Professor Hamish Laing has spent 35 years in the NHS, specialising originally in reconstructive plastic surgery. That led to a stint as Executive Medical Director of one of the biggest health boards in Wales, as well as being the CIO and Senior Responsible Officer for a programme to rebuild the NHS Wales websites.
Professor Laing is passionate about digital transformation and inclusion and has led a cross-sectoral review of clinical and digital strategies within his health board. He has spent his working life immersed in all aspects of the NHS, as both a practitioner and as a senior leader.
Today, he specialises in health policy at Swansea University. Here, we talk to him about digital transformation in the NHS, the role of health informatics and why digital health and care needs to be professionalised through schemes like the Federation for Informatics Professionals - FEDIP.
Talk to us about digitisation in the NHS
‘I think we’re seeing an increasing pace in the digitisation of the processes of delivering health care. There is a huge challenge around information. It used to be that that any information about a patient was held by the doctor and maybe eked out to them in small amounts.
‘Then, we had Google. which allowed patients to find out something about their condition. But now in a consultation, you might have a patient bring six months’ worth of their health data with them on a phone.
‘The role of clinicians is becoming interpreters of information, not the owners of the information. So, there is a democratisation, which is good, but that brings a whole lot of challenges with it, including the skills to work that way.
‘Elsewhere, we have more and more digital systems in hospitals, GP practices and in the community; therefore, the role of IT professionals is suddenly in greater focus. IT teams aren’t just running the accounting and supplies systems. Now, they are running mission-critical systems – and when that stops working or doesn’t work well, it’s a real risk and challenge. Digital has suddenly become a core part of the business at the NHS and it maybe hasn’t yet got that place in the organisational culture.’
It’s almost as if the pace of the technological developments in the NHS has been so fast that it has almost been overtaken by events. What do you think should happen?
‘These days, even a medium-sized business would have a chief digital officer or a chief technology officer on the board. They advise the business about how to get the best value out of digital and how digital can enable it to be better and more efficient, safer and more effective.
‘We don’t yet have that as a statutory role on health boards in Wales. We have someone whose role includes speaking for IT, but that’s very different from advising how the whole organisation realises the benefits of digital.
‘The NHS in the UK is a massive business. In Wales we spend £8 billion a year - more than 50 percent of the government’s budget goes on health. It needs somebody who, at board level, can be advising on how best to use those technologies to improve the sustainability of the health system and the delivery of care.’
Is there any clear vision, do you think when it comes to the digitalisation of health?
‘No, perhaps not really. There are pockets of vision and there are some real visionaries. In England, the Secretary of State for Health, Matt Hancock, has been very passionate about digital in health care, particularly where it directly impacts citizens and patients.
‘I think in Wales, we’ve had more of a focus, up to now, on the clinical systems in our hospitals and GP surgeries. We’re just beginning to focus on the citizen-facing digital arena and opening up our architecture, which is probably the most exciting change. There is going to be a chief digital officer for health and social care in Wales, which is great!’
What about the risks surrounding governance of data?
‘I think digital transformation is the thing that will probably create the greatest difference for patients. As an example, we have always thought of the medical records in hospitals as being ‘ours’, but they are the patients’, it’s their information.
‘We know that if you securely share that information with a patient, they become more engaged in their health care; they become better informed; they’re more likely to look after themselves because they have the information they need. So, it's good for them and it is also good for the NHS, as it allows us to interact with them digitally, too, which can be more efficient.
‘Of course, you must have good governance, comply with GDPR and be transparent, but that is entirely possible to do well. There are some great examples in Wales where we have shared records with patients safely and effectively to everyone’s benefit.’
What’s your take on the Federation of Informatics Professionals - FEDIP?
‘I think FEDIP has got the very honourable ambition of professionalising the work of colleagues in digital and health, by making sure there are standards, that there are expectations and that people are maintaining and developing their skills and knowledge. So that is entirely desirable and should be supported.’
Structurally, how does NHS Wales differ from NHS England?
‘At the moment, there is no separation between the executive for NHS Wales and the Health and Social care division in Welsh government - so it means that politicians are brought extremely close to the NHS. If something goes wrong in a hospital today, the minister will know about it and may well be asked questions in the Senedd (Welsh Parliament) about it.
‘This closeness means that politicians are very aware of the expectations of citizens about their NHS - and that’s a good thing. They probably understand the shared experiences of patients better as a result. But sometimes it does lead to prioritisation of matters, which wouldn’t necessarily seem obvious to those in the service. There are plans in development to separate some of the functions in the future.’
Is it fair to say NHS Wales can be agile because of its size?
‘Wales has a population of three million. We have just seven health boards and three trusts and you can get the chief executives of all those organisations in a room to agree stuff, so that’s really good. It’s also a size that is attractive to industry as a testbed for innovation - it’s big enough to be significant but small enough to be manageable.
‘Whether or not we always achieve the benefits of this, I’m not always sure. Sometimes we get bogged down and don’t always deliver things at the pace we would like to see. But, there are many examples when we have been very agile and we are ambitious to show others how it can be done - and that makes it a great place to work.’