Rewired at the NEC - A Live Panel on the Future of UK Digital Health

Hi, this is Steve Roost and you're listening to HealthTech Hour on UK Health Radio. Each week we give you the best news, views and interviews from the health technology world. From CEOs and founders to entrepreneurs and clinicians. The companies and people that are shaping the future place of healthcare. All on the world's number one Torque Health Radio. Hello and welcome to this week's HealthTech Hour, a very special HealthTech Hour. We are broadcasting live from Rewired in Birmingham and Rewired, if you don't know, is one of the largest health tech conferences. It's definitely the leading health tech conference in the UK. This show HealthTech Hour is very lucky to be a media partner of the event. Part of that is we get to do a completely unique podcast at the show. We are going to be speaking to three amazing people over the next hour. I hope you love it. Let's get straight into it. Thank you very much for joining, if you're listening live. Thank you very much for listening, if you're listening on any of the podcast channels. We get downloads in over 40 countries every single month, and it gives me great pleasure to introduce my first guest, Alex Guitha, from the Health Foundation. Hi, great to be here. How is your Rewired going? It's Alexander Lawrence because it's Haley Guitha. See, look, I already messed up my show. This is why we don't, this is why we rehearse. So, Alex Lawrence, Alexander Lawrence, nice to see you. How are you? I'm great, yeah, it's great to be here. I was trying to work out how many Rewords I've been doing now. I think this is probably going to be number five or six. Number five, okay, what was the first one like? Is it smaller? Has it gotten bigger? Has it gotten smaller? Well, I used to work at a trade association called Tech UK, which had over 350 health tech companies in membership. We represented them to government regulators, et cetera. And so, I used to know pretty much everyone here, and I'd walk around and know pretty much every stall and just spend the whole day bumping into members, which was great. It definitely feels bigger now, and I definitely know last people. Okay, well, yes, that's progress in some way. So, you recently, in the last couple of days, I believe, published some research, and it's that research that you're here to talk about, which I think is, well, if I walk around the conference, I can see that there are so many businesses involved in electronic patient records, right, in some way, shape or form. And a lot of them say something very similar from what I can tell. So, what is it that you're kind of here to talk about in your area of interest? Yeah, absolutely. So, the research came out this morning, so it's hot off the press. Yep. Published by the Health Foundation, it looks at a staff survey we did of over 1,700 NHS staff across all different care settings, asking them about their experience of using electronic patient records. We wanted to talk, we wanted to ask staff about this for a few reasons. Firstly, because EPRs are almost at 100%. Is that right? You'll keep seeing those headlines of, you know, three trusts left, two trusts left. Okay. Those ones, yeah, so we get to reach 100%, but we're almost there. Okay. And that kind of provided an impetus for us to think, you know, all this money and all of these resources and this effort and attention has been spent on getting to 100%. But how has anyone thought about what happens next? So, we've got these EPRs in place, but how are we actually using them? What are we, what benefits are we actually hoping to get out of them? Where are we going? So, that prompted us to do it. And also, you know, staff experiences, it's such a good metric for whether tech is actually working well on the ground. And I think you can't underestimate that. Okay. And when we talk about an electronic patient record, just for everyone listening, because we're a broad church. You know, there's all kinds of different people that listen to the show from all kinds of different countries. What are we really talking about at the call? I was the simplest definition of it. We are talking about the systems that are in GP surgeries in hospitals that ambulances use, any care setting basically. They're using systems, they're inputting your data into those systems, and they're functioning as electronic versions of paper health records, basically. That is what they are in their simplest form. In their kind of higher form, they can do much, much more than that. They can help optimize workflows. They can triage patients. They can send you appointment reminders. You can integrate AI tools into them. But in their simplest form, that's about it. And there's a lot of talk, or there was a lot of talk in the NHS 10-year plan. And around that time, that this sort of concept of electronic patient record is the beginning of the unlock of massive efficiency gains, massive prevention gains. What's your kind of take on that and how far away we are from that sort of alleged utopia? Yeah, we're definitely not there yet. I think that would be hard to argue. I don't think that electronic records in the state in which they are in and the majority of organisations are providing significant productivity gains yet. Interesting. But we did some work last year looking at a really advanced healthcare provider in the US looking at their electronic patient record system, which they've spent billions of pounds. Billions. Billions. Billions investing in and around 15 years. Wow. And that is delivering significant productivity gains. In what areas are those productivity gains coming from it? It's being used as a very sophisticated clinical decision-making tool to help clinicians. It's being used to coordinate care across different parts of this provider, which has lots of different hospitals and care settings under a umbrella. It's being used for quality improvement tools, population health analysis, all of these things. Which is kind of like what the 10-year plan said would be the thing that happens here. How many patients, roughly, is that system or that example? Do you know? Like, how does it compare? It's got to be in the millions. It's in the millions, but I can't pretend I can remember the exact figure. No, but it's basically a decent population size. Yeah. Okay. So do you feel like we're potentially underestimating the scale of investment and the timeline here to unlock this thing? Yeah. I think that when EPRs were first introduced in the UK and we sat out on this mission to digitise our records that the NHS thought that it was kind of a natural, modernising step that needed to happen. And not much thought was put into it beyond that. In terms of the specific benefits we wanted to see the specific areas where it might improve productivity. And the amount of investment, both kind of training of staff, which is a really important point that came up a lot in our survey. Training of staff, the money that you need to spend to update the hardware that these systems are running on, all of these kind of things. There might be legacy hardware that just can't run the version. Not fast enough Wi-Fi, all of these things. So yeah, 100% the scale of investment needed to optimise these systems, which is a bit of a kind of, it's not a very nice word to use. But it is like the right, it is a useful word, but essentially how effectively these systems are running, how useful they are. The investment you need to get them working well is considerable. And there was, I was chairing a panel earlier today, which was on AI. It was really interesting. So Joe Zang and Jess Morley, who are two of the leading researchers in the field of AI, they were kind of delivering a reality check. Sort of, they framed it as like reality versus snake oil in the AI space. And one of the things that came up was the vendor lock on the EPR system. IE, a lot of the data that supposedly will unlock these benefits is actually locked down in a vendor system. Like how has that come out in anything that you've been looking at? Yeah, it has, it came up both in the quality of research we did last year. We found that a lot of trust told us that it was much harder to access the data stored in the EPR system than they had anticipated, all of them they had been told. And then it also came up in our staff survey in the sense of over 70% of staff telling us they have to use more than one system on a daily basis. And kind of fragmentation and differences between systems being the number one barrier, some more effective use of EPRs, which is a wider point but kind of speaks to that problem of data access and interactability. Yeah, because it's all well and good putting in place an EPR. And EPRs should exist just because it doesn't make any sense to use paper. I mean like so fundamentally there should be an EPR. But actually when you're looking to go to the secondary and tertiary levels of benefit of an EPR, that's when you get into what you're talking about, which is the interoperability, the walled garden, the vendor lock and all that kind of stuff, right? Yeah, exactly. And it's those kind of more complicated uses, more complicated functionalities where we think and where other countries have shown us, you start to get productivity benefits. Yeah, you start to make life easier rather than harder for staff on the ground, patient care, start to improve all of those stuff. I've been shocked at how many companies here basically say they do the same thing in this hall. Like it looks like there's a lot of people roughly doing similar things. So it must be quite difficult for trust to be able to differentiate between. providers. I don't know if that's come up as well in research about like how staff deal with things that look and sound very similar but might not actually be similar. Yeah we didn't look at kind of different vendors specifically like we didn't ask for staff views on one vendor versus another but I think that there is a significant lack of procurement expertise on digital health generally within trusts like I think that's something that potentially the centre can help a lot more. Do you know what I love talking about this issue of procurement so I sit on the NHS England SME advisory board and that's across all SMEs. So like yes there's some digital people like Pockdog but there's also like for example one of them guys that sits on it Danny is the king of milk in the south west. So Danny delivers all of the milk to all hospitals in the south west. So if you're listening in the south west to England you have an across-to-coffee in a hospital Danny delivered a milk. So I think to that point NHS trusts and NHS institutions are actually pretty good at procuring hardware, physical items, right, like NHS supply chain etc etc, unit pricing, all that stuff. I think they're not great at procuring stuff where it's more service-based than definitely not digital. I don't know if you put anything. Yeah we published a report, I think this time last year it called the cost of digitising the NHS. It's a fantastic report everyone should go and read it. We basically tried to calculate how much money it would cost if the government basically fulfilled all of the promises it's made. I love that exam question. If the government did everything it said it would do, how much would that cost? Yeah a lot. That's a great question. And sorry I've completely forgotten. That's okay it was me laughing. They published a paper around how much it would cost and it was to do with procurement services. Oh and basically we one of the problems that that highlighted or one of the recommendations that came out of it was around changing the kind of the way that things are funded in terms of like capital funding to suit more like software services essentially. We found that it was totally not suited. I completely agree with you and I actually think this is one of the things that I harp on consistently about to anyone that will listen which is the digital health industry as an industry needs to be learning from people that have gotten really really really good at managing procurement with the NHS around physical items. We should be learning from those people Danny the King of milk and whoever supplies the bog roll and all these people they supply like billions of units of these things every single year. Somehow somewhere we need to try and figure out some working groups as to how we can take that and apply it over there because even supply chain NHS supply chain which I'm sure you've heard of that only works in hospitals. The NHS supply chain only applies in a hospital setting so it completely is completely irrelevant to the vast majority of the NHS. I think there's a lot in there. No I think that's really interesting because I think people often focus on how different recurring tech and digital is but what you're saying is there's actually a lot to learn from existing ways of working. Also it might take on anything in life it's like let's go figure out who's done it better who's doing it really well and then go and see what we can learn. I think that there's a tendency and I don't know why but I've definitely noticed it within the UK digital health industry at large and the kind of counterparts in the NHS system like who look at digital health to try and just reinvent the wheel constantly. Yeah 100% we're always trying to look especially at kind of international examples I think because the NHS is unique in lots of ways sometimes there can be hesitancy to learning from other countries particularly with the US and a lot of that hesitancy is warranted and you always have to kind of caveat when you're saying the US did this why can't we do it nevertheless like with the with the EPR example it's so useful that they're ahead of us you know because we can look at what they did wrong and what they got right and try and emulate that and actually when it comes to electronic patient records records the US took a fairly kind of NHSE approach they had a national they called it a meaningful use program yeah which they said this is how we're going to get to meaningful use of EPRs this is where every single provider needs to be by this date they have financial incentives. I love this okay because we're with Impokto we're lucky enough to now be looking ahead to submitting to the FDA for our US launch which is super exciting yeah the FDA has blown me away in terms of this efficacy versus and it's along the same lines which is like people like to stereotype the US healthcare system and I don't disagree with you know probably a lot of things that you wouldn't disagree with around health inequity and costs and all that kind of stuff but there are some things that they are so much further ahead by the FDA for example is a government-run institution with guaranteed timelines on responses and approvals or denials you can sit down with the people that are going to analyze your submission in advance etc it costs a few thousand dollars to go through because it's government funded and you compare that to the system here or in Europe in the UK where you bet they we've privatized medical device regulation so it's not nationalized so you have to go find a private provider who's interested in profit and every time they question your file you have to pay them and there's no timelines so I completely agree with you I think that like this blanket the NHS sorry the way the US does healthcare is bad it's really done yeah and I think you know the MHRA is thinking at the moment about how it approaches regulating AI we're acting as the the research partner to the MHRA on that piece of work and I think that international examples are going to form a really important part of that so you spoke to the FDA example and I know that they've also got a kind of sort of fast track pipeline in the innovative devices that they think have that the system has a real meaningful yeah they're much more interested and much braver around making bets or sort of accelerating things that they think will help then for some reason I don't think we're really brave enough to provide those except it's not to say everyone in that pathway will get approved it's just to say that well our business needs are our customer needs of this so if you're in that bucket we're going to accelerate the analysis I just don't feel like we're there yet at any level and I think part of it's because we haven't centralized that regulatory pathway it's been privatized so those private companies are for profit companies so they're going to do whatever maximises their profit so that's why I think a big difference is unfortunately because and that goes across all of Europe all European governments have outsourced medical device regulation yeah no it's really interesting to think about are there any European countries that you look at and think that are doing something interesting obviously there's a certain amount that's centralized across the EU but you know there's like DeGa in Germany or whatever so here's what's really interesting what governments in Europe and the UK can influence all happens after you've been approved they are unable to influence approval because they it is not in their gift to approve because the people that approve of this is this network of about 60 notified bodies BSI is the one that everyone knows here but there's loads and you have to apply to them for your approval and it's that notified body that would then update MHRA etc the MHRA plays no role whatsoever in the actual approval of any device it doesn't play a role at all so what you find is governments are actually quite good in the European governments like DeGa is a really good example in Germany that's a really good program that applies after you've been approved it's around uptake and funding and scale and it makes total sense nobody is able to influence actually speeding up the actual regulatory pathway and that's a really thorny question that no one's wanted to get their hands around yeah ever I mean I've been talking about it for a few years now and no one wants to go near it which is really interesting we obviously we did this EPR polling which was just with NHS staff but we also do much wider public polling we did this nationally representative survey where we asked questions about how the public feel about technology data AI we do it every year so we could track kind of changes in attitude and stuff that also came out a couple of weeks ago and one of the questions that we asked this year around kind of AI and regulation is kind of what trade-offs people are willing to accept when you ask them questions about regulation versus speed of adoption yeah and I won't go into into the results in detail but essentially like I think it's much more complicated than people would anticipate you know it really depends on what kind of scenario that particular device is intended for what the trade-off is like how long is the waiting list of that device isn't used these kinds of things and also varies a lot by gender by age by socioeconomic group yeah so as I said it's a really thorny issue that someone yeah hopefully the MHRA is going to get their hands on it if the if the MHRA could take control back of act if they could replicate the FDA that would be a huge step but that's that's a I would love to dig into that at some point but that's a whole showing in itself so Alex thank you so much coming on where do people go to find out about all of these papers and such and if they want to do some research themselves yeah so just go to the health foundation website and you'll find absolutely everything there the EPR survey is on the from page today and what is the health foundation just the health foundation sorry I should have thought that's an independent charity and I think thank we are working to build a healthier UK we do a mixture of kind of in-house research economics data analysis funding programs and campaigns brilliant Alex thank you so much Cera wasn't bad at her job, she was stuck in hidden grief. 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We explore the science of oxygenation, metabolism and alkalinity, while strengthening your emotional, spiritual, and physical well-being. This is a mastermind with heart, accountability, connection, wisdom and real support. Because your journey isn't just about surviving, it's about thriving. Join us by clicking on the alkaline collective mastermind banner on the UK Health Radio homepage or directly at alkaline-collective.com, where self-belief grows, healing deepens, and transformation begins. So, you're kind of a fixture at Rewind, right? These are your people, you know what I mean? It's very kind of you to say so. I do love the community, and actually I'm going to use the phrase "communities" because this is a show full of tribes, lots of tribes. You've got the CIO network, CCIO network, and CNIO network, so Digital Health convenes them, but you've got lots of other networks, chief, sorry, clinical safety offices are here. Everyone's coming together, the Shuri network is here. What's the Shuri network? Oh, so the Shuri network is a wonderful group of people who believe that women of colour, so the intersection, they should be represented more in Digital Health. And actually, I don't disagree with that premise. And actually you find that they aren't, sometimes they're not giving the opportunities, they're not giving the chance to shine. So the Shuri network, lift as you climb. Oh, nice. Go higher as you grow. And they're such a supportive group, amazing. I'm lucky to be an advisor to them. And Rewind has been a friend to the Shuri network and a friend to so many communities. I think that's a really good point. Of all the conferences, this is the one that I know where it really calls out the different communities. So it calls them out by name, so the CCIO, the CIO, the integrated care, the Shuri. Whereas other conferences, they sort of, there's a bit more thematic, you know what I mean? Whereas this one actually, you can come here and definitively find your people. You're so right. And I'm going to make a distinction, that's probably unfair. Go for it, man. I'm here for it. You've got lots of companies that are events, companies trying to do healthcare. Oh yeah. Digital Health is a group of people who do healthcare as their main thing. Yeah. Doing an event. Yes. And so they're from the inside out, rather than from the outside in. Yeah, it does feel like it's always felt Rewind that this is sort of the industry's conference. Yeah. You know, this is like for people to come together and feel free to talk to each other. So how many panels are you on this time? Three, is it four? What is it? I'm lucky to be on the committee. Right. So if there's a gap, just put your hand up, you know, it's one of those. So you're on, what you, you're on later talking about AIs or what are you talking about? I'm on tomorrow and I'm on an imaging one. Oh, yes, imaging. Yeah. And I'm also on the closing panel. Okay. When it comes to digital transformation and how do we get to the 10 year plan? So let's talk about that because I have heard a rumor. I'm not sure this could be a fact. I get confused with rumor and facts sometimes in the images, but it could be a fact. It could be a rumor that the government is about to announce that it is about to release the funding to deliver the 10 year plan. What is your take on this issue? I think that we have got the same problem for many years. Organizational memory gone. Yeah. And so we have to reinvent the wheel. That's, that's how happening a lot. Right. So as an entrepreneur yourself, you'll find that sometimes you're trying to sell to somebody and you're having to persuade them of something and you're thinking, but why didn't they get that? That was the same problem last year, year before, year before, year before. Yeah. Well, a lot of these problems are the same problems that we have for a long time. Right. So if you end up losing the staff who've got the digital transformation skills and they've got the experience, what happens to your ability to do it next year? Yeah. That's going, right? Yeah. And that's where my main concern is. I think we're losing organizational memory. You can give me money. You can't give me time. You can't give me experience. I think that's a really interesting take on, and I'm not going to get into the cuts and things like that because we're supposed to be with, there's a positive conference talking about future and excitement and things like that. However, that being said, I think people, and you can tell me if you think I'm wrong, but people talk about digital transformation as if it happens digitally. And it doesn't. It happens by people doing stuff, you know? Like it's, you can't just, yes, it's digital technology, but someone still has to actually get off their back side. So like, Pockdocks are a great example where like, you know, last week we were at a seek temple in the black country, right? And we upskilled local community workers to deliver screenings in the temple during prayers to a particular group that's considered to be underserved. Yes, that's part of digital transformation, but it was delivered quite a lot of people, right? And if those people had been there, they wouldn't, they wouldn't have happened. You've hit the nail on the head on an idea that people don't often have a name for. Right. And I'm a Ronald Heifetz nerd. Okay. So I look at adaptive leadership. Right. How do you change things? Can you anesthetize people and say, we're going to freeze you and we're going to impose change? Yeah. Or do you get them to be not only the problem and the solution at the same time? Because they are the problem. If they don't move, you get nothing. Absolutely. But if you treat them as partners in what's happening and then they lead it, the adaptive leadership is for you to say, look, I'm on the balcony looking down, helping people change themselves. Well, I think that in my experience, obviously I don't come from a healthcare background as you know. So I'm kind of, you know, the last few years doing this, learning as I go. So this, again, might be off base, but I think the NA, the healthcare system, because it's not just the NHS, it's the pharmacy and everything, the wider system, I think is uniquely misplaced to accept top-down change mandates. Rightly or wrongly, and there's been lots of examples of that. So if you're not able to work from the ground up and bring people with you and get people excited and coalescing around change, I think you're dead in the water. I just don't believe it comes from the top. I don't believe you can stand there waving to say, oh, we need to do this and then people are going to do it. I'm going to add, there's a health and care system. Yes. Yes, exactly. Yeah, and we always forget about the care sometimes. And there's wider determinants of health and the neighbourhoods. Yep. I think that multistakeholder work requires ownership at the lowest possible level. Yes. Subsidiarity. Really agree. And that requires a new form of leadership, which is why I look at high fets for adaptor leadership. Yeah. And you look at what's going on, for example, Dr. Minal Bakai and her work in the neighbourhoods. There are people out there who understand this implicitly. Yeah. You've got to delegate and devolve leadership down. Yes. And you have to enable them to deploy, enable them to deploy things that can actually have an impact. And yeah, I mean, I think a great example, though, it's got a little bit spicy recently, but they're the AVT thing, right? So AVT really took off because GPs and they were like, this is amazing. I'm going to try this. So those kind of things just come from the ground up and now obviously we're in a whole kerfuffle around Microsoft and whatever else, but again. Can I add something on AVT, right? Yeah, please. So I'm lucky. I was at Great Ormond Street when we did the biggest trial. This is across London. Is that right? Of AVT. AVT. Cool. I didn't know that. And it was really, really well handled. Was that with Tortoise? Was that the Tortoise one? Yes. And the way it was done was because pediatrics centre doing this, people thought it was going to be pediatrics only. Right. And they did everything. Adults, outpatient, ambulance, GP. Right. What they found was ED, emergency department, is where people wanted to hand over more. Is that right? And that's where they got the biggest benefit because there was a goal of making that benefit happen. But then I thought to myself, but then the metrics are wrong. Yeah. The benefit isn't just about seeing more people. What's the clinical quality, for example? Yes. And sometimes we use the wrong metrics to measure things, and again, that's another imposition. Yeah. It needs to be self-defined sometimes. Yes. And what's difficult here is that you obviously can't end up in a situation where you're trying to hurt cats. So that it's a very, you know, it's a very difficult balance between centralising around priorities to then allowing local deployment and local specialisation, right? There's some tension between what's central and what's devolved, right? Yes. And look, I'll go on the record and say this, I think in the UK in the NHS, we've made a mistake sometimes of being too strong at the centre, and not enough, for example, out in the regions and so on. What we need to do now with the loss of what's happening at the centre is redefine that and hold it. Yeah. And we're going to lose the people that would have helped us define it. I think this people thing, because obviously you walk around, [BLANK_AUDIO] Walk around rewired, if anyone's ever come, it's amazing, if you haven't come, you should come, it's a fantastic content. The only one I would say that rivals this for me is health in Amsterdam, which is a completely different vibe and a completely different concept. But rewired in health in Amsterdam are really, really up there. So, but this is really all about, for the most part, solutions, technology driven solutions to problems, clinical, operational, whatever they happen to be. Where is the discussion around the people, do you think? Do you think that we're missing that sort of transparency around this people-based discussion? What do you think? Elephant in the room is that no one wants to be overly critical when we all know the answers are not going to change. Right. But, yeah, the overall feeling across the conference for the last two or three years has been, why don't we help the people do the jobs better? Because technology is never going to be the full answer. In fact, when it comes to transformation, there's this argument that half of the money that you need, maybe even more than that, needs to go on the transformation rather than the solution. I mean, will it, we've seen this first hand again, I mean, in so many ways, what we realised when we started PopDoc was really that, one of the things that had held back point of care screening as a concept, in any, it wasn't just in cardiovascular studies, but across the board, was that it was dominated by people that made plastic boxes and dropped off plastic boxes on the door of the customer and then left. And we're like, well, you know, you've spent £5,000 on my box, thank you very much. I'll, you know, if you want more consumer voices, my consumable team and that was so far away from delivering impact and that the organisation itself needed so much support to deploy. We now need to move to this era where people are empowered, as you said, right? Empowering people isn't what we are used to doing in healthcare, we're used to doing things to people. Yes. And I think that's the culture shift that I'm hoping will happen. And technology is now moving so fast, where people are saying, I'm going to take control away from those who used to have power. So there's now this tension of, I used to have power when I hold onto it. And those saying, now I'm going to run away with it. And they're going to use, for example, an LLM to look at their symptoms. There's a tension that no one's really resolved. I'm not quite sure what's going to land up. Well, I think this LLM thing is a really interesting one. So my wife put this on LinkedIn recently, but she's just sadly been diagnosed with breast cancer about six weeks ago. So she comes from an oncology background. And so she's very well versed in oncology, very understanding, but she uploaded her, so she had a PET scan. She uploaded the PET scan, which was in French, by the way, to Claude. And it gave her an unbelievably detailed breakdown that matched almost exactly what the oncologist later said. And so I think that there's a, to your point, this technology is moving so fast where it's going to be very interesting to determine where the regulatory, empowerment, encouragement, concept kind of even comes in. It's like you have to completely reframe the debate. This is really technical, but we've moved away from convolutional neural networks, right? CNNs. To having foundational models. And the problem with the foundation model is that it's ingested a lot of rubbish as well as a lot of goods. So fine tuning is important. The fine tuning of the foundation model requires tons and tons of work and effort and skill. But if someone manages to get that done, they don't know whether they're going to get the approvals, the regulation and get the market. And also, actually, weirdly, we're a medical device company. So we've been through every single regulatory hoop and herd or et cetera. So I'm not saying this about us, but technology businesses don't willingly walk into regulatory environments. So they aren't going to want to do things that would accidentally qualify themselves as a medical device and bring themselves under that regulation. So it becomes very weird to figure out how it's going to end up, you know. And you also look at the size of the market. So if you can go into a market that's less regulated, you're going to go for it. And at the moment, a lot of companies saying, well, I'm going to stay in the US. I'm going to enjoy the US rather than come to Europe. Because Europe is going to make it harder for me. It might be safer and that's debatable, but it's going to be harder and more expensive. And that's why Europe is currently debating where its line should be. I think also, I was talking about this with Alex, and then we'll do this, and then I've got our next guest coming on. But the FDA, so we're going to be doing the US imminently, which is very exciting. And the FDA has blown me away with the quality versus Europe. So this isn't like NHS banking. It's actually got nothing to do with the NHS because it's the regulatory thing. But the FDA is a government-funded institution that by law guarantees when it responds, it has a maximum stop date for being able to provide you with an answer. Both of those things, by the way, are absolutely critical if you're trying to raise investment, so you can communicate accurately to investors and so on and so forth. And then they offer basically a pro bono service where you can speak to the examiners beforehand, so you can check your thesis before you submit. None of that exists in Europe. None. And so on the other thing the FDA does is it's very, very clear about signalling winners. So it says, right, if you're developing this type of technology, we will accelerate your process. And I just feel like that would be amazing if we could get to that point in Europe. It's not to say that those people have an easier right to get approved. That's not what I'm saying. It's not about lowering the bar on quality of the actual evaluation. It's just about accelerating and making it more transparent. Europe needs to take a lesson from the entrepreneurial culture and the commercialization culture that the US does so well, risk capital and the ability for an entrepreneur to just dream and go for it. Yeah. Because angel funding, VC funding, all of that's there. Europe is going to struggle if it doesn't match some of those things soon. Yeah, I think so. Particularly on some of these big attack bets, I think it's going to struggle. So apart from your talks, what have you found most exciting that you've seen so far at ReWide? I think there's two things that really come to mind. The first is that there are lots of companies here saying we are going to go for other markets. Interesting. And they're saying it not because they doubt this is the market. It's because they know this is not the current market for them. If you stay in the NHS alone, a lot of VCs are saying, look, we're just not going to be investing in you. The NHS is not the solo market. So they're wondering what market there is and problems in the GCC. Yep, that's tough, right? I've sort of closed the door a little. I would argue that actually there's a lot of opportunity. It's never easy and it's never a good time to go to the GCC. No, there's always hurdles. But if you were to go now, you're showing solidarity at a time when you probably should be showing solidarity. Right. So I'd say don't close it on the GCC. Singapore is an amazing market, but it's a reference market. It's how you get to other markets. Yeah, it's what is a couple of million people. Small. The US is always the eventual market. It's a holy grail for any healthcare business, but it's a scary jump. And so a lot of companies are saying this is the way they're going to go. Second thing that's really exciting, a lot of companies here are saying to me that they have found somebody within the system who, despite all the mess, believes in them and is willing to help them to get through. And so they're green shoots of, shall we say, recovery. It's not all doom and gloom. No, I don't buy into this doom and gloom narrative. I mean, I was talking to someone earlier. My take is that the NHS is always going to be in a semi-permanent state of restructure anyway. It's going to be such a perpetual change thing. So if you let yourself get too synced up with those changes, you're going to go mad. And you've got to listen to people who can give you the advice. I love Liam K. Hill for example. Oh, Liam, love that guy. And that's the kind of advice you need. Go at the right time, make the right comment, have the right business plan. Those are the kind of things that you need. And if you listen to the right people, you will find success. Perfect. And NHS innovation accelerator, they're going to watch the new fellow. Yeah, when's that? Tomorrow. Tomorrow is it. Great companies on there. I won't give you anything away. Yeah, we were here last year on that one. So Hassan, thank you so much for coming. Good luck with the speeches later. Good luck with the talks. And thanks a lot for helping co-produce an amazing conference. Thank you so much. Brilliant, Haley, Haley calling Haley. Hi. How's it going? Thank you. How are you? Yeah, get your cans on. Get your headphones on. Hi, how's it going? All right, how are you? I'm very good, thank you very much. Thanks for joining our show. The Health Deck cover. Thank you. So how have you found real world so far? Oh, I love it. It's like a family reunion. Yeah. I mean, all your cousins. Some you like, some you don't. Actual cousins, no. No, no, no. That's what it feels like. Yeah, because it's quite often the same faces, you know, quite tight network, I think, across the digital health industry. So yeah, it's great. And in your role in nursing, how have you interacted with digital health? Because this is predominantly a digital health-driven conference. Yeah, yeah. So what is, what, I guess, what, yeah, what has your interaction been and, you know, as in digital health in the next one? No, just in general, right? In your role and things like that. Yeah. How does nursing cross over with it? It's not always, it's not always when you talk about digital health. I don't know if necessarily everyone always thinks about nurses in nursing, you know. And they absolutely should. Yeah. The best workforce in the NHS. Is that right? Yeah, by far. Is it? Of course, yeah. You know, you think, probably every doctor you've got, probably five, six nurses. Is that right? Yeah, yeah, yeah. Wow. You need to check on the actual details. Yeah, I mean, we're not going to, we're going to hold your feet to the far end. Exactly. Yeah. So no, actually, the biggest workforce, the most consistent workforce. Okay. I think, you know, you think of a normal ward in a hospital. The doctors and the consultants and everyone are obviously instrumental. But they come and go. But there's the nurses that are sat there. Next to the patients. And why is it that nurses are more consistent? I think it's just the nature of the role, isn't it? They are. They're kind of place-based rather than follow the patients. Right. Mae'n gwneud eich sy'n gwneud sy'n gwneud digidwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymwch ymw oeddwn i'r gweithio, oeddwn i'r gweithio, oeddwn i'r gweithio, oeddwn i'r gweithio, oeddwn i'r gweithio. Mae'r gweithio, oeddwn i'r gweithio. Mae'r gweithio. Mae'r gweithio. Mae'r gweithio. Mae'r gweithio. Mae'r gweithio. Mae'r gweithio. some evaluation, maybe there's something you can think about there? - I think it's really, because it only benefits the supplier as well, doesn't it? - The fact that you believe, I'm going to go on a bit of a rant now, so it's just, but the fact that you believe that a supplier should have to be educated about the value of evaluating their technology is shocking to me, it's mean like that, if you're a supplier selling into what health is B2B sales, straight out, that B2B enterprise sales, right? Like if you're selling robots for good and safe, that's a fair, that's an enterprise and the fact that you would have to be educated, for example, around why it might be good to run an evaluation is insane to me, and I feel like there's a lot of, if I could wave a magic wand, I would love to be able to inject a bit of realism sometimes into the entrepreneurial culture around digital health, and just because you built the thing, that's table stakes, building the thing is like, if you don't have a thing, then don't talk to anyone. So I don't know, I just feel like there's something there, but I don't know if you found the same thing. - No, absolutely. Like I say, I think, well, I think it would benefit the supplier, because then they have the evidence, you know, we all know, as soon as a supplier starts talking to us in the NHS, it's like, where else are you live or the evidence, what else is it work, you know? - Yeah, who can I talk to? - It feels like an O-brainer. - It's like, who else can I talk to that's using your robot? - So actually, if it's built into contracting and the kind of supplier things that you will come back and you'll evaluate, you'll tell us what's working, what's not, it surely benefits everyone. And maybe it's because they don't want the negative things to come out, I don't know, but surely they're just things you can build on. - Well, yeah, and I think, I mean, if I think about PopDoc, for example, which is the company that I run, you know, some of the harshest feedback we got was obviously very in the early days from NHS people, the nurses and community workers and things like that that we're using in. It was given in an extremely blunt way, but we knew that would happen because it was the first version of the product. - Yeah. - But you're not, surely, because you want it to work for who you're intending to do it. - Yeah, like, you can stick your head in the sand, and that's all well and good, but then it won't get any better, and you won't scale, and you won't grow. So yeah, I think it's a, I just think it's a really, if you think about in the United States, for example, they're all about solving customer problems. - Yeah. - And the customer's king or queen, you know? So I just think maybe there's a little bit of that, and then it's coming here. - And I think you hit the nail and head there, it's about solving problems, so it's not about creating something, because you think it's, you know, you actually need to solve a problem. - Yeah. - We're really, we're not great at that in the NHS. You know, we are, especially with the likes of me as the nerdy nurse that goes out to things like this, and sees the next shiny thing, and I want it. - Sure. - And then I try and find a use case for it, but actually, you know, we need to be speaking problem solving, rather than just putting something in for something to say. - How good do you think, you could talk about nursing, or you could talk about the healthcare system in general, I don't mind. - How good do you think that you are at signalling the problems that you need to be solved the most? - Bad. - Okay. (laughs) - We don't often. - All right. - We don't often understand them. I think we don't spend the time understanding them, so, I mean, Haseym Point, we're doing some work, as I said, with documentation, our EPR, and we've now come to the point where we were like deciding whether to deploy or not. We've realised we haven't done that work, we haven't gone understand what the true pain points are, what problem we're trying to solve. So lots of things are made on assumptions, sitting around the table talking about it, but actually, when we go out and see it in action, that's where you get the truth. So yeah, we definitely need to get better at that. And again, it's the upfront investment, isn't it, you know, the planning and building that in so that process mapping can't be understated. So you want your current state, then what you're aiming for, and then the steps in between. - And do you feel like there are individuals in the system that are able to deliver that sort of process mapping? - So that sort of exists, or is it, a bit of a thing that gets forgotten about? - Yeah. - Is it genuine question? - No, you're right, so there are, and I think there is a skill, you know, do you need to have that skill? - Yeah, especially in a system as complex as the healthcare system. - Absolutely. And you know, I've seen some recently, I'm like, what's great, talk to you how I use the tech, we don't talk about anything else around the periphery, you know, with that complexity. - Yeah. - So it is a skill, and I think it's something we don't invest in very well. I think where we've seen it work really well is where you join up like, um, transformation. Quality improvement. - Okay. - So that's the same sort of methodology, you know, you define your problem, you map it out, and how do you fix it. So seeing really good results where those two teams come together, and actually we were just talking about it on a panel I was just on, and they shouldn't be two separate teams, like it should be, and you know, we've talked very much a lot in the past, as digital leaders, that actually shouldn't be digital transformation. It's just transformation. - Yeah, it's improvement. - I completely agree with you. Like calling it digital transformation is such a very misleading. - Yeah, absolutely. - It's just quite improving stuff. - Controversially, a few years ago, a question that will the CNIO role still be, you know, will it have an, does it have an expiry date, and I think it does, because it will just be changed. - Yeah. - It won't be digital change, and it won't be a need for this isolated person championing the digital, because that will just be the norm. - Yeah, I do think that there's an element that we have to try and shift all this into BAU. - Of course. - Yeah, I make it everyone's business. It's not just digital people. - Yeah. - Exactly, and it's not us doing it to you, this, you know, it's a partnership. - Right, so we've got a couple of minutes left. What are you most excited about seeing at Rewired, or you may have already seen? - I am most excited. I think about the suppliers. I like going around and seeing what's new. - The new shiny stuff. - Yeah, exactly. And I like to say catching up, the networking thing is so powerful. - Yeah. - It's that we're in, tend to be quite lonely, especially like there's the leadership roles. There's tend to be only one of you in a trust trying to deliver mountains, and not everyone gets it. So, you know, it's nice having the networks, because that's always my favourite bit. - Okay, good. And are you on any panels? - Or are you? - Yes, and so I'm the chair of the advisory, C&I O advisory panel for digital health. So, us as chairs have just done a panel session, and I'm also talking later about half us for about some work we're doing in these middles. - Perfect. Well, Haley, thank you so much for coming on the show. - Thanks for having me. - And have a great Rewired. - Yeah, thank you very much. - See you later. - Yeah, perfect. Right, so that was our Rewired Special, and it was great to have you with us, so thank you very much for joining the three guests, Alex, Hassan and Haley, and we will be back again next week with another great show, so thank you very much for listening.