Exploring the digital impact in Northern Ireland’s health and social care system

The pandemic accelerated the urgency for reform in health and social care around the world, which strained resources to unprecedented levels. The effects are still being felt and in Northern Ireland specifically, ongoing political instability is further complicating approaches to digital transformation. Although progress is being made that should be recognized and celebrated, Dan West, CDIO for Health and Social Care in Northern Ireland’s Department of Health, understands that the pandemic still casts a lingering shadow over national health and care systems, contributing to continuing rampant fatigue among staff and subsequent strikes over pay.

“From a people perspective, things are pretty strained at the moment,” he says. “All of the capacity and operational challenges that were present in healthcare prior to the pandemic are magnified now. Waiting lists have grown and diagnosis and treatments have been delayed or missed due to some of the burden the pandemic brought on the system. Plus, the absence of a functioning devolved executive, due to an ongoing dispute by the DUP over the Northern Ireland protocol, adds to all of those challenges. It all reduces the ability to arrive at a budget settlement that shifts resources into the health and social care space. So you can see how my job has had to react to all of those stimulants.”

Leaders in the public sector and healthcare might worry about a return of red tape that could slow down innovation, too, but West has a more resilient outlook to progress by, as he says, never wasting a crisis.

“We’ve been able to accelerate the things we knew we needed, but we also had a rate of adoption of collaboration and flexible working tools that we wouldn’t have seen in peacetime, if you like,” he says. “I was doing some work in a trust in the English NHS and we gave everybody tools, laptops and mobile solutions, and redesigned the operating model and how we worked together. There was resistance, though, where people felt they still needed an office, but there was an exponential increase in the use of virtual tools and capabilities to how we interacted with each other as professionals, and with our patients. We need to make sure that how we deliver digital capability to our staff, and how we do digital enablement of services for citizens, is not allow that elasticity in bureaucracy to snap us back to traditional ways of working.”

CIO Leadership Live’s Drinkwater recently spoke with West about how to put people first in a system under increasing pressure to function as it strives to digitally transform amid a backdrop of political and environmental uncertainty. Watch the full video below for more insights.

On balancing efficiencies: To sustain health and social care services into the future, we need to find a way to get more output from the same or maybe even reducing resources. And I don’t think anybody would suggest that digital is some kind of panacea to all of this. The real requirement is in and around staff. But the absence of the money to hire more doctors and nurses, the lead time, and then training them to bring them into the service means that digital has to be part of the jigsaw puzzle to address those challenges. The projects and products we delivered during COVID-19 adopted some of the techniques and technologies that allowed more efficient digitally enabled services.  

On continuing important work: There’s an impact on the experience of citizens, interacting with health and social care services, and leveraging cloud technologies, smart phone apps, and agile delivery methodologies that allowed us to quickly put things in place in a way we haven’t done previously. The COVID Care NI app, for instance, is like a symptom checker and chat bot that provides a personalized package of advice based on personal circumstances and how it related to evolving regulations. Also, the Bluetooth proximity app Stop COVID NI was the first of its kind to launch in the UK, and the first globally to achieve international interoperability, given our shared border with the Republic of Ireland and the Epidemiological Unit of the Island of Ireland. It was important for us to create our sharing capability. A new way of delivering vaccines and vaccine management and convenient booking capabilities was also big. All of those things really changed the paradigm. It moved away from the traditional, matriarchal approach to delivering healthcare services, galvanizing and empowering patients and their families more and how they interacted with services. I’m interested in how we could maintain momentum around those experiences in a post-pandemic world, to leverage technologies and techniques like that, to deliver improved and modernized experiences and services.

On progressing the digital conversation: The fail fast mentality to get product out there that can help us change the way people work and live is one of the key focuses for all technologists in parallel to public scrutiny. People will be more risk-averse than they were during the pandemic, so let’s not allow those big public processes to push us back into traditional ways of working. What we saw was the digital tail wagging the clinical dog. Historically, we tried to avoid that. We tried to have the operational care model and service design drive out technology requirements. I’m not suggesting that shouldn’t be how the world works, but during COVID, the technologists could go beyond the current operating environment where we were trying to build the pandemic response, and look around the world and see the pockets of innovation and best practice—like building a new vaccine management platform with a publicly accessible appointment booking service. That didn’t come from an operational or clinical policy discussion. It was something a colleague in Scotland introduced me to, and I then took it as a digital reader to the Public Health Operational and Clinical Response to say, “We need to start thinking about this.” We can bring digital upstream in the policy conversation and collaborate differently with clinicians who have a better understanding of the benefit and potential impact that digital can have, as well as the way they form relationships and transactions with citizens. All those considerations that allow us to alter the dynamic and accelerate how we can transform services is an environment that’s resistant to change.

On grassroots involvement: I had never done startup stage work in technology, but it’s something I’m interested in to build my own experiences. I’m also quite passionate about the local technology sector. So I’m helping a young reg-tech and insure-tech business to create an initial suite of products that will work within governments, the insurance industry, and home and business owners to address the fact that one in five properties in the UK can’t secure risk-reflective and affordable insurance against flood damage. That’s not sustainable for us, as a society. So technology has a part to play in the information relationship between governments, the insurance industry, and those businesses and homeowners, so that as we increase resilience of our properties through flood risk interventions, we can build that body of evidence that drives us toward a risk-reflected market in insurance. It’s a really interesting opportunity and a different environment to work in compared to the health and care day job. Belfast is getting a good reputation now for technology, so getting involved in a startup and taking it through a launch was quite an interesting opportunity.

On the value of people: To continue delivering and working through priorities for our trusts, and make the digital journey achievable is we have to recognize that projects and programs are just a means to an end. The technology itself is not what we’re all about. It’s about the people being able to deliver better healthcare services, our staff being able to do their jobs better, and our citizens interacting with safer, modern and more convenient healthcare experiences. It’s the opportunity to shift health and social care from being an economic burden for society in Northern Ireland to a real opportunity for growth and innovation. And those people aspects of that technology portfolio must be our focus over the next few years as we carry on this digitization journey in health and care. In a resource constrained environment, we have to evidence that all of these technology investments are delivering a real change for people in the region.