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CIO interview: Sam Shah, director for digital development, NHS England

Uniquely, Sam Shah is both a clinician and a technology leader, and he hopes to use both skillsets to overhaul IT in the health service

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Sam Shah is an executive hybrid – an experienced manager with awareness of the application of digital technology in a range of sectors. He is now using his knowledge to bring lasting change to the NHS, and healthcare is an environment he knows better than most, as he also works as a clinician in primary care in Kent.

Shah’s amalgam of skills means he is well placed to fulfil his role as director for digital development at NHS England, where he is working with suppliers and other partners to develop customer-centric services.

Shah – who spoke with Computer Weekly at Big Data World at Excel, London – recognises that his hybrid background and role is unusual, yet he also believes it provides him with the perfect platform to lead change.

“I feel incredibly privileged – I’m so lucky that I still get to see patients, but I also get to bring in my knowledge and experience of digital and technology from outside health so that I can improve our approach to the development of healthcare in the NHS,” he says.

Shah gets to work with the chief clinical officer of the NHS, the health service’s CIO and its chief digital officer on a daily basis. He also works closely with the various policy leads and directors responsible for the business transformation and service-change developments that are taking place across the health service.

“I get to be a bridge between those different agents that help bring about change,” says Shah. “What’s really important to me is not necessarily just what all of us think in the centre, but what happens to my colleagues every day on the ground.”

That is where his responsibilities in primary care make a crucial contribution. “I like to get out there, whether that’s with clinicians, service users or CIOs, and see what’s happening,” says Shah, who wants to use digital technology to boost customer experiences.

The good news is that Shah believes some of the groundwork for a fresh approach to technology is already in place. He says most hospitals already have “lots of good equipment that’s connected up in some way”. Now, he says, the challenge is to bring these technical elements together to create benefits for patients.

“Technology has a role in digital health and the delivery of medicine itself”

Sam Shah, NHS England

“Every health system around the world has different challenges – there are pros and cons to every system,” he says.

“In the NHS, we have a significant opportunity to drive change. For me, technology has a role in digital health and the delivery of medicine itself.”

Shah’s experiences from beyond the healthcare sector span a range of industries, including academia, law and finance. He says one of the key elements he learned from the private sector is the importance of working to achieve set business outcomes.

“If I think about other industries I’ve been in, we really focused on the underlying needs of users and how we translate those requirements into great interfaces, so that we develop a high-value exchange that means people start using the services we create,” says Shah, before suggesting that this concentration on value is something he aims to replicate in the NHS.

“If we create an environment where the technology is the best it can be for its use case, then people will naturally use it and the digital transformation in the NHS we all want will take place,” he says. “If we constantly listen to user requirements – and undertake discovery in the best way possible, and start to work out what the best interfaces are – then we’re much more likely to provide meaningful technological change.”

Shah’s role now is to investigate the opportunity for digitally enabled transformation in the health service. That means building a bond between the technologists who can help inspire change and the clinicians who will benefit from new systems and services.

“We need a coming together of innovators and the providers that develop the deep infrastructure that is currently used across the NHS and related healthcare organisations,” he says.

“The coming together of those two types of providers is a helpful way to achieve digital-led change.”

Developing standards and frameworks

Shah presents the NHS as a federation of entities across England, which includes 15,500 healthcare organisations. These organisations help the service manage 24 million visits to accident and emergency units and 340 million GP consultations each year.

“We deal with a lot of data and a lot of people,” says Shah. “But this federation of entities has to manage data flows in multiple directions across the estate. Data management creates complexity in healthcare.” says Shah. NHS IT must help turn this information into useful insight, he adds.

“In that moment when people need us most, we have to make very quick decisions – data at that point to clinicians is incredibly important. It’s very hard in such a regulated environment to disrupt and to bring in new technologies that make the most of data.”

But Shah is hopeful that change is on the horizon. He suggests recent announcements are helping to create the foundations for IT-enabled change in the heath service. Crucially, the new technology strategy for the NHS, revealed by health secretary Matt Hancock last year, endeavours to create central standards for suppliers working with the NHS.

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In February, Hancock announced the new digital organisation for the NHS, known as NHSX. This service will help set standards and best-practice techniques around technology, particularly concerning the use of open source code. Shah hopes these developments will lead to positive change.

“We’ve got an excellent secretary of state at the moment who is really focused on driving digital transformation through the NHS,” he says.

“There’s now a vision about how technology can be used to create the future of the NHS through innovation and how we connect up an emerging ecosystem of providers.”

Making sure staff understand the power of technology

Two recently released reports will also guide the NHS’s technology strategy moving forward. The Long Term Plan sets out the health service's policy for the next 10 years, with IT playing a key role, while the Topol Review considers how staff should be prepared when it comes to using emerging technologies.

Shah believes the effective use of standards across emerging technology will help break forms of supplier lock-in that have previously characterised much of the provision of NHS systems and services. To help encourage providers generate innovative solutions to business challenges in the health service, Shah says the sector needs to be a more attractive place for IT suppliers.

“We’re keen to help – we want to generate grants to help innovators in the UK work in partnership with the NHS,” he says. “We have an entire network of academics and scientists that support our work. And we have a much more open approach to development, so that suppliers can start working with the NHS in a more meaningful way.

“As we amass more data and connect more datasets, we have an opportunity to bring about precision public health to reduce inequalities and to reduce the burden on society. We can create precision medicine that allows clinicians to prescribe much more precisely around the needs of the patient and their optimal needs. Our world is becoming more data-driven, but we need help from suppliers to deliver these services.”

Getting the fundamentals right first

As suppliers and entrepreneurial innovators work to create new approaches to care, Shah says the digital services the NHS provides must be omni-channel. Rather than thinking there is potentially one magic product that fits every case, the NHS must create an ecosystem that uses open standards to support connectivity and choice.

“For some individuals, the best channel might be voice – for others, it might be video or text,” he says. “Whatever that channel is, we’ve got to build services around the needs of our users to create the future of the health service,” says Shah.

“As a clinician, I always take it back to basics. Whatever happens, more likely than not, there will be a patient in front of me who needs treatment. That interaction between patient and clinician is fundamental to why we exist as the NHS and why we provide the best service we can.”

Shah says the basis for omni-channel development work will be the initiatives he is now helping to lead around standards. “If that’s our starting point, then everything we do has to emanate from that very space – which means we need to get the basic infrastructure right to make that interaction the best it can be,” he says.

Supporting progression in the health service

Shah believes a whole host of technologies – from artificial intelligence to virtual reality and blockchain to quantum computing – could have an impact in the NHS in the long term. He expects these technologies to seep into the health service during the next decade, but their exploitation will be tightly related to use cases and data governance policies.

“There’s lot of great technology out there, much of which is already being developed in other industries,” says Shah. “In the NHS, we operate in a more regulated environment, so we have to go through a bit more process to get there.”

He says Estonia represents a good case study on connected health. Shah also mentions developments in Spain, Dubai and Australia. But there are good pockets of best practice in England too, including some pioneering development in specific local councils and NHS trusts.

Leeds is a great example of a place that’s racing ahead in comparison to other places,” he says. “There’s pockets of good practice around the world, but what we need is industry collaboration to help generate benefits. I’m positive – society has to progress. I think we’re in an exciting place in the health service.”

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