Swapping Bureaucracy for Trust

First published in TECH FOR GOOD, Issue 16.

By Dr Rizwan Malik, Consultant Radiologist and Divisional Medical Director of the Bolton NHS Foundation Trust

A perceived failure to innovate is one of the sticks with which the NHS is most regularly beaten. How many times have we seen, heard or read stories and opinions to that end?

One of the biggest paradoxes here, though, is that the NHS harbours some of the most innovative thinkers in the medical profession. There are huge numbers of very capable people with great ideas across the service, whether that be in research, healthcare, technology, administration or anywhere else. The key to NHS innovation is trusting and tapping into that talent.

For too long the link between NHS decision-makers and its people on the ground simply hasn’t been there. There have been too many “gatekeepers” who have tinkered around the edges for too long in the name of transformation. They have ignored the vast experiences of the individuals and teams that use NHS systems every day and who can see where change could make a genuine difference for both staff and patients.

I have been a Consultant Radiologist in the NHS for nearly 15 years. I am also Managing Director of South Manchester Radiology, a company which provides innovation and transformation services to both the public and private sector. These roles have given me a helicopter view of the issues we have and, in my opinion, building trust across the health- care spectrum is the only way to drive true innovation.

COVID-19 has given us a taste of what could be achieved, and I can share a really simple example of this. Radiologists such as myself, in collaboration with innovative CTOs and technologists, have spent the last decade proposing plat- forms and systems to allow radiology to be performed remotely if required. It was generally rejected.

When lockdown happened, however, those proposals were rapidly dusted off and it was quickly decided it was some- thing we should do. Then suddenly the problem became time - you had hospi- tals who had staff everywhere needing expensive monitors, and we were held up with a supply chain issue. But within three months we went from the first discus- sions to having kits in place for radiolo- gists to work from different locations.

That is just one example, but learning lessons from the pandemic will be essen- tial going forward. Change is possible if all stakeholders are determined and focused on the same thing - too often any improvements have been ‘Heath Robinson’ fixes not sustainable for the future, or more ambitious change is rejected completely because other things haven’t been fixed or updated. On that point, one shouldn’t predicate the other. We shouldn’t stop progress because the stuff that we’ve got could be replaced.

In radiology specifically, talk of digital and data transformation is rife, including in the area of imaging and reporting. There is a shift towards adopting tools which facilitate more guidelines and structure around how a clinician reports, and I am generally in favour of standard- ised imaging and reporting.

What’s crucial, though, is that these tools benefit clinicians and patients, not just data scientists. As a radiologist, this approach needs to make me more effi- cient, while it also needs to be advanced enough to gather the right information and not revert to templated inputs. Again, it’s all about collaborating and taking the lead from those in the field.

In that example, if we can get to a point where reporting outputs are in a standard format then we can be more robust about how cases are followed up and patients get the best service. Ultimately I yearn for the day where we have better connected systems across the board, both domestically and globally, and - even though there are pockets of excellence today - the data we collect and generate is used to radically improve healthcare provision at scale.

While there is that constant and very real battle between the now and the future in the NHS, we can be at the fore- front of that change. The vital thing is to work closer with those who link strategy to patient care, and in the end replace bureaucracy with trust.