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CIO interview: Toby Avery, CDIO, Surrey and Borders NHS Partnership Foundation Trust

It is rare for NHS tech leaders to take both IT and digital responsibility, but Toby Avery is using his broad role to build wider partnerships and collaborations across the south-east

Toby Avery, chief digital and information officer (CDIO) at Surrey and Borders NHS Partnership Foundation Trust, is something of a leadership rarity in healthcare IT. He reckons there are just a handful of CDIOs at NHS trusts, rather than the more common titles of CIO or IT director. So why is Avery a CDIO?

One key explanation is a promotion. After previously being CIO, Avery moved to the executive team in Surrey and Borders in spring 2019. Along with his promotion, he took on additional responsibilities. Avery and his C-suite colleagues reflected on what his focus should be as an executive committee member, rather than as someone reporting to the executive team. That analysis took place through two lenses – internal and external.

“The conclusion we came to is that, in a lot of other sectors, the digital officer is often the more externally focused person – the person thinking about how the organisation is delivering services for its customers,” he says. “They think about growing the business and they’re thinking much more externally.

“The CIO is often a much more internally focused position – it’s the IT director role rebadged in lots of cases. And the thing we realised was that, in my new executive role, I need to be crossing both boundaries. So I have an internal responsibility, but actually I have an increasing external responsibility, too.”

Changing outside perceptions

Avery says the external focus of the position gives him the opportunity to not just look beyond the IT department to other areas of the trust, but to also look beyond the traditional enterprise firewall. He says the best digital leaders in any sector think beyond the datacentre – and, in his role, that often means focusing on the wider healthcare system.

“That might include our regional position, such as talking about how we bring together CIOs in our region to work more effectively together across key areas, such as professionalisation, collaboration, procurement opportunities, and all these kinds of different things,” he says.

“It’s about how we can collaborate on innovation and do things at scale and do things differently”

Toby Avery, Surrey and Borders NHS Partnership Foundation Trust

Avery gives an example of this cross-region thinking. He says CIOs and chief technology officers (CTOs) across Kent, Surrey and Sussex have come together to think about successful forms of IT leadership. These leaders have formed the South-East Digital Healthcare Partnership, which is an attempt to think about how tech chiefs in the region can work together to spread best practice.

“It’s about how we can collaborate on innovation and do things at scale and do things differently,” he says. “That’s come together in the last few weeks. We’re advertising for sponsors at the moment, and we’re hoping to have our inaugural conference in February 2020.”

Avery says there are about 40 digital healthcare leaders in the region. The aim is to also include other members of the executive committees in the discussions. Such inclusive action could create a sea-change in perceptions.

“A year or so ago, one of our esteemed leaders from the centre, in a very public conference, described Kent as a ‘digital desert’,” says Avery. “That was a spur to say, ‘Actually, you know, we’re right next to London, and London trusts shout about the great stuff they’re doing. But actually, there’s some really good stuff happening in our areas, but who knows about it?’”

Pushing change in new places

Avery hopes this community-led thinking will help to boost professionalism and give people a fresh perspective of the transformative work on healthcare that is taking place across the region. “If we can come together and we can be effective, can we actually influence policy?” he says.

He envisages that these best-practice lessons will also have an impact back in his own trust. Avery hopes to drive a digital transformation in the way the trust operates, particularly in terms of the Surrey Care Record, which is a secure, encrypted extract of records from health and social care providers. He is also pushing change in hitherto unconnected areas, such as children’s healthcare services.

“A few years ago, you wouldn’t have had an IT guy in that room,” he says. “And now we’re thinking about how we can connect services and bring them together to re-imagine how we deliver clinical services to deliver better outcomes for patients.”

Avery refers to the aims for digital transformation in his own trust as “a tale of two cities”. Surrey has legacy technology that his team is working hard to replace, but until that work is complete, it’s hard to move fully into more pioneering areas, which is a shift that is already gathering pace in some places.

“We’re moving into user-centred design, user research, and we built our first design team this year,” he says. “We’re beginning to build a second design team and we’re innovating on the [Microsoft] Office 365 platform, building out our products, teams and Power Apps to support different use cases across the organisation.”

Managing multiple requirements

Avery says the two states he has to manage – staff using legacy kit and others who can take advantage of digital services and mobile apps – creates a tension. His role is to carefully manage both frustrations and expectations regarding the implementation of technology. Crucially, he believes the management of IT is a dual-speed process.

“There is a recognition that we need some stuff that’s going to deliver value, and we need it quite quickly, which helps buy us the time to fix some of the underlying infrastructure challenges that we’ve got,” he says.

One of the priorities this year has been what Avery refers to as a massive infrastructure programme, which involves replacing the entire network. Like other healthcare organisations, the trust is rolling out Windows 10, which includes replacing a large amount of its IT estate.

The developments follow the trust’s implementation of Office 365 a couple of years ago. Avery says the organisation is now looking to make the most of that platform and other cloud-based services.

“We’re re-imagining our digital strategy at the moment,” he says. “In the next few months, we hope to take our digital strategy to our executive team for comment.”

Avery says that strategy will provide clarity around what the digital care record means for the trust. The focus will be on ensuring that technology and data are used in a joined-up approach to healthcare that helps to connect communities.

Joining up patient data

The reality, he says, is that his trust delivers healthcare services across a much broader system than a single organisation. The patient at the end of these services doesn’t care whether they’re in a GP surgery, mental health trust or community hospital – all they care about is getting better.

“How do we start thinking about the technology we need to support that individual throughout their entire pathway?” says Avery. “How do we identify the individual and support them, so that we don’t have to ask them the same questions in every different organisation they touch?”

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That lack of connectivity between records and organisations is a problem that will be familiar to anyone who is a regular user of NHS services. Righting those concerns will be a huge task, says Avery, but it is a challenge he is looking to address through his new digital strategy.

“What is exciting in our patch is that we are now beginning to have those conversations,” he says. “We’ve got some good thought leaders in this space. Nobody’s really solved this challenge yet, as people are at different stages of the journey, but I think we’ve got some good investments coming our way.”

Avery points to £13m of community transformation funds that have already been allocated to the Surrey and Frimley Integrated Care System. This work will aim to pull the core of mental health services out of primary care and into secondary care at GP surgeries.

“Those services will then be much closer to the individual’s needs, so that they’re less likely to need admission to hospital,” he says. “But that also means we’ve got to put in the interoperable technology that allows us to support the data flow for that individual, whatever organisation they’re touching.”

Winning everyone over

Like so many of his healthcare peers, Avery recognises the day-to-day tension involved in balancing operational IT with potentially life-changing innovation. Talk about the potential impact of artificial intelligence and machine learning in the NHS is all well and good, but the likelihood of those changes taking place are minimal if organisations are still struggling with legacy kit and running applications on Windows XP.

“I think that tension is a real challenge,” he says, referring to the need for healthcare CIOs to buy credibility for technology-driven change. “But you don’t have to do something innovative for the whole organisation, you just need to find use cases where you can really drive some value and free up some cash.”

Avery looks back on his own journey at Surrey and believes that, when he came in three years ago, IT was seen as “boxes and wires”. Although he hasn’t necessarily won everyone over, digital is now seen much more as an enabler.

“I describe the digital maturity journey as going from IT being seen as a support function – which it still is in an awful lot of NHS organisations – to a mature place where digital is the opportunity to completely transform or re-imagine the way we do things,” he says.

“That’s the kind of journey we’re on as an organisation. It’s about clinical services and digital specialists coming together to re-imagine how we deliver healthcare pathways. There’s so much opportunity, but we haven’t solved it yet, by any stretch.”

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