanna: That’s exactly right, actually. You said the right word there in terms of existence. At a grassroots level, there isn’t a sense of existential threat to the NHS. Others may see that longer term at a very strategic level, but at the short flow that isn’t seen because as you say, although I don’t think many people in the NHS would say it’s well funded. You’re right, it is funded in that whatever happens there is always some form of solution. Whereas in commercial land, you go out of business. Something major changes. I worked in pharmaceuticals when the limited list, which was the introduction of generic prescribing came in. I think 1985. That took 35% of our roche at that time, their profits off the line straight away overnight. That just meant mass redundancies, wholesale cuts in budgets overnight. That thing doesn’t really happen to the NHS.
Zoe: It raises the very large question of what is it going to take to change the NHS and improve it for the future? What are the strategies that we can take?
Joanna: Personally, I would like to see the center dictate more, but I know that’s quite a politically sensitive thing to say. The national program for IT tried to do that. It was broadly considered the national program was unsuccessful. It did some good things but generally, if you Google ‘biggest IT failure’, the national program from IT-
Joanna: -is still up there at the top or close to now. I do think that we’ve either got to accept it’s going to take a very long time, or we do need to be a little bit braver and mandate some things. One of the things I asked when I first arrived in 2013 was, “Why are we still allowing NHS trust to build data centers? Why are we not just having a national data center strategy, outsource it to one or two partners, have two or three geographically dispersed sensibly data centers, and then over time move everyone into those?
Why don’t we standardize our networks and devices to get the economies of scale?” The answer is there’s a discomfort with mandating because of the history of the national program. I think until we do that, it will inevitably take a very long time because you’re waiting for each trust to get it to the same place. Now, there are obviously incentives through funding, there’s the latest programs about every trust must have an EPR by March ’25. There are things that are to be done, but what’s the consequence of failure, of not meeting those targets? Well, to your point, some heads might roll individually, but collectively nothing much changes.
Zoe: You can actually see why there could be this reluctance at the center when the consequence of getting a national IT strategy wrong is you will be on the list and remembered forever as someone who got it wrong. Whereas doing it right per se, there’s almost this sense of, “Well, it’s a hard issue.” Is it anyone’s one problem that they haven’t completely fixed it, so I can see that that’s a big challenge. I suppose one of the questions is, is there the tech expertise at the center to get this right or is it just a question of the right information’s there, it’s just making sure those voices are heard?
Joanna: I think it’s a bit of both. To be honest, there are some brilliant people in the NHS. I know a lot of really good people in the center, particularly out in the different trusts. Real determination. I’m hugely impressed by some of my colleagues. I’m not worthy by comparison to some of these folks who have been here such a long time and are so passionate and determined. There are great people there and they know what the answer is.
I just think it is that recognition that unless it’s mandated that– back to that sense of a global organization who can mandate. If it’s not mandated, there’s just other priorities. We have buildings where windows are falling out, so the priorities are different. Each trust has a different challenge and the board is trying to juggle all of those things. Genuinely, I think, I don’t what the answer is, otherwise other than accepting it will take a long time government putting more funding in in order to help.
Perhaps some mandates around things that really wouldn’t be so controversial, as I say. Things like your network provider, your data centers, your devices, really those are commodities. Whereas when you start talking about which system to use, you’ve got to get clinicians using those systems. That’s a little different.
Zoe: Perhaps there are different specialisms and different requirements.
Joanna: Yes, of course.
Zoe: It’s so interesting. I just heard a perspective recently that it’s one of those things you hear you go, “Oh, yes. Exactly,” which is pretty much what you’re saying that all of the political parties want to make savings through efficiency gains, and through improving systems so that they cost less and we get more value. However, no one’s really owning up at the moment to the fact that to get those efficiency gains, you have to spend more in the short term. They don’t just turn up for free. You have to invest in order to save.
Joanna: Yes, exactly right. The things that you need to invest in are some things also that the NHS struggles with. The marketplace for really good technology skills is more than the day rates they really want to pay, and so that constraints. It’s not just about being given the money to buy a thing, it’s having the money to properly implement, and then manage it.
Then that introduces more and more managed service ideas but that’s a revenue model, not a capital model. We typically tend to get more capital than revenue. Also, then there’s the impact on existing roles, and that gets into that difficult topic that the NHS doesn’t really like to do redundancy. It’s committed to redeployment, not redundancy. Again, those are the things that a commercial organization doesn’t have the same problems with.
Zoe: Again, you have to do what it takes to survive, right?
Zoe: We all behave differently when our life is threatened. [laughs] To take a more positive slant, which parts of technology are you most excited about for health care coming up?
Joanna: There are a number. The obvious one is still all around data. There is no doubt that if we understand data better, we can treat people better. We can design better pathways of care. We can potentially prevent. We can keep people at home better.
The remote technologies, both whether it’s telemonitoring devices or just remote consultations mean that we can be having more of the virtual ward concept expanding, so we can be treating people at home to avoid them coming in. We can be treating people at home after discharging them promptly, then technology enables all of that. For me, that’s almost an operational level that’s not particularly exciting, but I think arguably almost makes the biggest difference.
Then there’s the really exciting stuff, robotics, AI, all of those things, which I’m seeing amazing things. I was at an event recently and a clinician presented how they’re actually doing surgery in the metaverse.
They’re actually having people wearing the HoloLens and interacting with clinicians in different parts of the world, in theater while they’re operating. They’re taking that concept of multidisciplinary team working to the next level. Now, that’s really exciting. I’m not so sure how much of a game changer that is versus just preventing people having to be admitted, and getting them home faster. Those are now more basic technologies.
Zoe: Absolutely. I have to say that I completely agree with you that as a long-term technologist, the changes that are most fundamental are the new applications of established technology rather than the kind of cutting-edge creative ideas for what could we do, actually. There’s so much value in really taking solid technologies but using them to such great effect. How many people? Does it worse than their condition or adds an extra burden for them to have to travel in order to be seen and treated?
Zoe: How incredible not just in terms of saving time and money, which it does as well, but actually improving the experience of those patients? I think that’s absolutely incredible.
Joanna: We’ve all got our personal examples, but for me right this weekend, so my husband, he has a number of underlying conditions. He’s quite a poorly man. Over this last week, he was clearly deteriorating a little in terms of more tired, more breathless. We were worrying, has he got a bit of an infection? It’s incredibly hard to get a GP appointment. As a result of that, you wait another day, you wait another day, you get to the weekend. Actually 111 we have always found, with him, to be quite successful. Because of his health conditions, they don’t take any chances.
Embarrassingly, they rush an ambulance out. I didn’t want that. I just wanted, frankly, antibiotics but they rushed him out. It turns out he had sepsis. Caught it in time. He’s still in the majors now. He was in recess for 12 hours.
That could probably have all been avoided if we’d had easy prompt access to a clinician who could have looked at him, taken a few simple diagnostics and said, “Need you on some strong antibiotics now.” I’m not blaming anyone, it’s just the circumstances we find ourselves in. The GPs are hugely overloaded. It’s very, very difficult. When we had COVID, everything was done remotely. Actually, bizarrely you could speak to your doctor far easier during COVID because they only did remote. Now they’ve opened up practices again, it seems to have got very, very difficult to get appointments with your doctor.
Zoe: Yes, it seems to be this funny situation now that lots of people are complaining they get remote appointments but they can’t get a remote appointment today. There’s somehow now a–
Zoe: -massive queue. It’s–
Joanna: I just want to be clear. He’s always had fantastic care. I’m very sympathetic, but I think that’s an example where the technology– he could have been prevented from having to be at a critical point that then took emergency resources and time. That could have been prevented. It wasn’t for us not wanting to, but we didn’t know it was urgent enough to press it.
Zoe: Because you are not trained medical professionals, right?
Zoe: Let’s chat a bit more about the pandemic because I think it’s such an interesting, almost inflection point really, both in terms of medicine and the incredible coming together and the development of these vaccines that have changed the landscape in terms of if you look at the beginning of the pandemic and the end of the pandemic, and alongside that, we were at the right points in terms of technology that already existed to be able to harness that and enable remote healthcare, remote working in a way that hadn’t been seen before. What was your experience of that being in the middle of it?
Joanna: It was fantastic because as you say, a lot of the trusts, not all, of course, a lot of the trusts had already got some level of remote connectivity. Being technical, they’ve got VPNs, people have got laptops and they were doing, in many cases, remote consultations were already happening but in a very limited way, very much driven by a particular clinician who wanted– as you say, cystic fibrosis, why bring them in? Why not talk to them at home?
For many trusts actually being given permission to suddenly do that at speed, some of the vendors providing equipment for free to support that. Some of these unsung heroes who don’t get a mention, it swept away all the barriers and it was fantastic. Other trusts didn’t have that in place, but again, were supported to just make it so, and again with great vendor community support. That was wonderful to watch. At least that’s still there. That can’t be taken away. It’s still all there but then to see us going back to the difficulties of approvals and all those things that are really important but it was a wonderful time, to be honest. It was a wonderful time. Not, not from the impression-
Zoe: Yes, of course.
Joanna: -side, but from the ability to react quickly, as you say, with proven technology, with the barriers removed. Back to existential, actually, that was, wasn’t it?
Zoe: Exactly, yes.
Joanna: We showed what we could do. If we could just take some of that and put it in the mix as normal, wouldn’t that be great?
Zoe: Well, on that note, thank you so much, Joanna. I have enjoyed our chat so much. I really hope this helps us to shine a light for others.