Weeknote: 20 to 24 March 2023

A small but elegant Classical black fire grate with shelves either side, surrounded by a simple marble and wood fire surround. On the right-hand shelf, facing out, is a black ceramic owl with white circles around its eyes
Fireplace at Beatrix Potter’s house, Hill Top, in the Lake District

Back to work after a much-needed week off, during which we attended the funeral of a family friend who died too soon.

What did I enjoy?

Spending every day of the week in the new Leeds office, including chance meetings with colleagues, almost like the old days.

I was especially pleased to hear that Rochelle and other user research colleagues got to demonstrate NHS England’s recently opened in-house user research lab to our CEO Amanda Pritchard and other national leaders as a part of a visit on Tuesday.

I also enjoyed a call with John, the NHS England interim Chief Information Officer, where we discussed some frameworks and tools that might be helpful in making sense of our new context. After years of fragmentation, there’s now a UK public sector top-5 Digital, Data, and Technology organisation to lead the NHS in England, and that has to feel different from the legacy NHS England from which our new organisation is emerging.

New work to enhance the NHS’s national digital channels, and how they integrate with services including 111 online, continued to take shape while I was away on leave. At a drop-in session for colleagues across our Product teams, I was able to present the latest thinking on the “navigation” strand for which I’m workstream lead. In a call a few days later, someone asked if we were under-promising with a view to over-delivering. I hope so. The teams are still rightly cautious about precisely which of the opportunities they’re investigating will win out in terms of both feasibility and value.

I joined a meeting between strategy team colleagues and digital specialists on how we can better help patients navigate and access primary and urgent care services as a whole. The fact that these teams are working together is a huge step forward for me, and an early proof for me that the merger of NHS Digital and NHS England will make things better for patients and frontline staff.

What was hard?

In the emerging strategic conversations, there’s still a tension between addressing short term problems and longer term possibilities. This manifested in something badged as a future view that looked quite unambitious. The colleagues involved are open to working together to get it right. There’s also something about teasing apart those steps in the patient journey that rely on constrained professional skillsets, from those where modern digital businesses scale rapidly without humans in the loop.

For everything I say about the upside of the merger, the changes add an undertone of insecurity, which makes it hard for colleagues to collaborate as openly as they would ordinarily. Everyone feels vulnerable. We have teams from the old NHS England who feel as if they’re being taken over by NHS Digital. At the same time, colleagues from NHS Digital, who have lost their employer’s brand identity, feel as it’s all an NHS England takeover. I was prompted to revisit my weeknotes from early last year when we said goodbye to the NHSX brand.

It will be a relief to get through this phase and have colleagues settled securely into their roles and multidisciplinary team structures.

What did I learn?

I enjoyed listening to this  podcast conversation between Tom Loosemore, Deborah El-Sayed, and Matthew Taylor on how integrated care boards can capitalise on the digital revolution: The digital transformation gambit: simpler, faster, safer services?

Also reading Tom Stafford on “why we may overestimate chatGPT, and why smarter people may be particularly prone to this”: On the over and under detection of agency

A particular point in Tom Stafford’s piece struck a chord with me:

“the raw selection bias that the best answers from chatGPT are most likely to be shared, or users are likely to keep trying until the get a good answer (a variety of optional stopping, a known bias generating mechanism in formal experimentation)”

Optional stopping is definitely a feature of the use of both human authored and AI-enhanced triage tools in health, and a point to guard against when comparing their effectiveness.

What do I need to take care of?

It’s very nearly the end of the financial year, and the start of a new one where the business processes of our new merged organisation will be developed, tried, and iterated in earnest. I have a clear set of expecations of what will work for the portfolio area that I lead, including:

  • a unified prioritisation of all the work we do, regardless of their historic funding arrangements in the legacy organisations
  • enduring funding for our people and teams, so that management attention focuses on the question “are our teams working on the most important things for the NHS?”, not on “have we got the financial approvals to keep our team together next month?”

While everyone says they want to work this way in principle, the mechanisms for doing it are not 100% clear, and in the absence of that, there will be a temptation to slide back into the old processes that people understand, even though they make no sense at all in our new organisational context.

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