Reflections from our Fellows

It is becoming increasingly clear that the level of ‘adoption’ is a good litmus test to show how effective we have been in our attempts to deliver transformational change across populations, where digital apps or tools are an intrinsic part of the patient pathway transformation.

Kwesi Afful, 2018 NHS Digital Pioneer, Digital Innovation Lead at Brent CCG, writes “The ‘assortment’ of NHS employees is best placed to facilitate this change [change towards a proactive health service], yet there is a big problem. The skill-mix of the people isn’t the problem, it’s the knowledge, experience and confidence which is the problem.

Kwesi’s experience highlights that the “un-relenting pressure to deliver projects ASAP with associated savings found and delivered ‘in-year’, inhibits even the most switched on senior management team of changing the way they work because they simply do not have the time. So staff awareness and application of what’s involved with digital health becomes haphazard, varied and at worst, dangerous.”

I read recently an interesting article written by a well know American serial entrepreneur and author that “… practitioners, we ignore the evidence in favour of what feels ‘right’, or because of our attachment to a narrative or what we’ve done before. We stand on principal, not results.

He goes on to say “So, before presenting the evidence, before assuming that people will change their work in response to the data, we need enrolment. We have to ask for a commitment and If the evidence shows that there’s a better way to do this, are you open to changing?

I am not sure whether we can apply this philosophy black and white to healthcare, but I do believe there is some truth in what he is saying. Enrolment is fundamental to taking projects from an idea on a piece of paper to adoption through to the point where outcomes are starting to be delivered.

The capacity required to take time out to ‘Enrol’ users and those supporting the users cannot be taken for granted, neither can the skills involved to Enrol be underestimated. Time away from the front line to work on “projects” instead of delivering clinical services to the patient clearly has an opportunity cost.

There is another practical challenge that often goes unmentioned, and one that was well articulated by a number of our NHS Digital Pioneers at their recent ‘action learning day’. That is learning how to collaborate with Industry with confidence. What do you do if you are a Service lead (e.g. Urgent Care lead), or a Consultant (e.g Thoracic Surgeon), or a Clinical Research Fellow, and you are in charge of leading the roll out of a digital solution as part of a service or pathway transformation programme?

At no point during your clinical training have you been taught about contract law, negotiation skills, or commercial models required to formalise a commercial agreement with a commercial entity, such as a digital health company. No-one has explained the innovators journey to you and likely development approach (e.g. lean start-up). Nothing has prepared you for protecting yourself against being ‘taken for a ride’ by a commercial entity, offering agreements with unreasonable terms. Let’s call this ‘Commercial literacy’, just enough to ensure that one can progress a project, where there is a relationship with a 3rd party technology SME, on more of a level playing field.

Some in the role of ‘change maker’ leading these projects can call upon commercial teams or transformation teams within their organisations to assist. But it seems that these services are not available across the board, and even if they are, responses to all questions cannot be guaranteed. This risks leaving individuals stranded, flying solo, slightly exposed and out on a limb at times.

In summary, what we need more of on a practical project level are:

  • ‘Protected time’ for project leads to invest in the enrolment of users and those supporting users.
  • The skills to be more effective at enrolling:- through better influencing, storytelling, developing stronger business cases, improved benefits articulation.
  • The skills and awareness to develop a basic level of commercial literacy in the context of working more effectively with suppliers.

The NHS Digital Pioneer Fellowship offers Fellow two out of three of the above practical skills and a chance to become more commercially aware:

Protected Time – this needs to be supported by the host organisation and needs to be factored into project planning right from the outset.

Skills for enrolment – we offer modules and mentors who can support fellows in the areas of influencing, storytelling, business case development, benefits articulation.

Commercial literacy – through access to our legal and IG experts via the Fellowship programme we hope we can play a part in answering some of the burning questions that fellows may have on this.

To find out more about the NHS Digital Pioneer Fellowship visit