Juliet Bauer on the value of ‘knowledge from the other side’

Juliet Bauer is on a mission to make individual’s experience of online NHS services as compelling as possible, break down current barriers and help achieve a decisive shift to digitally delivered health services.

Juliet Bauer, joined NHS England as director of digital experience last November with responsibility for the flagship NHS.uk project, from a six-year spell as a digital leader at the Times Newspaper and a spell at health start-up Supercarers.

She is the third member of NHS England’s digital leadership team, alongside Will Smart and Professor Keith McNeill, NHS England’s CIO and CCIO. But arguably, with responsibility for making the NHS a cutting edge provider of compelling digital services, hers is the toughest brief of all.

In an exclusive interview with Digital Health News, she says her external experience is at the core of what she brings to the role, “Knowledge from the other side is incredibly valuable.”

Outlining the frustration of working for a start-up trying to get its product into the NHS, Bauer wants to ensure that future innovators do not suffer her experience of being shut out, unable to break in.

And, it’s not only professional experience that motivates Bauer to increase its digital offering, but her personal experience of the disconnects of the NHS.  Writing on NHS England’s blog, she describes how a life-threatening pregnancy showed her first-hand how digital could be improved within the NHS.

“Vital data was not collected or connected. Information from all my interactions across the system was not to hand when it was needed. Under pressure professionals were spending too much time trying to fill the gaps.”

After being appointed in September 2016, Bauer has been given a year to deliver on key digital initiatives that underpin Personalised Health and Care 2020, including: the app library, NHS.uk, citizen identity, developer space.  Many of these have been floating around in various guises for some time.  She sat down with Digital Health News in London to discuss her plans.

Developer.nhs.uk

Quietly launched just before Easter, there is now a new NHS developer platform, Developer.nhs.uk, that allows access to health data, test apps and access standards.

Bauer says there has been a demand for something like the platform for a very long time.

“The challenge has been that if you’re a developer or entrepreneur, and you create something in the health space, navigating the system is a key barrier.”

She added: “That’s unacceptable, we need to make it clear to them, because otherwise we’re not harnessing the power they can bring.”

In 2016, Simon Stevens, NHS England chief executive, attempt to tackle the problem of NHS adopting new technologies. A med tech tariff was introduced, as were the innovation test beds to try out new technologies.

Bauer is also hoping that the distinction between technology and clinical care begins to blur as the current barriers lessen.

“Over time I’ll think what we’ll find is that, as we have in other industries, is that a wider group of our 1.4 million employees will themselves also be digital innovators.”

The long-awaited app library

A beta version of the latest incarnation of NHS App Library, and what even Bauer admits as “obviously an early start”, went live earlier this month.

Looking pretty clunky in this iteration, there are about 25 apps live on the site across varying categories and with different NHS approval rates. The highest rating from the NHS is “NHS Approved”, which currently only one app has, certifying that it has a clinical evidence base behind it.

Bauer says this is just a start and that over the next three to six months the clinically evidenced apps would be increasing by several a month.

This level of certification is what Bauer hopes to save this app library from the fate of previous attempts, which led to it being shut down in 2015 due to concerns that some of the apps it contained were not based in the UK, might be prone to data leakage, or could not show evidence of their effectiveness.

Bauer told Digital Health News last month that all the apps would be “technically safe”, meaning the data is secure, which she said would “address some of the challenges we had the last time round we tried to do this”.

When asked on the medico-legal regulation and offering patients reassurance, Bauer said it’s about being as “explicit as possible with within the front end app store is making sure patients can see what this app does and in plain English understand what that means.”

Bauer says the small scale of the launch is just a start: “Part of what I think I’m passionate about is making sure that we don’t do these huge pieces nationally without having tested that they work at a smaller level.”

NHS Choices 2.0

Another digital project that has been resurrected and re-announced over the years is a revamp of NHS Choices, the patient-facing website of the NHS.

In September 2016 health secretary Jeremy Hunt announced the plans to revamp NHS Choices, but the NHS.uk team has been blogging about the project since 2015.

It was back in June 2015 that the rebranding was announced by Beverley Bryant, then director of strategic systems and technology at NHS England.

The popularity of such a website is clear though with NHS Choices receiving 52 million visits in March alone.

When pushed on what would make NHS.uk different from NHS Choices Bauer said that the thousands of pages on NHS Choices are being transformed into more mobile friendly and responsive pages.  This means that from NHS.uk you can book an appointment with a GP, get repeat prescription, register for a GP or find a pharmacy.

“All the things that it doesn’t sound like rocket science, but they are the things that people want, and there the things that have traditionally been hard in a system that isn’t all tied together.”

NHS.uk will also provide a gateway through to citizen’s personal GP record from September.

September is aloes the target date for the launch of citizen identity which will allow a secure login to NHS.uk through a system such as GOV.UK Verify or Patient Online. Bauer said there are trials and focus groups currently working on this target.

Cycles and cycles

When asked about the seemingly repetitive nature of a lot of NHS England’s digital projects, Bauer responded that “we’re going to keep having cycles over the next forever”.

Describing it as “iterative continuation, and if that feels like a continuing cycle then I’m pleased about that”.

Keeping the blinkers off

Hoping to keep a seat that allows her to see both the flaws and successes of the NHS, Bauer has a five-year goal:

“I hope that for the people who want to use digital channels first, and for people who want to help the NHS not spend money on things it doesn’t need to, we have made things easier for them”.

While acknowledging that the pace does not match the industries that she has previously worked in, Bauer says that in the last six months a lot of progress has been made.

“Hopefully you see that we are moving things in the right direction, it’s not always at the pace that you would be able to do in other sectors, but it’s exciting that it’s going in the right direction.”