CIO interview: Graham Evans, CITO, North Tees and Hartlepool NHS Trust
North Tees and Hartlepool NHS Foundation Trust’s chief information and technology officer talks about joining up health and care, the importance of keeping up to date with technology, and why trying to deliver perfection won’t work
Graham Evans is a busy man. Not only is he the chief information and technology officer (CITO) for North Tees and Hartlepool NHS Foundation Trust, but he also leads digital transformation across the region following his recent appointment as chief digital officer (CDO) for the North East and North Cumbria Integrated Care System.
Health and care integration tops the agenda in government, and, says Evans, is absolutely vital to the future of the NHS.
The health service, he says, has changed a lot since its conception in 1948, and is now struggling to “deliver the things it needs”.
“As we move forward, the move to an integrated care system, or an integrated care partnership, to deliver patient care at scale irrespective of the care setting, is absolutely fundamental,” says Evans.
However, that means looking further afield, beyond the walls of North Tees and Hartlepool.
Integration and collaboration
The North East and North Cumbria Integrated Care System is formed of three Sustainability and Transformation Partnerships (STPs) across the North East, Tees Valley and North and East Cumbria.
Joining up disparate systems, organisations, opinions and views is not a simple task. “You’ve got to think system, not organisation,” says Evans.
“It’s about how we look at bringing the system together, with technology perhaps as the glue that bonds some of these disparate parts of the health and care spectrum together, to make sure we are all able to connect in a new health and care ecosystem.
“We’re only going to be as good as the weakest link, so it’s fundamental that organisations move and invest in technology to make sure they are both secure and capable of interoperable information exchange in the future.”
There has to be a common thread to the journey across all organisations involved, Evans adds. It can be tricky, as even within the NHS local organisations are, to a large extent, in competition with each other, and it can be difficult to get everyone on the same page.
“We’re only going to be as good as the weakest link, so it’s fundamental that organisations move and invest in technology to make sure they are both secure and capable of interoperable information exchange in the future”
Graham Evans, North Tees and Hartlepool NHS Foundation Trust
It’s not the technical bit that’s difficult, he says, it’s the cultural bit. Every organisation has their own internal governance, budget and individual challenges. However, Evans has a trick up his sleeve.
“I’m not saying I have all the answers to that, but the trick I have is to describe the vision [by asking], ‘What is it we want to do that will benefit the patients and citizens within our locale, and how do we then solve some of this, where necessary and appropriate, using technology?’
“It would be really good for the patient information to be accessible wherever the point of care needs to be, be it within primary, secondary or social care,” he says, adding that he hopes “many people will agree with that”.
“It’s not rocket science, but it’s the right thing to do, and if we want to provide the best possible care, wherever that’s delivered, technology has a massive part to play in that delivery.”
Social care integration and patient consent
Another difficult task is integrating with social care, which comes with its own challenges. Evans says there have been about two years of conversations with social care partners, and it’s finally beginning to bear fruit.
“I think it’s fair to say that social care and their information systems are very different to what we have within health. Not to say they are any less good, just different,” he says.
“But I think with the advent of open standards, interoperability and all that good stuff, we’re limited by our imaginations to a large extent.”
The key here is to ensure trust, both between organisations, and between organisations and patients or citizens.
“With the advent of open standards, interoperability and all that good stuff, we’re limited by our imaginations to a large extent”
Graham Evans, North Tees and Hartlepool NHS Foundation Trust
It’s back down to getting that trust between organisations and making sure you have the appropriate governance in place, because information sharing and the agreement that goes with that can often be the reason things are difficult.
“In my view, it’s clear that we need to make sure patient consent is the first thing we gain, and as part of our broader regional interoperability agenda, delivering something that will turn into the Great North Care Record. Getting patient preferences is the key,” says Evans.
Consent has been a bit of a minefield for the NHS, particularly in the wake of Care.data. According to Evans, there needs to be a circle of trust, with different types of consent for different parts of the record.
A patient should be able to say they want to share part of the record with certain NHS or social care organisations, keep part of the record private, and equally share part of it for research purposes.
“Speaking bluntly, it’s the patient’s data, and if we can get the right mindset in that regard we will truly transform the way we manage patients,” says Evans.
Giving patients access to their own records will also play a big part, he adds. “It will help them become more connected in their own health and care provision, and that’s really where we can start to take some of the burden off secondary care, and perhaps social care services,” he says, adding that it’s definitely not a one-size-fits-all scenario, and digital won’t be for everyone.
North Tees takes digital seriously
Being CDO for the region is a part-time role, and Evans spends most of his days running the ship at North Tees and Hartlepool NHS Foundation Trust. The trust is classed as a “fast follower”, and is one of the more digitally advanced trusts in the country.
In 2015, North Tees and Hartlepool NHS Foundation Trust became the first English trust to go live with the TrackCare electronic patient record system (EPR) from Intersystems, which up until then was mostly known as being the most popular EPR in Scotland.
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The hybrid EPR has allowed the trust to get rid of many disparate systems and have all the information in one place, which Evans says is “worth its weight in gold”.
The system also allows connection to GP records through the medical interoperability gateway (MIG), which means clinicians at the trust can, with the patient’s consent, see the full GP record. The next step, says Evans, is to reverse that information flow, so GPs can get access to the secondary care record.
The changes at North Tees have been incremental, but have allowed the trust to gain tools and techniques to run the trust in a different way. From day one, getting clinicians on board has been the key success factor, says Evans.
When you have clinicians talking positively about how technology is helping them, “you know you’ve cracked it”, he says.
“I often start by saying, ‘What’s the problem we’re trying to fix?’ What you find in the NHS is people saying they need a new bit of IT without really working out what that IT needs to do.
“So you give them some IT, and suddenly the IT becomes the problem because it’s not really fixing the problem they had. Quite often, you give them a spanner when what they really needed was a screwdriver.”
This is where engaging with clinicians is so important. If you get the clinical team involved in an open and inclusive conversation with the “technical people” from the start, it’s much easier to come up with a solution that’s appropriate.
Board-level buy-in
Another key factor in North Tees’ success is board-level buy-in. “Fundamentally, you need somebody with quite a strong voice at the board or executive level of the organisation,” says Evans, who is also the trust’s senior information risk owner.
“It’s on my head to make sure we manage our information assets and the information flows in accordance with policy and legislation. That’s fundamental. It’s also critical to have the full support of a board, primarily the CEO and the chairman, and I have absolute support from those individuals within my trust.”
The importance of digital and keeping your systems up to date most definitely hit home following the WannaCry cyber attack last year.
The reason so many of the organisations were unable to manage the cyber attack was because they were running on unwarranted or out-of-date legacy systems, says Evans.
“This is a journey, it doesn’t just happen, and we won’t get everything right first time. I’m a firm believer that if we continually try to deliver perfection, we won’t do much at all”
Graham Evans, North Tees and Hartlepool NHS Foundation Trust
“So the strapline I use in this regard is: ‘Technology is not about the cost of doing business, it’s a strategic investment’.”
Avoid perfection
Another key factor to success is to make sure you’re aware that you’re never finished. It’s a journey, it doesn’t happen overnight and you have to be agile as technology and patients’ needs continue to evolve.
“This is a journey, it doesn’t just happen, and we won’t get everything right first time. I’m a firm believer that if we continually try to deliver perfection, we won’t do much at all,” Evans says.
“So let’s do things that are good and can then be improved on towards perfection, rather than saying we can’t do anything until it’s perfect. If we take that approach, we’ll never do anything.”
