Lewisham and Greenwich NHS Trust

Justin Beardsmore is a seasoned healthcare technology leader based in London, currently serving as the Chief Technology Officer at Lewisham and Greenwich NHS Trust. With over seven years in this role, he specializes in strategy, transformation, and operations within large acute and local health economies. Justin collaborates closely with the CIO, providing strategic oversight, and ensuring that IT technology aligns with innovative care delivery approaches. His expertise bridges gaps between the Trust and regional partners, enabling fully integrated healthcare services.

Through this article, Justin points out that the shift in England’s digital health leadership from blue to red signals a need for strategic focus in a challenging environment.

England’s digital health and social care leadership has changed from blue to red for the first time in ten years. Health and social care are devolved to the five nations for those unfamiliar. The ministerial runners and riders have also been appointed, along with their advisors. Some are new, some are from the Blair years, but all have a wealth of healthcare policy experience.

In its second term, the previous incarnation leveraged the economic boom to reduce waiting times and improve the building estate within fiscal constraints. They squeezed the pits. This government has no boom and the same waiting list problem but with a broader society stagnation problem. However, like the first, they have inherited a crumping hospital estate and a hospital-centric system. They, however, may not have the luxury of two terms, as the British voting public is more transactional in its voting habits.

Amidst the era of AI and the determinism of West Coast tech Bro, the question arises: where do the priorities lie, and what is the role of Digital? Paul Johnson, the go-to figure for independent public economic thinking, asserts, ‘It is beyond the reach of a healthcare service to close the gap in our healthcare inequalities’. The NHS alone cannot solve the growing demand, so digitally empowering the NHS will have limitations. The think-thank AI Evangelists, who predict £25 billion in public sector savings in five years, are focused on high transactional central government processes, not the cottage industry of healthcare.

This is not totally doom and gloom, but we must be realistic. Healthcare costs in the US have flatlined since Obama’s time due to several factors, including people paying out of pocket. One in five people in the UK pays out of pocket for private healthcare. Technology is playing a significant role in making private healthcare more accessible. Look how you use technology to book your private physiotherapy appointment or access a growing range of dental health services across the high street.

So, assuming a one-term government, where do you focus your attention and limited resources? The first thing they can do is what governments should do: create stability and confidence in leadership and an environment where organisations can focus on long-term invocation. No more reorganisation, please. Keep most of the senior government health team in place for at least 70% of the parliament term. Remove the Value Added Tax (VAT) requirements for NHS organisations, as this adds complexity and squashes department service business cases where the cost reduction is tight in the first five years.

“Bridging the critical hospital requirements with the desire to improve primary care, there needs to be a revisit to the rapid advance of remote working during covid and moving provision into the community.”

The final area is for the centre to be more visionary. If we have commissioned Microsoft for the NHSmail collaboration, be bold with this and enable GEN AI across the platform of all knowledge workers. Stop spreading the fiscal costs to providers. One central business case to replace 250 local ones. We saw the value of this during Covid with the rollout of video conferencing. If it’s accessible, then people will use it. There is a lot of digital talent in the NHS outside of traditional digital teams. This talent will play with technology but cannot commit to a six-month business case development process that needs board approval. The main point is that we understand a ten-year EPR programme will be difficult, so let’s keep the rest simple.

Even though the new government has signalled a desire to invest more in primary care, they know hospitals still need to exist. Therefore, the building estate must be reduced and optimised. This is the second area of focus. PostCOVID has shed light on smart building technology.

Proven findings in this field must be leveraged to reduce operating costs and improve well-being. We need to learn. Providers are beginning to address bed management as part of their post-COVID learning, but this needs to be extended to theatre optimisation. I’ve seen this theme develop in blogs and healthcare conferences. There are also several start-up companies in this space. Again, nothing new.

This will cost capital. There are concerns that capital budgets are being raided and hospital 2.0 programme designs are being amended to reduce costs. There is no quick fix here. The government must borrow now to enable investment. Stabile leadership will assure the markets that this is an invest-to-save mission that will benefit long-term sickness.

Resilience and security must be baked into the cost of doing business in the new world order. There is no firm evidence that the current Ukraine conflict or civil bombing in the Second World War caused mass civil panic. However, this will stop rogue states from trying it, especially in the social media age. The government needs to decide what it needs to protect and where. Teaching hospitals and testing centres in large urban areas should be a priority.

Bridging the critical hospital requirements with the desire to improve primary care, there needs to be a revisit to the rapid advance of remote working during COVID and moving provision into the community. Most organisations have provided some form of proven remote working technology to address both requirements. However, the need to move quickly has resulted in less and confused actual benefits. There needs to be alignment with building and workforce strategy. This is better down at the ICS level but needs incentive from the government. Regeneration of the high streets and releasing public buildings for brown site housing are all examples where cross-government funding can be coordinated.

Finally, there must be a focus on delivery. Everything suggested so far isn’t groundbreaking; it’s been done before. It needs to be delivered more quickly with clear benefits and strategic public, not NHS goals. The recent US election sheds light on the one-timer state governor’s approach to executive leadership and public listening. Fixing the roads will improve health and wellbeing.