In conversation with… Ali Noorani, Orthopaedic Surgeon
Ali Noorani is an Orthopaedic Surgeon at St Bartholomew's & Royal London Hospital specialising in trauma and upper limb surgery.
He also holds a number of additional roles as: Medical Director and Chairman for Orthopaedic Specialists, President and Chairman for The Harley Street Specialist Hospital, Chief Medical Advisor for JS Healthcare Division, and CEO of Next AI.
In this interview, Ali discusses the use of AI for surgery, why start-ups being involved in implementing local solutions is "the way to go", and the biggest barrier to innovation within the NHS.
Ali was interviewed in October 2021 - this piece was originally published as subscriber-exclusive content.
Tell us a bit about yourself and what your role entails.
“I'm a Shoulder and Elbow consultant at the Royal London Hospital which is now one of Europe's biggest level 1 trauma centres. I also have a number of different roles outside the NHS as well.
”I'm the Founder and Medical Director and Head of Strategy for an orthopaedic group called Orthopaedic Specialists. Currently, we have 28 doctors on our team.
”I'm also President and Chairman of The Harley Street Specialist Hospital group.
”That's me in a nutshell. People come to me in different capacities for opinions and insight.
”For me, I see myself primarily as a Shoulder and Elbow surgeon.
Orthopaedics was a natural choice for me to go into. Not only are both my parents surgeons, but shoulders and elbows are poorly understood joints and I was interested in using my abilities to deliver something that other people couldn’t do.”
Since you trained as a doctor, how has digital healthcare progressed?
“I’d say quite significantly. We've gone from a system of sending letters out to all the patients to now having most of our patient communications done over email. Personally, and for all of my colleagues, social media is now massive, and this was non-existent when I started. In fact, a lot of the communications in medicine is now done on some kind of instant messaging service.
”Telemedicine has also grown massively, although it was already a big part of our portfolio as orthopaedic surgeons. It’s obviously really accessible and easy to use and can be used anywhere, and now at least 30% of my consultations are no longer face to face.”
How do you see digital health evolving to assist you in your role now?
“We’re seeing a real expansion in computational AI algorithms. I’m involved in a small start-up called “Next AI” and we look after databases and work out, through algorithms, how to treat certain healthcare problems.
In the immediate future, I see us using algorithms from big data for improving patient outcomes and giving them better, more informed choices.
”A classic example of this is if a 60-year-old man came in with a knee problem. One doctor might say to everyone that knee operations are great and if you get a replacement it will last 20 years. But the reality is that everyone’s different and you can’t say what works for the obese 60-year-old man would work for a slim 50-year-old female. This kind of decision making is becoming more and more prominent, and the patterns are there to see in big data. I see that as something that’s going to play a bigger role in diagnostics in the future.
”If we discuss AI for physical work, like surgeries, I think we’re less interested in how that is going to assist us.”
“The diagnostics are definitely the most exciting part and go further in finding the best solution for individual patients. More informed patients make better choices and that’s the role I see digital playing in the near future.”
What do you think is the biggest barrier to implementing new technologies in the NHS?
“The bureaucracy. There’s no doubt that the NHS is a fantastic institution with some great physicians and doctors - I feel that strongly. But it’s just a little bit too big.
“Even if you have really well meaning people within such a big organisation, the reality is that you’re unlikely to be able to work cohesively and will always be pulling in all different directions. That’s the real reason why we suffer.”
“Obviously the NHS still has a lot to do about record integration and information availability, but the problem always comes down to the NHS being so big that even if you have a task force and put billions behind the problem, something always goes wrong and the money is wasted.”
“I think small start-ups and smaller companies being involved in implementing local solutions is a much better way to go. So you have to either have a number of small local solutions, or one big solution for everybody. There’s nothing in the middle, unfortunately.”
If the NHS could do one thing tomorrow to make digital a reality, what do you think it should be?
“Unfortunately, there is no one thing they could do that will solve this. But I do think that the NHS needs a little more of a centralised role in policy making. They’d be able to say what should or shouldn’t be done, as well as if planned implementations are achievable or not.
”There’s so many different trusts and so many different things that need assistance. They need a bigger unified voice.”
