By Geraint Lewis. 10 May 2019
By Geraint Lewis. 10 May 2019
Having worked in the United States, where there is no universal healthcare, I am acutely aware of what a precious thing it is to have a healthcare system that is free at the point of contact. Back working in the NHS, it gives me a great sense of pride to include the tagline ‘high quality care for all’ in my email signature.
I started my working life as a hospital doctor, working mostly in A&E and in other acute specialities. However, I found increasingly that my true interest was in improving the health of whole populations rather than focusing on individual patients. So, after completing my postgraduate physician’s exams, I decided to specialise in public health.
My first post as a public health registrar was at Croydon Primary Care Trust in south London, where I began working with data in earnest for the first time. Back then, Croydon had some of the country’s best data resources, including an anonymous dataset of GP data that was linked to hospital data and stretched back many years.
Within the NHS we must ensure that AI doesn't exacerbate inequalities
The Department of Health commissioned a think-tank called the King’s Fund to work with us on this dataset, in order to build a tool that could predict which patients were at high risk of being re-admitted to hospital as an emergency in the next 12 months.
After finishing my consultant training, which included a fellowship at New York University, I worked at another think-tank called the Nuffield Trust. Our team at the Trust applied similar techniques to make predictions of adverse social care outcomes, and also to evaluate preventive health services such as tele-care and community matrons.
Finally, my last job before joining NHS England was in Chicago, where I helped establish a chain of Accountable Care Organisations (ACOs) across the United States. Established as part of President Obama’s reforms, ACOs take responsibility for the quality and efficiency of the care being delivered to a defined population of patients.
The kinds of innovative uses of data that we used in my previous roles are just the tip of the iceberg. I know there is a lot of hype about artificial intelligence (AI) at the moment, but there’s no doubt in my mind that AI will have a similar scale of impact on our lives over the next few years as did the start of the internet in the 1990s. But it needs to be developed in a careful, ethical and considered way. In particular, within the NHS, we must ensure that AI doesn’t exacerbate inequalities, that it doesn’t compromise patient safety, and that we bring the public’s trust and confidence with us as we introduce these new technologies to transform services.
One of my current priorities is to build a consensus on what data should flow around the health and care system, and how this will happen, both for improving the care of individual patients and for so-called “secondary uses” of data, such as planning and research. Local Health and Care Records will have a central role to play in both cases. They ensure that data can flow seamlessly across local health and care settings that need to work together to care for patients.
Information governance (IG) gets a bad rap. So, a second priority for me is to help improve that reputation. I draw an analogy with health and safety. Myths about how health and safety has ‘gone mad’ abound but they belie the truth that rates of fatal injuries have fallen precipitously over the past 30 years, saving thousands of lives.
IG, likewise, has a pivotal role in improving the security of our datasets and building the public’s confidence in how we use data. But the time has come to dispel some of the most pervasive myths about IG, and to change the culture so that staff across the NHS see IG colleagues as valued members of their transformation team.
My final priority relates to transparency. Data can be used to detect where services are working well and where they need to be improved. Better data about patients’ experiences of care and their clinical outcomes can help to pinpoint areas of good practice that the rest of the NHS can learn from. It can also determine where improvements need to be made.
I think the creation of NHS X is a phenomenal opportunity to show the world that the NHS is serious about digital transformation, and also about transparency and trust. We can all see how data has radically transformed our daily lives in so many ways – from online banking to streaming TV. I get the feeling that we are just on the cusp of a similar transformation in healthcare.