Roundup of 2025 part 1: NHS digital transformation

Sophie Burton-Jones: Hello, and welcome to Talking digital health, a podcast by law firm Mills & Reeve, hosted by health and tech lawyers Sophie Burton-Jones and Charlotte Lewis. Our aim is to discuss key topics of interest to those procuring tech in the NHS and those selling tech to the NHS. If you like this podcast, then please follow or subscribe and maybe even leave a review. It really helps us with our reach. I'm Sophie Burton Jones.

Charlotte Lewis: And I'm Charlotte Lewis, and we're your hosts for this episode. You might remember we launched this podcast back in January. As it's December, we thought we'd finish the year with a roundup of some key bits and pieces from our guests and episodes for 2025.

This is part one, which focuses on our NHS digital transformation episodes, and part two is coming next week, and focuses on our selling to the NHS episodes. So where do we start our roundup? Well, we thought it should be on the front line with our hardworking clinicians, nurses, and other healthcare professionals. We talked to Dr. Temi Akitikori about what success looks like to them on the front line, and how can suppliers understand their needs.

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Sophie Burton-Jones: So how do you think digital transformation programmes can ensure they align with clinical needs and pathways and improve patient care, aside from the embedding?

Temi Akitikori: It boils down to intention in my personal view. I would ensure that everyone, both innovators and stakeholders alike, were all on the same page about the expectations and the goals of what success looks like, and what they're trying to achieve. If I had my way, probably everyone involved, I would say, "Come along. We're going on a long call." And it won't be the nice, bells and whistles and everything clean and everyone's bare below the elbows that is usually done in this day and age. It would be, "No, we're going in the middle of the night, we're going to be in A&E all together. You're going to see what happens when everyone turns up to a handover, and there's maybe a quarter of the staff present." Not even missing, but a quarter of the staff needed for minimal staffing levels present, and see how decisions get made.

He who feels the heat knows it. You need to see the constraints of the service, hear all the difficult decisions that have to be made, so that they can feel the consequences of some of the decisions that they're making, and what some of the changes could or should look like.

Charlotte Lewis: I think that's amazing, and I totally agree. I mean, we take it for granted, I think, that people think that they understand, but nobody could say that they truly understand the pressures facing those clinical teams unless, as you say, you've put yourself in the most pressured scenario, I suspect.

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Charlotte Lewis: It was really lovely to hear Temi talking there about how it's really important for that part of a digital transformation team to really feel the consequence of that digital transformation, and to understand the impact of that change. We talked about how that was actually a really bold and powerful thing that she was suggesting, but we thought it was an amazing thing. Really spoke to her passion in this space.

Sophie Burton-Jones: Yeah, and I think it comes back to that point that we hear really often about it needs to be a user-centric design. If it isn't, you're not going to get the adoption that you need for you actually to realise the benefits - you have to be in the shoes of the people that are going to use that product day in, day out, and it has to be solving a specific problem that they have. Moving on then, with that in mind, we also then spoke to Charlotte John about involving and supporting stakeholders in digital transformation, and we asked her how organisations can help support their people with change and bring them on that journey with them.

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Charlotte John: For me, organisations can support their people adapt to change by just never assuming that people understand the vision, and really articulating that message to all those that are involved in care and in this transformation project, and engaging with them early. As we've said, it's so important to bring people on that journey to empower them. People don't want change done to them. They want to be part of the solution, and that really comes from leadership and that change and empowerment right at the beginning of a project. Help them to see the benefits, and listen to the fears that they're facing.

Don't underestimate how much stress and burnout, especially our frontline staff are under right now. It does have an impact on how resilient they are to change. So I think it's really important that we, as much as we need to innovate and we need to transform the way we give care to our patients, we really need to make sure that we are helping the frontline staff and all the support staff behind the scenes really adapt to change by empowering them to be part of this journey.

Charlotte Lewis: I really liked your point about they shouldn't be things that are done to people, they should be done with people. I think that's a really important message that people should have maybe at a ... Well, I was going to say at the forefront of their mind, but maybe stuck on a post-it note in front of their faces.

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Charlotte Lewis: So building on Temi's comment there with Charlotte’s, I think what was really loud and clear from that episode was how important it is to have really strong leadership that understands what the organisation's trying to do and can clearly articulate that to people on the ground so that you can bring people along on that journey with you.

And we talk about the idea of things should be done with people, not to people, and it really does require very strong and clear leadership in order to do that. So again, another great conversation with Charlotte about that and the important messages there.

Sophie Burton-Jones: Yeah, and when you look back at it now, you think, "Oh, I wish we could include more of each session and episode in this roundup."

But obviously you can go and listen to the full session in more detail. But it, it's really nice to go back to it for us and hear it all again.

Charlotte Lewis: Definitely. I've really enjoyed going back and listening to them again for this.

Sophie Burton-Jones: Skipping forward a bit in the process of digital transformation, we also thought it'd be good to get somebody along to talk about supply management and why that shouldn't be forgotten. There's a lot of focus on the implementation and getting things up and running and procuring, but when you've been through all of that, there's a real risk that things can fall apart at a later stage when you're essentially in business as usual. I spoke to Tracey Laforte who gave us some great advice on how to deal with supply issues and avoid or lessen the impact as you're going along in that contract life cycle.

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However well the relationship goes, there, there can always be issues that come up in the life of a contract. When issues get brought to you, how often do you think they could have been avoided potentially, or at least the impact lessened if there'd been some sort of better relationship management earlier on? I know we've slightly touched on that.

Tracey Laforte: Nearly 100%. If you're coming to me when there's an issue, you bet your bottom dollar had we been involved earlier on, that issue could have been avoided, technically speaking. Not in every case. Sometimes it is how a service is delivered and it has a material impact and that can't be foreseen. That's not contractual management, that's how the service is going day to day, so it's like your PACS, for example. Your PACS system goes down, means your radiographers can't read the images, means that your consultants are sitting there in clinic without images in front of them to be able to do their diagnostics.

That's, slightly different. But if it comes to a point where you're at loggerheads because you haven't paid an invoice or you haven't responded to this service level or this… You kind of feel like, actually, this stripping back, that could have been dealt with earlier, it didn't need to go to a dispute resolution position because you should've been talking earlier.

During COVID, obviously we couldn't have face-to-face conversations. It was all very much Teams. I think that's taken an awful lot of it out because half of what we do isn't how we communicate verbally, it's the body language in the room. It's the tension, it's how you defuse a situation, and sometimes that's best done face to face. I know recently we've heard a few disputes. I'm straight away, "Right, we're in a room, we're meeting, and we're going to talk this through," because it's a much better way of dealing with things.

Sophie Burton-Jones: Yeah, and you can react more, can't you, to the situation and like you say, the body language and what’s going on and how you might be able to defuse it, that kind of thing.

Tracey Laforte: Yeah, especially when you're doing some of these complex contracts. As you know, we've worked on a couple of electronic patient records in the past and some of the conversations we've had actually would've gone across a little bit better had we been in a room, and probably transacted a lot quicker.

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Sophie Burton-Jones: So Charlotte, you obviously weren't able to join us on that particular episode, but I know you listened to it afterwards. Have you got any particular thoughts or key things that are coming to you out of the episode of Tracey?

Charlotte Lewis: Yeah, definitely. I thought it was really powerful that she made the point that actually nearly 100% of times issues could have been avoided or the impact lessened if there'd been some sort of better relationship management earlier on.

I think that's a really important message to take home because, again, it boils down to people and how people work together. All of these examples really hinge on that, and if we can get people in a room early on talking about these issues, then so many of the problems further down the line can be avoided.

Sophie Burton-Jones: Yeah, and we see it so often that people come to us and they want some initial support and advice on things starting to go wrong, and they don't quite know how to manage it because they don't want to seem too aggressive. They want to make sure that the relationship can continue, because it's a really important relationship in terms of critical IT, and you shouldn't be scared of going back to the contract and talking about what it actually requires and, and having that conversation. It doesn't have to come across as aggressive and our disputes colleagues, we have that conversation with them so often in terms of, “Have you gone and looked back at some of your rights to request information and rights to request a regular meeting?” and sometimes they're not happening in the format that they set out in the contract.

You can take people along and on that journey without it coming across as really aggressive and, "If you don't do this, we're going to sue you tomorrow." That's not what you're trying to do. You're trying to do that more active management of those issues.

Skipping along again to another episode, we heard from Dr. Vivian Yiu about the importance of looking at lessons learned as well. You know, you've been through that whole journey. You're coming towards the end, or you're perhaps looking to refresh or change. What has happened? Have people had time to sit back and reflect and make sure the same things don't happen again?

And Vivian was speaking specifically about her trust’s virtual ward rollout, but I think in our view, this whole process of lessons learned is really important for digital projects generally when they've got such an impact on the day-to-day life of people in a trust and the patients.

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Sophie Burton-Jones: I guess we've talked so far about the kind of setting it up and getting it going, but once the virtual ward was up and running, were there any issues or changes required, and how did you approach that?

Vivian Yiu: I would say that during those first few months, and even now two years on (it's our two-year anniversary in November) there's been a lot of learning. I think one of the key things to think about with a virtual ward is that it's a very new way of caring for patients, so if you or your trust haven't done this before, you need to be prepared that there'll be a lot of things that you'll need to learn and change, and I don't think there's one set formula that works for everyone. Each of our healthcare systems are different. Your patient population will be different. And I think your trust's appetite for risk and innovation may also be different, and I think all of those things are important to bear in mind.

With myself in my own trust, we hadn't had a virtual ward before. Some trusts had through COVID, and so it was not a new experience for them, and they were able to scale up much quicker. For the West Suffolk, it was a very new experience, and so trying to get clinical colleagues on board with this new way of working was a long process. It takes time to convince colleagues that it's safe to manage patients at home. It also takes time to convince patients and their families that this is a safe way to care for them at home as well.

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Charlotte Lewis: So for me, something that really came across quite clearly from Vivian was that the lesson that they've learned is the importance of being flexible and not being too rigid because things are going to change and evolve with something new, and if you can be open-minded and open-minded to change, that's going to make that process smoother. Obviously, you'd need to align that to a sort of overall plan. You need to know what you're trying to achieve, but the way in which you get there may well evolve, and rightly so, and just being prepared for that seemed to be quite a clear message from her.

Sophie Burton-Jones: I think I've seen it in the past. There's some sort of infographic that makes its way around LinkedIn or a meme or something like that now and again, where it says how you think in your mind a project's going to run, and it's this nice kind of linear diagonal line, and then it's in reality what happens, and it squiggles all over the place, and I think that's a really good analogy for what you've just been describing and Vivian talked about.

Moving along right to the end of the journey of a digital transformation, we talked to our colleague, Nathalia Perera, about the dreaded reprocurement of your existing contract because, you know, you've got to the end of the life cycle of that contract. Procurement regulations require you, almost always, to go out to market and reprocure. We talked to her about whether it's something you absolutely have to do. Are there any grounds that mean that you don't have to do? I know it fills a lot of people with dread.

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Sophie Burton-Jones: First of all, Nathalia, I mean, we really like our current provider. Can we just stick with them when we go forwards?

Nathalia Perera: Sadly, usually no. Unless there are some good grounds for what we call a lawful direct award, so, you know, where you don't run a competition to award a contract directly, then usually you do have to run a competitive procurement. But relevant to an IT type of contract, there might be an ability if only one person is technically capable of doing it, or if there's some kind of exclusive rights or intellectual property reasons why only that provider can provide, that might be a reason to stick with your current provider.

But generally, no, you have to start planning well in advance of the expiry of your contract, you know, working backwards from transition, working backwards all the way to maybe early market engagement, and then you have to go out to market.

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Charlotte Lewis: So it might not be what everybody wants to hear, but chances are you probably are going to have to run a competitive procurement exercise unless you've got some grounds to extend or use the same provider.

I think it's important that you know that, because there's no point burying your head in the sand and pretending like it's not going to happen, and then a couple of months before your contract comes to an end, you think, "Oh, no, now we do definitely have to run a procurement, and we've left it all too late," which we do see frequently.

I think forewarned is forearmed. Know that there’s a good chance that you're going to have to do it, and get prepared early rather than avoiding the problem. Unfortunately, if you try and avoid the problem, it will become a problem, and probably a bigger one.

Sophie Burton-Jones: Yeah. And also, just lean on the experts, you know? You've probably got a procurement team in-house who do this thing or do these types of things all the time. The earlier you get them involved, and potentially other external advisors, hopefully the smoother that that process will be.

So that's it for our first year discussing digital transformation in the NHS, but never fear, the shift from analogue to digital that features front and centre in the NHS 10 year plan means there's still lots to discuss when we're back next year, so there will be more episodes. And we've already got lots of great guests planned, so we look forward to connecting with everybody then.

But in the meantime, we hope everyone has a good Christmas and New Year, and we will see you in 2026. And it hopefully goes without saying, but we will anyway, that at Mills & Reeve we're very happy to discuss any legal queries you might have whether you're buying or selling healthtech, and our individual contact details are available on our website at mills-reeve.com.

Thank you for joining this episode of Talking digital health by law firm Mills & Reeve.

Charlotte Lewis: And merry Christmas!