The leader of one of the most mature shared care records in the country has recently become partnerships director at Ethical Healthcare Consulting, the only not for profit health informatics consultancy in the UK. In this article he talks about the challenges facing IT as the NHS emerges from the Covid-19 pandemic and prepares for another round of reform, and how he hopes to address them at a consultancy committed to ‘doing the right thing’.
Andy Kinnear has just stepped back from a 30-year career in the NHS, where he was best known for his pioneering work on the Connecting Care shared care record in Bristol.
Working closely with Orion Health, the record has grown steadily from a way of sharing information between acute hospitals and GPs out-of-hours to a foundation for joined-up health and care across the city, South Gloucestershire and North Somerset.
During the first phase of the Covid-19 pandemic, it also made its first foray into population health management, by embedding a risk calculator to help clinicians work out the risk to individual patients posed by the disease.
Now, Kinnear has joined Ethical Healthcare Consulting, just as the government has published its own ambitions for Integration and Innovation in a white paper and set a September deadline for healthcare communities to get a ‘basic’ shared care record in place.
So, why has he joined Ethical? What are the big challenges that are still facing NHS IT? And how is the not for profit consultancy going to help to address them?
Why Ethical? “Ethical is different. The guy who founded it, [chief executive] Thomas Webb, comes from an NHS background and he is very committed to NHS values. On the website, he says he ‘just bloody loves the NHS and everything it stands for’ and he has set out to create the kind of consultancy that the NHS would create, if it could.
“That’s what attracted me and people like [clinical director] Anne Cooper [formerly the chief nurse at NHS Digital] and [principal consultant in health system collaboration] Joe McDonald [a pioneer of chief clinical information officers pioneer and, until recently, one of the leaders of the Great North Care Record]. The culture feels familiar.”
What is the role of Ethical in health tech? “I sometimes talk about the four ‘engines’ of health tech. National policy is one engine. Turning that into national delivery is another engine. Then, there are vendors and the energy that comes from the supplier space. And, finally, there’s the local health and care system, deploying on the frontline.
“We need all of those engines to be running at their optimum and to be aligned to driving forward the fourth engine, the local engine, because that is where the greatest impact lies. Ethical is about making that happen.
“If you look at our portfolio of work, you’ll see it is all about helping digital leaders to work out a transformation strategy, to bring in the right electronic patient record, to set up a shared care record. We help them to define what the next steps are going to look like and, sometimes, we support them on implementation as well.
“Because of our background, we can really see where our clients are coming from. Actually, for me, the people I am working with are not clients, they are me, in another life. If I am working on a business case for shared care records, it’s not going to be just another high-level document, it’s going to reflect ten- years of real life doing it in Bristol.”
Are we entering a new era of digital health, post-Covid? “I’d like to think so, because we saw a big increase in digital adoption during the first wave. We saw organisations roll-out remote working, sort out virtual consultations, and reconfigure their EPRs and their shared care records to support pandemic ways of working.
“However, I worry that didn’t move the dial as much as it should. Matthew Swindells [a former NHS trust leader turned Cerner executive] drew a set of six tiles on his ‘placemat’ [when returned to the health service to lead on transformation and technology when Jeremy Hunt was health secretary].
“The first tile was digital records – or EPRs and the ‘paperless’ challenge. The second was interoperability - or getting systems to join-up. The third was data - using the huge, untapped oilwell of NHS information for analysis and planning.
“The fourth was digital experience for patients. The fifth was the science fiction bit - genomics, machine learning and AI. And the sixth was maintenance - keeping it all secure and up to date. I still think that’s a really good descriptor of what digital health is all about.
“And, unfortunately, most of the challenges are still in the first couple of tiles; in deploying systems and sorting out shared care records. So, it will be interesting to see, as the NHS gets back to something like normal working, how much change sticks.”
strong>Are there new ideas to work with? “There are, and when I’m feeling more optimistic, I look at some of the great work that forward thinking trusts are doing with new entrants on cloud provision, and open architectures, and creating a plug and play ecosystem for innovative apps. Fortunately, Ethical gets to work in that space as well!”
What are your views on the roll-out of shared care records? “Getting shared care records in place has got to be a good thing. What I learned in Bristol is that clinicians make risk-based decisions, using the information that is available to them.
“So, if you can give clinicians access to more information then, as long as it is appropriate to the care setting they are in, and the role they are performing, they will make better, safer decisions. The other thing I learned is that implementing a shared care record brings about some interesting cultural shifts.
“First, people start thinking about data as a tool of their trade. In 2010, we had doctors telling us they didn’t want to share data through Connecting Care because it was ‘their’ data, and by 2015 we had the same doctors telling us they had changed the way they recorded data because they knew other professionals would need to use it at different points along the patient journey.
“Second, people realise there is a patient journey that doesn’t start and stop at the door of their clinic or office. At the start of Connecting Care programme, we had people saying ‘we are interested in your programme, but what is in it for us?’ and after we had been running for a while, we had people saying ‘how can we get involved in your programme, because it’s going to be great for our patients?’. You get a shift in the conversation.”
How do you feel about this new challenge? “Ethical isn’t just a name. we demonstrate our values through our behaviour. The people who are coming to work for Ethical come from different backgrounds, and look at things in different ways, but in the end what matters is that they have a track record of delivery.
“When I led Digital Transformation team at South Central and West Commissioning Support Unit [the organisation that led Connecting Care while providing other forms of IT support to health and care organisations in Bristol], I used to say that our aim could be summed up in three words: delivery, delivery, delivery.
“That’s still my aim, working for Ethical. Because if you do good work, people will ask you to do more of it, and the business will look after itself.”
Andy is recognised as one of the NHS’ most influential digital leaders. Until spring 2020, he was director of digital transformation at NHS South, Central and West Commissioning Support Unit, which directs digital transformation programmes across Southern England. He was also chair of the health and care executive of BCS, The Chartered Institute for IT, and won the inaugural Digital Health Award in 2018 for his work to establish the Federation for Informatics Professionals, or FEDIP. He is currently working on interesting Covid-19 related projects and is a member of the Highland Marketing advisory board.