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CIO interview: James Freed, CIO, Health Education England

As well as the usual IT leadership tasks, the healthcare IT chief is also responsible for helping to develop digital skills and awareness for staff across the health and care sectors in England

James Freed is not your average healthcare CIO. Not content with leading internal IT for Health Education England (HEE), an arm’s-length body responsible for education and training, he is also helping to lead a national programme to ensure health and care workers can make the most of digital transformation.

“So my job title is CIO and, as a CIO, my job is not dissimilar to every other IT leader in the world,” he says. “It’s to make sure the organisation takes the greatest opportunity and has the lowest amount of risk in the data, information, knowledge and technology that it chooses to employ in order to undertake its activity.”

HEE’s key activity, says Freed, is to provide national leadership and coordination for the education and training of the health workforce within England. As CIO, Freed has to understand the demands of this activity and help to deliver education and training through technology and data.

But his additional responsibility, where he is leading work on the Building a Digital Ready Workforce programme on behalf of the National Information Board, gives him an interesting split in his day-to-day activities. Leading this initiative gives Freed a fresh take on the changing role of the CIO in UK healthcare.

“I used to work in the NHS National Programme for IT (NPfIT), for my sins, and what I witnessed there was quite a macho culture,” he says. “What I’ve often seen is an expectation as a technologist – and it’s probably even worse as a CIO, because you’re in a position of power – that you’re expected to be able to divine what users need, without actually having to talk to them.

“One of the things that’s happened in the last five years in the area of digital government is a growing recognition that you have to talk to your users. You need to keep them much closer to the products that you’re designing – you need to shorten your development cycles and change your direction based on genuine user feedback, rather than your interpretation of what their needs might be.”

“In the area of digital government, there is a growing recognition that you have to talk to your users”

James Freed, Health Education England

Freed trained as a molecular biologist before moving into IT. After working across various hospitals in London, he moved to NHS Connecting for Health, the agency responsible for NPfIT. Freed subsequently worked for the Health Protection Agency, where he led information management, and Public Health England, where he was head of information strategy. He joined HEE in June 2015.

Freed, who spoke with Computer Weekly at the recent HETT conference, says he took the CIO position because it provided an opportunity to do what he thinks he does best – creating and leading a model for change. “What I wanted was an opportunity to help,” he says.

“In my time with the Health Protection Agency and Public Health England, I found my calling, which is based around how I believe that we, as health informaticians, can help make the healthcare system better for people.”

Freed says that translates into a consideration of how he and his colleagues can get greater efficiencies from the taxpayers’ pound, and how they can support health and care workers to deliver high-quality services. “Those are the things that really drive me,” he says.

“Moving to HEE was an opportunity to do that, and to do it in a CIO role. So not only was I able to write a strategy, but I was also responsible for delivering it. I think of education as a public health intervention – I see the concept of sharing knowledge as a key element of how you support any industry to succeed. And the healthcare industry is the one I care about most.”

Making digital readiness a priority

Freed says one of the things he is most proud of is his work around the Building a Digital Ready Workforce programme. This initiative aims to create an inclusive culture of innovation. It is intended to help everyone in the health and care sector in England become comfortable with using digital tools, so they then become more efficient and productive.

“The strides we’re taking there – in collaboration with a whole bunch of people from academia, industry and frontline healthcare organisations – have got a real chance of making a significant difference in helping us to become more adaptable as organisations and people,” he says.

Freed has also made progress in internal technology systems. He points to the implementation of the Trainee Information System (TIS), which he describes as a user database, and the system that support the management and administration of junior doctors across the NHS.

TIS is a bespoke system that replaces an older legacy technology. The new platform went live in spring 2018 and, by October of that year, more than 600 new trust users were using TIS. “We went from a position where we were buying products to one where we built our own technology, and we went live successfully,” says Freed.

Boosting skills capability

The hard work continues for Freed, both in terms of the technology systems he manages and the training programmes he helps to lead. He says his team’s job is to help everyone in health and care – 1.4 million people in the NHS and about 1.7 million in social care professions – to be digitally ready.

So how do you make sure 3.1 million people are digitally ready? Freed recognises that it’s a challenging question to answer. Even his own organisation uses different definitions for digital readiness, but it has published a capability framework on the HEE website. Freed attempts to provide more clarity.

“In a nutshell, it’s all those skills, capabilities, attitudes and behaviours that enable you to thrive in today’s 21st century society,” he says. “It’s the sorts of things that mean you can see a problem, whether it’s something you suffer from, your colleague, your service user or a patient, and you feel empowered – and have the right skills – to solve it.

“Now, that might not mean you know how to do everything, but it might mean you know how to find out. So that is digital readiness, in my mind – it’s being adaptable as an individual to enable staff that you interact with to improve. So, how do you do it? How do you nudge people to change? We think there are three elements to this – self-assessment, the Digital Championship [see below], and signposting.”

Supporting a cultural transformation

When it comes to developing the first of these elements, Freed says HEE is currently in alpha mode around the creation of its own self-assessment tool. He says the organisation’s research indicates that it is possible to measure confidence and knowledge, but it is much harder to measure a skills base.

“That’s because we talk about skills related to specific tools, and every single health and care provider has got different toolsets employed in a slightly different way,” he says. “So we can’t yet nationally measure the skills base. Nonetheless, we are working on a self-assessment tool, with some customisation locally.”

The second element of digital readiness, says Freed, is around improving staff once their level of maturity is identified. He says HEE is undertaking work in this area with a couple of organisations around what it refers to as its “Digital Championship” model, which involves supporting local organisations in their learning and development initiatives.

“It’s about thinking how we support those local organisations to upscale about one in 20 of the people in the organisation to act as a hub to convene groups, to talk about problems, and to share knowledge about how to solve those problems,” he says.

“That could be workarounds for existing systems, it could be how to complete recruitment, or it could be something much more specific, such as how to introduce a telemedicine clinic.”

But once you have nudged people enough to the point where they are able to find things out for themselves, how do you put them in contact with the people and the knowledge they need? The answer to that, says Freed, is the third element of ensuring digital readiness – the creation of a signposting tool.

“We have no shortage of learning opportunities in this world,” he says. “The difficulty is that people don’t know how to find them – and when they do find then, they don’t know if they’re any good. We will be producing a signposting tool, working with a number of colleagues in academia and industry, and with our own in-house e-learning for healthcare team.”

Developing strategic healthcare leaders

Freed reflects on these activities and recognises that he fulfils an unusual role, with dual responsibilities, in an unusual organisation. He says HEE has a broad remit that encompasses direct support and management for individuals, but also workforce planning and workforce transformation activities at a regional and national level.

“The reason that HEE exists is because no one else can do that job,” he says. “And my role now as CIO is to align the expertise within the informatics profession – our data, information, knowledge and technology professionals – behind the strategic ambitions of our business leaders in HEE. It’s all about the people element of getting that partnership working.”

Freed’s aim is to foster closer working across health and care and, more specifically, to build closer alignment between HEE’s business and informatics teams. Through these partnerships, he hopes to address a range of core issues that will impact the future of healthcare provision, such as the supply of staff and the upskilling of workers.

“But it’s more than just developing the profession,” he says, reflecting on his own experiences of being a healthcare CIO. “It’s also about developing our strategic leaders to understand what agile and digital means for their futures.”

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