This was the advert from The IHM to get us to go to this health chat!

“Rashik Parmar is a Fellow of IBM, the leader of IBM’s European technical community and an IBM Distinguished Engineer. He was previously President of IBM’s Academy of Technology and has spent his whole career immersed in technology and artificial intelligence”.

OK – yes, we hoped for insight.  And we did get it.

(And if you want to view the recording of this chat – click here – to see if you agree with my take on it!)

Could he perhaps just give us a bit of a steer on and IT Road map for the NHS? That’s what the IT people usually say. Road map. How pleasantly old fashioned! But what about all that new fanged stuff? Machine Learning and Artificial Intelligence? Always just AI now of course…

Backstory is always the fascinating parts of these health chats with Roy Lilley. And Rashik was no exception. Born in Africa, Mombassa, parents from India. Terrorised at ‘a level you can’t imagine’ as Indians in a foreign land. Carried cash bundles always to pay off threatening locals. Pushed out and ended up in Leeds, following an Aunty from a year prior. Family always held that belief that you had to become a doctor – everything else was a failure. But his careers teacher said he wasn’t bright enough for that route. 1978 was early to decide to go into computing. But that he did, and managed to get A level course in Computer Science at a night school, sourced by a teacher at school. Hope he or she remembers! Decided on Imperial over Cambridge (the only choice then?), because the 3 year course did everything from Silicon to make the chopping, to Coding itself. And he always wanted to understand the A to Z of what he was talking about. Stood him in good stead when he got summer jobs at IBM in Leeds. But an aptitude test and 4 interviews for a summer job says a lot about IBM searching for talent early – or just arrogant??! 1984 now (not prophetically appropriate)  – still pre Internet of course.Desk tops had only just arrived. The 20 young visitors we had from Windsor Girls School must have wondered what this ancient history story was all about? More of them later.

What’s the next big thing, asks Roy. We get smaller and faster – but that’s just progress not ground shaking? What about AI and machine Learning? Rashik did point out that you can do very little on a day to day basis without Technology intervening. Even turning on a tap involves many interfaces further down the line to open the right bits of the reservoir and piping and to look after the water quality. We don’t see it most of the time unless it goes wrong of course. He bemoaned SciFi writers for making us believes ruff and systems were already here, not just a figment of imagination.

He told a story that became a good focus for us all. 80 year old picked up from her care home to go for routine out patients appointment. Saw doc for 5 minutes. But had 3 hour wait first. Then was taken to the wrong pick up point for her ambulance home. Not looked at or questioned for 10 hours. No food, no interaction, no one cared.

And there’s the rub. We want the shiny new tech to cure cancer. But let’s be honest. Tech can’t do the full brain and emotion yet. And maybe never will. But it can a really shine in the mundane. Routine work is what it will help with most, in all types of organisation, not just the NHS. The business case in the old lady’s case should be iPad or similar all talking to each other all along the patient pathways. The best part of £600 had been spent on that 5 minute out patients appointment. Only the cleaner asking what she was doing still waiting fixed the situation. Amelia Tickell representing the next generation and her school friends from Windsor wondered if AI at the mass produced robotic level could have helped her. Not today, Rashik said. But companion bots are being introduced in Japan – driven by a total lack of Carers workforce. People though talked and confided more in a cat robot than humanoid…fascinating! She also asked about what should people study the STEM subjects. His advice was fab. “Do what matters to you. Being good is far more important than followed the trend.

Roy did get into population health and peoples data. And big brother watching and admonishing you for that bag of crisps…but we don’t want to be told, we want to be informed. Now I felt we were getting there….

Other highlights?

• Should we regulate engineers? There probably does need to be an Ethics and Conduct code.
• Algorithms are always biased to serve the needs and prejudices of the community they are serving.
• 11 to 15 % of the data we have is plain wrong. It needs cleaning first. (And sad we don’t know exact figure!)
• The NHS has a huge bank of talent and is very lucky to have them
• Only 3% of clinicians are comfortable using AI

Let’s expand that last one. Training – e learning – helps when you need to get people tuned into cyber security. It will take huge efforts but hey, perhaps we can do the same with leading edge GPs? Gotta start somewhere!

Machine learning process was fascinating. 3 equations:

Data+ analysis –> information

Information + context –> insight

Insight + action –> Outcome

And to put this into action? You need different skill sets:

Squirrels – to capture and understand data

Owls – to use the data and provide its context

Foxes – the mathematicians, to create the machine learning algorithms.

Weaver Birds – (tiny birds who build the biggest nest to court their mate) these are your data engineers

Hawks – to oversee ethics and legality

No one person can run the project. All skill sets need to be covered.

My final view? No, I agree we can’t abdicate to AI. But we can force it to help with mundane, so we can have time to do the people bits better. The spectrum of skills is a fascinating area. Can we do it? Do we have a choice? As was said more than once, the future comes a lot faster than you think…

There was so much more to this chat. Go watch it. Click here. Fascinating. The future is now. We just need to centralise the project and do it.

Ruth May, Chief Nursing Officer, England

Ruth May Health Chat – With Roy Lilley, nhsmanagers.net

Chief Nurse, NHS England. On the Board. Reports into Chief Exec, Simon Stevens. I wish I’d been there to take in the atmosphere. It’s not bad on Periscope (link here to view the whole – well worth it!). This is my take after viewing the event.

Roy Lilley felt a bit more belligerent, in your face and more intent on disagreeing then normal. I’ve been to nearly all the Health Chats. My hunch is that if Roy thinks the job of the interviewee is crucial to the NHS being a haven of excellence and to continue to get better, he is even more passionate than normal (and he is pretty passionate anyway, as you will have witnessed). Ruth May gave as good as she got – and there was a lot of support from the audience, which did sound like it had a number of very interested nursing warriors in it!

Nursing was in the family. She went to gain experience of nursing  after A levels. Degree later – MBA in Hospital Management. We had the graduate chat – do nurses need a degree, really? She knew that was coming, and sort of ignored it. “We need to have graduate level conversations”. End of. Then another humdinger. Being accepted as a woman in senior role? She knew that was coming. Recounted a story when she met the then Health Secretary, Virginia Bottomley. Ruth’s boss in the gratuitously demeaning and condescending way that us thoughtless men sometimes manage said “where’s the little girl gone…”. Virginia came back in at the end of the meeting and said to Ruth “Don’t let that happen again”. And I’m guessing she hasn’t?

2 years as a theatre nurse, Frimley Park to St Albans/ Hemel Hempstead before the transition to management. She wanted to be at the leading edge. And to still be clinical. I got the feeling she thought it was crucial – people tell you a lot more if you wear the uniform with pride too, and get your hands dirty. You keep the door open.

I get the impression Ruth learned as much from working with excellent bosses and leaders, and she stole their methods and ideas with much pride. I contend you learn as much from bad leaders – you know you would never do it like that seems to be a stronger learning for me. But I suppose it says a lot about her mindset that many of her learning examples and her current experiences were all couched in the positive.

Ruth’s number one priority is workforce. She knew that question was coming, too. How do we stop people leaving? How do we get people to come back? How can we be more flexible? How do we stop people moving from hospital nursing to primary care – where the shift work is much less onerous? How do we stop 20% of newly qualified nurses leaving almost as soon as they are graduates? Should we really be stealing overseas nurses from their home countries?

And that wasn’t all the question areas!

Roy banged on. “We don’t want business cases, we want action. You’re the Chief Nurse. Go to the Board and tell them”. OK. There’s no magic thing you can do. No really instant fix (except getting returners to consider coming back via Mumsnet , which sounds like an excellent idea). But sharing best practice can turn the megalith around. Churn of nurses is now 11.9%. Lowest it has been for 4 years. This chat was on Ruth’s 137th day in post. She has already got 5000 extra clinical placement places for nurses for this Septembers intake. 168 Trusts have signed up. It’s the biggest increase ever.

The flexibility issue exercised both the protagonists a lot. It appears that some people just push the boundary well. One of the many software packages for working out the rotas is called Allocate (others are available…). Milton Keynes worked with the software people and made it more flexible. Roy contends that this makes sense to be a national solution – a nationally worked out piece of kit that is then provided more cheaply? Makes sense to me…

The flexibility issue is there even in other areas – like training of new nurses. Why have the only graduate course starting date in September? Surely there could be intakes in January and March or whatever too? And what about the Apprentice Levy? £2 bn. is tied up in this. Why do it? When an apprentice has to be supernumerary on the ward, so it doesn’t really help with cover and rotas. Ruth could just go to the Board and ring fence the training budget and make a special case for the apprentice levy?

 It all sounds so easy in a chat…

Ruth’s other priorities are about pride in the work and celebrating success. Make everyone proud to be a nurse – so more likely to stay? 2020 is going to be the year of the nurse. Should there be a national nurse uniform? This audience thought so. One job. One linking sense of belonging. One enormous proud workforce. Simon Stevens has often stated that we want the NHS to be the best place to work for. I think Ruth’s level of priorities, including a very strong collective voice will help this to become a reality.

There were lots of great questions – what about the 55% of nurses who work outside of the NHS? What about Community nurses? What about primary care nursing? You’ll have to watch the recording to get to these answers. But the last question was from Amelia Tickell, who had started the show too. “When I go back to school, what can you say to the question why should I become a nurse?”.

“It’s an amazing profession, where you are with people at the most profound moments of their lives. At the start, at times of illness and at the end. That to me is priceless”

I can’t really add to that. Thank you Ruth.