In conversation with… Alan Davies, Innovative Programmes and Partnerships Director at Health Education England
Alan Davies' work at Health Education England focuses on supporting the spread and adoption of innovative workforce programs through establishing and building collaborative partnerships with other health and care partners at national & regional levels.
Alan was interviewed in November 2021 - this piece was originally published as subscriber-exclusive content.
What does your role entail and how did you get there?
“I'm Innovative Programmes & Partnerships Director, in the Innovation, Digital & Transformation Directorate at Health Education England (HEE). HEE is the arms length body charged with helping to ensure we have the right numbers of workforce, with the right skills at the right time. My role covers the matrixed connection between new and innovative programmes of work within the directorate linking up partners both within and outside health and care at national and regional levels to maximise delivery success.
“My role covers the matrixed connection between new and innovative programmes of work within the directorate”
“I started my role just as the pandemic was kicking off, so when I first arrived the pressing problem was how to continue operating primary care when people couldn’t physically visit - the solution at the time was to work with our NHSE Digital First Primary Care colleagues to accelerate the usage of online consulting via developing the concept together of Remote Total Triage with the associated skills related. Interestingly 18 months later we still seeking to find the right balance between remote and face to face diagnosis in many places.”
How does Health Education England support digitisation of healthcare in England?
“In healthcare right now, it's very obvious that we're struggling with a number of factors. On the one hand, we haven't totally beaten COVID yet, we are simply suppressing the worst of it. The NHS still has a significant proportion of COVID patients presenting. We’ve also got a tired workforce that has been struggling for the last 18 months to cope with the demand and with some horrendous situations. Some of the staff are reaching the point where they want to leave the service, some to retire, and some sadly have themselves been very sick or even died. So, we're short of people.
“A lot of these new models of care have been well known & tested for a good while now (anyone remember the Vanguards or NHS Testbeds? ..) but change sometimes necessarily is slow…”
“Through Covid as I’ve mentioned already some new models of care around inpatient and outpatient pathways have had to be accelerated into widespread use linking Health and Care in ways not normalised before and digital tech has a critical enabling role to play. A lot of these new models of care have been well known & tested for a good while now (anyone remember the Vanguards or NHS Testbeds? ..) but change sometimes necessarily is slow…
”HEE has a key lead role to play with wider partners in ensuring we have a workforce that is trained, upskilled and digitally ready from board room to front line worker and able to utilise these new models of care as they are needed and rolled out.”
How has Health Education England’s role changed since the COVID-19 pandemic started?
“Digital will no doubt be an enabling thread running through some of the scenarios, outcomes and conclusions.”
“The COVID-19 pandemic has spotlighted the need for a flexible trained workforce in sufficient numbers not only to cope with the demands of today but also for the future too.
”During the pandemic HEE was highly successful in supporting NHSE through the redeployment of doctors and nurses in training and in encouraging back and refresher training retirees through our e-learning for healthcare platform (elfh).
”More recently HEE has been asked to lead by minsters some joint work with other ALB’s looking forward 15 years to try and ensure we build in more of the lessons learned from the pandemic in a long term workforce plan – although consultations are ongoing via some large deliberative events it is expected that digital will no doubt be an enabling thread running through some of the scenarios, outcomes and conclusions.”
What do you think are the biggest barriers to implementing digital change in the NHS?
“The NHS is a very interesting thing to seek to implement innovative change into. First of all it isn’t simply one organisation its actually lots of linked sub-organisations all working together – this makes traditional top down models of command and control difficult to operate.
“We don’t know what we don’t know and much of the NHS is too busy operating to catch up with the latest evidenced digital enabled pathway.”
“Next we must take into account that clinicians are trained to be responsible for their own decisions and to follow established and proven safety practice, that produces a really interesting conundrum – the appreciation of the need for change given demographic and disease related challenges yet the need to stay the same and follow tried and tested ways of working.
”Other factors that weigh in heavily are:
Ignorance – we don’t know what we don’t know and much of the NHS is too busy operating to catch up with the latest evidenced digital enabled pathway
Negativity - previous bad experience, digital is not a ‘silver bullet’ but a proportion of staff have had negative experience in the past and that experience can taint a view of future digital introduction
Evidence – how much is enough evidence? Bodies such as NICE are seeking to answer that question through the Evidence Standards Framework
Funding – Lack of funding either to lay down much needed digital infrastructure upon which more workforce facing tools can be layered or interoperability to connect up islands of data into useful information
Training – Coming from HEE you’d expect me to comment on this but it’s a fact that training is sometimes overlooked or treated as an expensive option in terms of time
Time – busy organisations providing round the clock care look at the time involved in implementing new digital technologies with a degree of disinterest & pessimism"
What digital technology do you think will be best in clearing the backlog?
“This is a complex question. But in recent times, I've been reminded of the banking sector and the retail sector. Probably like me, you do most of your banking electronically nowadays. I have my app that has my financial details, I make transactions - I can't even remember the last time I used cash. So there has been a consumer change to using digital as a new, ubiquitous way to get stuff done.
“We need to move further and faster with an ecosystem of digital tools to help us triage cooperatively better, utilise the most appropriate places of care and manage our health better for those of us that are able and willing to do so.”
“But, just recently, the plan to accelerate the usage of consolidated Primary care data for preventive and predictive care was frustrated because of over-riding public suspicion and a perceived lack of consultation. I think rather than being defensive, we need to get on the front foot in a positive sense and engage with the public around what it wants for its services and outcomes and how working cooperatively with health and care professionals and using digital we can jointly deliver on that.
The NHS App has taken us some way down that line, NHS 111 online similarly but we need to move further and faster with an ecosystem of digital tools to help us triage cooperatively better, utilise the most appropriate places of care and manage our health better for those of us that are able and willing to do so.
So tools such as self-triage, bed management - patient flow, discharge management, remote consultation, vital signs monitoring and disease and condition education and goal setting all build towards reducing patient influx where it can be avoided to acutes, ensuring efficient flow if they are needing to be admitted and enabling the timely discharge and management of recovery or reablement once they are back into the community
So not trivial, but doable, and utilising helpfully enabling digital technology that the public use similarly in other sectors of life today.”
