#439: What 35 years inside the NHS taught Cisco's healthcare lead, Declan Hadley

0:02Taking all the really good stuff of AI, but really doing it for the benefit of communities. We'll see small enterprises being able to use tech, locally owned tech to drive innovation. But most importantly, the people in the West Midlands benefit from that. The money that's been generated in the taxes go back into that region. Hey everyone, welcoming Declan Hadley to the Health Tech Podcast this week. Declan is the healthcare leader at Cisco, which you may know, big tech company, but was previously for 13 years health informatics director at Lancashire NHS Foundation Trust. So knows a thing or two about technology in the NHS, don't you, Declan?

0:46Welcome. How are you doing? I'm fine. Thanks, James. I actually worked for Lancashire and South Cumbria and in that region for 35 years. So that's a career on its own. So my background is very much in the NHS. I started my career working in an old psychiatric institution, which has been subsequently closed down. I trained as a mental health nurse many, many years ago and worked in... So did my dad. Did he? yeah the it was a it was a it was a rather it was a great time really I always look back on that part of my my NHS career fondly I enjoyed it those things don't really or asylum doesn't really exist anymore in the in the same form it's still there's still services interestingly James I know we're kind of jumping around a little bit here but uh oh 40 years later um I've been supporting Langston South Cumbria Trust on a project where I worked as a nurse during my training.

1:52Oh, wow. Rebuilding one of the sites, creating a specialist learning disabilities unit. It's a nice full circle moment. It's a beautiful circle moment. It really is. I feel very proud of what they've achieved at that trust. And the unit looks fabulous. I'm hoping to go and have a visit in the next couple of weeks. Yeah. Because back in those days when you trained, my dad was saying, you know, you'd get so far uh in nursing and then it would essentially be right do you want to do management do you want to do teaching or do you want to do research and that was so that that that's not that's true actually my my journey was um because it was at Whittingham Hospital um in in Preston Old County Asylum and they were closing it down and they were trying to look for opportunities to um to give career opportunities to nurses and they said to me as they did others are you interested in any training and I said I wouldn't mind an IT course and I went on an IT course and then I ended up working in the IT well it wasn't even called an IT department then IT really didn't exist I think we only had half a dozen computers in the hospital and a network an old novel network for those people who can remember that far back and that was my transition from nursing into IT all those years ago and you did that full time i i had a period where i kind of worked across the two but yeah i went i i was seconded across into the it department on the basis that they were trying to relocate we we give nurses and others and the hospital opportunities to do different things were you always techie was that was that like were you into computers and all that sort of stuff or was it just sort of yeah i was i i have to admit i am a silent geek and i'm a geek behind my shoulder here my home assistant and stuff like that i have i love my technology on my desk here i try and have to screen out certain areas it looks a right bloody mess but i've always got tech loads of different tech little computers and stuff like that so oh yeah yeah so oh very nice it was a natural transition at the time i think it certainly suited me although i i miss i i genuinely genuinely miss some of the experience and the purpose of looking after patients it's funny i yeah i do feel similar i actually have um it's really weird i have a recurring dream that i have to give an anesthetic and it's funny because as time goes on i get worse and worse and worse at doing so and i get further and further behind in what i'm meant to be doing in running this anesthetic but it always reminds me though honestly when i when i wake up that clearly there is part of me that that that still misses that it is just a shame that you know I couldn't make it work and they can you know I'm in part of the conditions but mainly just what I wanted to do and and and spend my time it just it just never it just never aligned but um yeah it's interesting because yeah my dad had a very similar career actually so he um started off as a mental health nurse I think he ended up as a ended up as a cardiac nurse but um then eventually went in so he went into management so then he did hospital management and then essentially became i think it was like a band 10 back then which they had and it was a it was a chief nursing officer type role of um of of a hospital in the midlands and then um then yeah broke his arm in three places uh i think severed his braca radialis nerve so his arm didn't move in a certain direction and they said well you have to retire and he's like what i'm just a pen a pen pusher why do i have to retire and then they made him retire from the NHS unfortunately but that was his career but yeah he started down in Taunton so he was down there doing his mental health nursing I think but anyway I think James when we look at it now I know I look at three rows team tip classes the NHS I worked in on the front line it's not there anymore I don't think I think some other staff are still trying to do really good things in very difficult circumstances and I just you know I wonder whether I could I even cope now if I went back into the NHS it's it's quite interesting isn't it because you've obviously seen that from a position of um you know seniority on that management side obviously rising up to health informatics director which I imagine it sounds like you probably it's probably like they created roles for you every time like moving up into roles that probably never existed.

6:23So what was your experience of looking at the UK health system over that 35-year period? What's your take on it? What changed? I think it's easy to, when I look at even the role I'm in now at Cisco, I look at, and I think it's easy to sort of be quite negative and say, you know, the NHS needs to digitise and all those kind of things. But I've seen loads and loads of examples, people developing technologies and it generally getting better. OK, the pace might not be what people would want. And I think pace is not delivered by changes in technology. It's generally driven at the pace that the front line can change, the pace of change in terms of what individuals do day to day.

7:13So I think I'm still optimistic. I was involved in my, before I came out of the NHS into Cisco, in shared care records and interoperability and sharing information. And I think whilst you can be very negative about IT in healthcare, it can have a transformational effect. And there are lots and lots of stories in my own particular experience about sharing very basic information across different care settings can have profound impact. You know, in terms of, you know, stories that you've probably had, James, where you have a patient turning up in A &E and they were in an A &E department in Blackburn and then they turn up in Preston.

7:57And because we didn't know that they'd had certain medications in Blackburn, they were applied again in Preston and it's caused harm. And, you know, so I think the avoiding harm or trying to reduce the impact of harm, technology's got a huge, huge thing. A lot of the things I do now are kind of anchored in what I've seen over the last 40 years and influenced by that. I still, I mean, one of the things for me, James, is innovation. the challenges of innovation on the front line, there's no shortage of good ideas you as a clinician will have had some great ideas, it's just the whole system almost comes to, almost is there to prevent you innovating in some respects for whatever reasons and there's all sorts of stories where innovators have been stopped from doing what they're trying to do by the system they operate in so I think, you know, as I've moved my career, trying to trying to support innovators help help staff on the front line deal with all the to be crude the shit that they have to deal with is is is one of the things i feel very strongly about yeah and i think having that grounding as being a clinician as well initially it never leaves you like the empathy that you have for them it's like the biggest question that i well i say the biggest question the question i get asked a lot is you know what what would you actually do if you you know magic wand what would you do to to rapidly change the nhs for the better or the health system or you know whatever however they phrase that my answer is always the same like incentivize sites to treat their staff better and watch the whole thing change downstream and okay it's a bit trite and it's a bit you know probably reductive to say that but i i do genuinely believe in so many good things downstream of incentivizing staff to have a better experience because even things that i can see now that kind of things like you know applications to medical school you know i'm seeing because i'm party i have the same thesis as you by the way about sharing information it's just that i do that over here in health tech and i try and do things like this that get information from you to others that can then act on it and prevent them making mistakes in the same way that getting medication information from one hospital to the other prevents making mistakes i'm trying to do that in the whole innovative sphere but i genuinely look now i'm looking on tiktok at the amount of clinicians on tiktok that are like asking for jobs in other places or sharing their journey into getting a job outside of medicine and i'm not joking hundreds hundreds plural of comments saying how do i do this i want to leave to this condition these conditions aren't great and i'm now sitting here wondering like what's the effect on applications to medical and nursing schools and physios and ot's and and all allied health professionals like what are the applications looking like into this system because we're no longer in a place where that information is gate kept it used to be the case that you'd get through medical school it was loads of fun you'd do your house jobs it was loads of fun and then all of a sudden the pressure start piling on later down the line but you've got your career at that point and there's loads of other benefits by the way because you're a pillar of society you've got status you've got you know rep you know proportionally you've probably got more money than you did than you do now i'm wondering like who on earth is is applying anymore for the reasons of status money security because none of those things seem to exist anymore so it's it's really it's really interesting to me that that i think we might be too late to avoid a big dip in I don't know whether it's numbers of staff or people that end up leaving but I think I think there's a real risk in the NHS at the moment because I think there was an iceberg hitting that we've been on we've been on course to hit for a very long time that I'm I'm now really seeing in plain focus that I think it's too late I think it's too late to turn the ship and I don't I don't quite know what that looks like when we hit it Well, I'm always an optimist.

12:08I've always been. And being an optimist comes with its own danger. It's easy to be disillusioned, but I still remain optimistic about, you know, you can't work in an institution for 30 odd years and not really feel and want to see that institution succeed. I agree with you, though, James. I think the last two years have been incredibly challenging for lots of people. There's loads of organisers. I was talking to colleagues just yesterday in NHS England, and they're going through some incredibly stressful moments in terms of uncertainty about the future. and I think that you know my lived experience of coming from the NHS into Cisco Cisco treats its employees so so much better honestly it's almost black and white the way that they're so so polarized in terms of um create you know even though you say well you're selling stuff well they are but you know all about purpose community um it really I mean maybe I just landed lucky i maybe i landed in an organization that's the way it is i don't know i've no bench benchmark because i've only really worked in the private sector in cisco but i do work with lots of other organizations in terms of partners and things and it just is stark james the the difference between how the private sector and the public sector operate that said you know there are always going to be stories of some on the front line brilliant individuals who despite everything still get up in the morning and go to work and do fabulous things and organizations that do fabulous things and there are there are lighthouses out there of really good organizations they're not all the same but we do dismiss human capital in the public sector quite easily and it's shameful really it really is so you know one of the things i always think is what can we we do as industry to try and help and and and not make it worse make it better what can we do to make it better yeah interesting interesting and i definitely want to come on to that but before we do health informatics director at lancashire um you were in that role for a while um and you were responsible for information i guess is one way of putting it like you yeah you had responsibility for for the the clinical information that goes on so that means you're over things like health records technology and all that sort of stuff can you just explain what that role is and the reason that I asked the question is because we have a lot of listeners a lot of listeners to this podcast from all the way across the health tech ecosystem so we have clinicians that might not know what that is we might want to move into that role we have startups that might want to get in touch with that role or or they might learn from you why not to so can you just sort of orientate us into what a health informatics director is do all trusts have one i know that all sort of make it up as they go along as well i think i think they talk about the role so the title of the role has probably changed now if it was a if it was now it would be called a chief digital information officer or chief information officer.

15:36There are different titles, but it's generally somebody who kind of leads on the portfolio around digital data and IT, DDAT as they might call it nowadays. The vernacular, the language changes every few years, but broadly they're in there. So if you're out there trying to engage with healthcare, these kind of roles are the ones who have that responsibility, a portfolio of things that they do. A lot of time and energy at the moment is spent on connecting and integrating clinical systems. So these are the things that manage the patient record or images that contribute to that patient record, PACS, picture archiving system.

16:22Any time you go for a scan or an X-ray or something like that, all that information is aggregated into a kind of centralized record. And there are varying degrees of maturity across the NHS and probably, you know, many organizations, some of the organs. So I've worked both at a trust level and at a system level, at an ICB, Integrated Care Board level, across a number of organizations. Most organizations are differing variants of maturity, James. And even the organizations that you worked in will be different compared to others. And some have an all singing and dancing solution that they've got in place and others have a multitude of systems.

17:08So it wouldn't be unusual for an acute hospital to have two, three, four hundred systems that they need to manage and maintain on a daily basis. And that's huge complexity and creates huge issues for the staff on the front line. You've got to log into all sorts of different systems. But one thing, James, I say now, although I'm in the private sector and in Cisco, I'm in rehab almost to understand about, and you might say, well, you'd say this definitely because you work for Cisco, the importance of getting the infrastructure right. because if it's not right and you're on a you're sat by a patient's bedside trying to capture some information from that patient um you can you can't necessarily get access to the information systems that you need to at the point where you need to get access to those systems or you're logging into multiple systems and you're all seeing this yourself and you're putting the same information into different systems or you're trying to remember what you put in that one and that one or you happen to access different systems to get a picture of the patient.

18:19So these roles that we're talking about, these chief digital information officer roles, CIO roles, they're there to manage, maintain, and deliver a roadmap to improve those systems over a period of time. What I'd say to any of the listeners out there is there are many other roles that you need to connect and link with. So obviously chief digital information officer or that kind of character is important. But there are, in terms of clinical, the clinical agenda, many other types of roles. So there's a chief clinical information officer, CCIO, or a chief nursing officer, CNAO, and even a chief AHP officer now.

19:02So these are typically clinicians, frontline staff who decided to get more engaged in the digital agenda. And they can offer anybody out there huge insights. Typically, they're driving, you know, they're there for advocates for their professional groups, but also advocates for the patient because ultimately whatever we're doing, the information we're collecting is to support patients and their families. So those kind of roles are really important. And then most information IT departments have a whole raft of other technical roles and professional transformational roles. If you see characters like digital transformation officer, they're always a great starting point to get involved in.

19:52I'd also say to industry, and particularly startups, and James, I've done some work with a number of startups over the years. i would say go and talk to people you may have a james and you'll know this from your own background you'll speak to people although come and talk to me i've got a great idea we're going to do x y and z and you're going yeah yeah that sounds like a great how are you going to go about it why would you do it how does that support patients what's it how does it support the staff there's some brilliant ideas but not necessarily grounded in reality and somebody will go and say I'm going to talk to my venture capitalist, my angel investor, and I'll say, so how many of these solutions have you deployed?

20:36How many problems on seats have you got? And they'll go, what do you mean? Well, most organizations are really quite conservative in some respects, and they will want to have proof that whatever you're selling or proposing to them has value. so really don't you know wherever possible try and go and engage with organizations don't come with your idea you might have a great idea but contextualize your great idea with with the realities on the front line or in the organizations that you're trying to sell to so that you can understand what their needs are just on that point i can remember i i was at an accelerator called the digital health dot london accelerator it was like a an eight one of the nhs ones that help start or show you know um i can remember even since since then one of the things that we were taught was uh all trust board meetings are published publicly you you can literally i mean in fact do you know what i've never said it this way before because in a post chat gbt world you could probably just get chat gbt to scrape find download or if you've got them just upload them all into chat gpt then just upload your startup pitch deck into chat gpt and just say right cross-reference these two and tell me which trusts to target exactly why i'm targeting them give me an evidence-based report that i can just hand straight to them tick deep research and then just leave it for 10 minutes all of a sudden you could probably get yourself a few million of revenue doing that there is so much information most most of all yeah through organizations are subject to the freedom of information act yeah oh that's also true yeah you can you can you can do you can do it anonymously if you wanted to but you're absolutely right james and i i certainly encourage i do it and i encourage um the sellers that i interact with to go on don't just turn up at a trust go and read the board reports for the last hundred percent go and read their patient safety report go and go and go and read their strategy and plan really start to understand what that organization needs, what they're trying to achieve.

22:45And you'll have so much better of a conversation with those customers when you go and see them. It's time well spent. In a way, James, it's almost rude not to have done that before you guys. I agree. I agree. And actually, you'll remember this even from being on the front line, because I certainly do, even when drug reps used to come around and try and flog you something. it's easy to dislike those people when they turn up with their laminated stuff in this in their pristine suits and try and flog you something it's very easy to dislike that energy and inverted commas in the messy clinical environment i'm turning up in scrubs that are ripped and i've got someone else's blood on them and like all this sort of stuff and and it's easy to dislike apart from the fact that the good ones always i always felt like they knew and understood our situation the bad ones didn't the bad ones would try and commandeer a room and they would stick out like a sore thumb whereas the good ones would that they you always just felt listened to and understood by them and i think that that always spoke volumes to me and i think you're absolutely right it's the same for startups you know i remember on this on this podcast i've spoken to um i spoke to dom from tortoise who's one of the ai scribes um and they're doing work at a load of different nhs spaces but he spoke on this podcast about he would literally just go to an nhs ward and just ask them questions obviously get permission to be there etc all the rest of it but not just not just rock up and open a door and nick someone else's card to go in although fair play for the entrepreneurial spirit there uh less so for the patient safety but um but but genuinely we're just we're just going to ask questions what are you worried about with this like what would what would this mean if this was this then what would that be like just just asking questions and that listening and understanding and it's not even the information you get it's actually the relationships that you build absolutely it's the punchline because people then trust you yeah yeah exactly this well i don't what i also do and uh you know colleagues inside Cisco and partners have often said, oh, I'm doing a talk on such and such, or I'm going to meet such and such.

24:59And I said, one thing, when you go and talk to health services, health services staff, if you go and talk about your own experience or your family's experience as a patient, and we've all got personal, you know, the one thing about the NHS is it touches all of us at some point in our lives. You can't go wrong. If you're just talking about, you know, contextualize whatever it is you're selling to your own situation, you cannot go wrong because you can't argue with your own personal lived experience of how you've experienced the NHS. So if you've not, you know, I still think you should do the due diligence.

25:34Absolutely. Every, you know, our listeners out there or your listeners out there should be respectful for that organisation, spend some time researching it. But think about your own experiences as well, about how you're, you know, if you've been in hospital recently, what was it like? How was it like in the outpatient department? that's really good insights and everybody has those insights so james is you know this this your own personal experience is incredibly valuable and i think frontline staff kind of well they'll resonate won't they you'll have had it yourself of course patients come and talk to you you're talking about experiences of course um in those roles in lancashire i mean how much did you engage with industry and i don't know on reflection when you look back would you do that more would you do that i would do james i i said like i'm in rehab i would i would be i would behave very differently now if i went back into the nhs into a cd more more or less more i right okay because i i'd no idea which way that was going i i would i would i um more okay interesting i i think i would characterize myself as quite a grumpy uh cdio at the time and it was quite right difficult for me to uh i would engage and i and and it probably was quite just you know i selected about who i engaged with and it was generally the ones i felt like i had a bit more rapport um yeah okay my my experience now on this side and how i've seen some other organizations engage and there was one in the in coventry warwick for example who who are actively engaging with industry and i think what i've learned is you can gain so much as an organization by engaging with industry if you do it you know obviously procurement rules and things can make it challenging for people but they shouldn't make it a barrier because by understanding what's out there understanding what others are doing you you can improve your own outcomes you can improve your own buying patterns and things like that how do you deal with the problem of floodgates with that though because i imagine if you if you open the door if word gets out hey declan's pretty open to a pitch all of a sudden i mean we've both had an nhs inbox at some point so we both know we both know what those things look like opening now to 500 startups to come and knock at the door with no discernible real way of critically appraising those without a big time sink from you i imagine like how do you sort the wheat from the chaff and do any sort of qualificational filter you're absolutely right it's going to get a deluge but i think the things we just talked about in terms of um having those organizations that approach you so a cold email that you know is being sent by a mailer not interested in that yeah just going to dismiss it somebody who came back to me and said you know i live locally or i'm interested in this or i'm working with this organization i might be i live locally that's an interesting one yeah uh and and that that that happens to me now you know i was talking to a guy uh echo how and he lived in the village just down the road and i thought well and i was talking to him about some work we're doing at the hospital i trained at 40 years ago and uh he wants to do some work there and i went that sounds great you know let's let's explore it i feel like there's going to be a personal connection so i think we're emotional beings and you're selling to people as you said yeah yeah so i think you know the way you engage with it with with um with organizations is going to be important i i mean i think there's a there's a flip side to this that you know i think i would go back and engage more with with industry and certainly with innovators clinical entrepreneurs but oh i would always open my door to a clinical entrepreneur because they're coming at it from a from a from a kind of position of understanding and not power knowledge um i think you mean the program specifically when you say that yeah i'm i'm a i think most of the clinical on there's a clinical entrepreneurs program james which you may be aware of yeah yeah absolutely tony woods is the good guy who was leading that still may be young yeah tony young sorry yeah those those are those programs i think are really really important the health innovation networks or the innovation agencies in old money i think they've and you talked about the one in london the accelerator programs they're quite a useful way of engaging the flip side of this is having kind of engaged with some innovative companies the nhs is so slow to procure so slow to move a lot of you know those are those innovators there's smes starve to death by the time they get a contract and if you think you're going to get a contract in 12 months you're going to be incredibly disappointed it's such a slow, slow burn.

30:36It's really hard work. And we need to address that. One of the very aspiring and very impressive CIOs is up in Lancet, South Cumbria, in my old organisation, to be honest. And she's working with Tech UK and others to try and think about ways that we can procure for, or innovate for procurement, or procure for innovation, perhaps is a better way of describing it, which is ways you can engage these really creative startups. and find a way to support them and hopefully then engage in a contract negotiation at some point down the road. But, James, it's not quick. There's nothing that's quick in this space.

31:17I think innovators need to be prepared for that. Yeah. I think on that point as well, it's a shame because I've very much defended the alternative view to this previously in my careers plural um but the nhs can't be your sole focus as a market and i think that it's it's an uncomfortable truth and an uncomfortable reality i think for most not all there'll be there'll be some particularly i guess the bootstrapped or something that's not relying on fast contracts and the rest of it but i think for the venture-backed companies that need therefore incredible pace incredible scale i am struggling to to to now defend the opinion that the nhs is a good market in inverted commas for health tech companies i mean i think it's indefensible actually i i think as a public good you know in terms of how much we spend as a country on health care health and social care but health care specifically we should be delivering more value to to the country plc that's interesting yeah i think that's an interesting perspective that actually it's the responsibility of well you know james as well as i do that most of what affects people's health is not the healthcare system it's work home all those kind of you know relationships friends yeah and actually nhs plc if you want to call it or uk plc we put so much of our country's resources into it and you know i do work for a big tech company but i work for a very ethical big tech company that does try and cultivate smes we have a very rich partner ecosystem and really, really kind of well-matured way of doing it.

33:18We should collectively be growing the country's life, tech and mind sciences industry. I know government decent are trying to do this. Others are trying to do it. I'm not being critical, but I think when you look at it, our performance, it could be better, couldn't it? Yeah. Cisco then, what role have you now got at Cisco? I mean, healthcare lead for the UK, that's pretty grand, isn't it? It's grand. I wasn't going to say nebulous, but it is nebulous. You are right. Tell me about the role. Tell me about what you do. And I guess Cisco more broadly as well, because actually Cisco is one of those companies that goes in that sort of box of like, yeah, they do tech things.

34:06They do things, networks. What the hell is that? Yeah, what's a network? But they do those. they probably own some cables that are quite thick that go under the sea so so if i'm honest with you james i didn't really understand what tech did when i i came into the organization it's like bloody hell it's huge it's massive it's really far reaching again i've i've said i'm in this i joke about being in rehab um as an organization so much of my role as healthcare need. I say I've got three broad things that I do. Engaging with government central bodies, hopefully guiding and hoping those organizations understand the value of Cisco and what it can do.

34:57In terms of that conversation we just had about UK PLC, it does try and do things for good. A third of my role is spent with customers and it's a real privilege now. One of the things I would say about coming out of the public sector for such a long time is I have a real I really get to see lots and lots of organizations it does give you a helicopter view of of what's happening and how organizations are performing and I can see the really really good ones you know I'm a big I'm a massive advocate massive kind of I like developing you know you get to a point in your career where you get a lot of enjoyment where you kind of coach and help develop people and I love seeing some of the really like shining stars the people you think are they're going to do really really well they're a future leader or whatever but a third of my role is going out and meeting customers helping customers and then a third of my role is around innovation and i've got a whole program of innovation that what we're doing which is you know engaging small industry and others in that thing but Cisco what does Cisco do so we have a huge presence in the NHS huge our level of incumbency in the NHS really took me by surprise it's you know most of the NHS is using Cisco infrastructure in some shape or form okay we probably would describe ourselves as a security company a networking company we've got this a range of technologies all infrastructure related but it's security is at the heart of what we do you know most of the conversations i get engaged in sco are security first and then yeah what we're trying to do but things like communications technology the technology um and loads of people have heard me say this james the technology that sells us be the facts and takeaways out in the industry you know so the technology's called omnichannel communications that sends you messages and nudges you and does all that sort of stuff we do loads of that and i've got this mission how do you take all that wonderful technology and use that for good in terms of driving better behaviors health outcomes all that kind of you know nudge interventions all that kind of wonderful stuff that helps people make the right choices at the right moments um but so as a company we've got this kind of communications platform that's got loads and loads of capabilities.

37:21But as you'd expect, with a massive, massive thing around AI at the moment, artificial intelligence. And the business is genuinely ramping up, has been ramping up for a number of years around AI. There's kind of three bold things. AI in the products, AI in the technology, that communication technology. And the other thing is about AI, sovereign AI, about how we support customers, particularly in the NHS. to, and as you as a clinician, this probably kind of resonates with you, all the brilliant people we've got in the NHS, how do we use that knowledge and insights to create capabilities around AI that are locally owned?

38:05So we've just started an initiative with DCIC called Barnsley Tech Town. It literally was only a couple of weeks ago it was announced. But the principle behind it is sovereign capabilities. so the campaign building i call it you know teaching people to fish is we're giving them the kit we're giving them potentially the skills to go and develop their own ai capabilities so you know you as a clinician taking your insights developing a language model that you've developed you've it's your data you've developed it and it's yours to go out and sell and use as you wish but You're going to generate the value of it.

38:46And that capability, that last capability around AI, is also relevant to small industries. So I've got a project that's coming to the fore in Liverpool where we're looking at how we can use that sovereign AI capability to support small innovative ideas that are locally generated. What would be an example? so for example in Liverpool they're looking at embryo identification so which embryos are the most viable embryos but it's the people who are in IVF yeah yeah because there's lots of lots of solutions out there but not a lot of science behind some of those James but there's specialists in that Liverpool area that understand it at a level that not many people do how do we how do we draw on their insights their understanding to create a better solution i love this i love this stuff because i i think honestly i think this is like the next iteration one of the next iterations of healthcare i think it's actually one of the frontiers of healthcare yeah i spoke to the neco founder about this um ceo about this yeah i'm on the on the neco podcast a few weeks ago but i think so many companies now are in the business of turning the imperceptible knowledge of clinicians built on clinician to clinician to clinician over the course of their career but also build standing on the shoulders of giants with people that have like written textbooks and documented stuff that we then read and we go in at that level and then build on it with our experience but so much of that information disappears yaomar the neko co was talking about his daughter has a knee condition that there's this one clinician globally that has felt this knee that understands what good bad indifferent is and therefore holds all of that how do we turn that into actual data that can then be passed on and built on through generations and my goodness that just holding a knee is one thing but then as you say embryo identification in in in IVF or who knows how many hundreds of thousands of millions of of use cases of this there are but I think I think this is one of the true values of what AI can bring to healthcare and that's really importantly on that, James, is so that people who own that information, who manage that information, the citizens who that information belongs to, benefit.

41:09So this is about commoditization of AI. It's all about local ownership of AI. So the Barnsley thing, although it's not really formed yet, should be about Barnsley benefited, Barnsley's knowledge benefited. And I don't know, there's some technologies out there that Blackpool are doing, for example that you know the data center that's processing the data is heating a swimming pool uh yeah yeah yeah yeah yeah project i want to do in bradford about you know there's a project which people will know about born in bradford but if that was being processed in bradford how could that heat the homes in bradford that kind of stuff so this is a this is a about taking all the really good stuff of ai but really doing it for the benefit of communities um in in In Birmingham, there's a project that's just been supported by D6, something called the Local Innovation Partnership Fund.

42:03And some of the strands in there, I'm hoping that we'll see small enterprises based in the West Midlands being able to use tech, locally owned tech, to drive innovation. But most importantly, the people in the West Midlands benefit from that. The money that's been generated, the taxes, go back into that region. that's when we know we're really really really motoring doesn't it love that and i know you're thinking well you're a big tech company aren't you gonna well actually no we're here to do good as well as make some money and that's what i've learned in the last five years that you can still do some purposeful things and do you you this is you've got great experience here because you've come from that very slow moving you know very risk averse nhs role where you're still responsible for moving things forward but it has to be done safely and it has to be done properly when you're looking at the world of healthcare now you're looking at it maybe through the cisco lens maybe through partly your nhs lens maybe you know you can think back and remember how you thought clinically even and you know being a being an evidence-based uh you know safety first person as you will be as a clinician as am i we always look through the lens of safety and we always look through the lens of patient safety it's like this this reflex that you just can't ever get rid of when it's that's the first thing you're taught in your career and i can see you nodding so i'm glad it i'm glad it persists through your career as well how do you look at the world now in terms of you know the risk of safety with everything because we're going at some pace here we're all of a sudden now talking about sovereign ai you know learning on the like this this is like it's been a it's been a really steep curve this learning curve that we're all going through with AI now and we're having to come to terms with a lot we're having to come to terms with processing information and who does that information belong to and and you know things like you're saying are actually trying to plot a path towards more public and common good there rather than single company single person ownership which when you look at some of the big companies at the top of the NHS and the amount of shareholders they have you're like oh one person one person owns all the data of all of this system hmm that's quite interesting but how do you how do you look at how do you feel about the safety of all of this as well so safe safeties uh i've been uh having some very good conversations with health safety health services safety investigation board hssid and they've just produced some things around um the potential impact of electronic patient records.

44:44They've got loads of really brilliant people. I want to carry on working with them and look at how can we design in safety. There's a number of dimensions to the question about how do we manage this rapidly changing environment. We've got to take a balanced view, James, because sometimes technology has the power to enable and empower people. When you look at some of the voluntary sector and some of the charities around people with sight issues or hearing issues or other disabilities, ADHD, neurodiverse people, technology can liberate them and do things. So you've always got to balance this thing about being safe as opposed to slowing things down.

45:31Some of those groups out there can actively be part of evaluating safety. i'm a massive advocate of of trying to do things in situ so that i mentioned earlier about the innovation we've created a from cisco and partners we've created a lister alliance lister was a was an innovator who developed antiseptic techniques as you all know oh joseph yes yeah and the alliance model is because it's all about people coming together so we create these living labs and we did one in uh it's come to a conclusion now in in nottingham with the national rehabilitation center and what we've done there james is um rather than saying here's a technology just get on and use it we've created a living lab with frontline staff where they've really tried to organically take that technology and try and test it in their real world environment but obviously with measures and things to keep keep patients safe and it seems to work where you bring together technologies because often it's not one technology that really delivers change it's a combination of technologies coming together that's you know this kind of for the older audience the graphic equalizer changes a number of small little nudges and things that you need together so you can get a raft of different technologies that bring about impact but you need to consider that in clinical practice yes and also patients as well and how they interact with that but you've got to these are where your audience, the innovators out there need to come together and be open to integration, be open to trying and adapting their technologies.

47:11When we did the Lister Alliance Living Lab at Nottingham, one of the players in there rewrote their software because they realized it didn't work in the way that they thought it would work. So I think when we look at safety, we've got to make sure that we've got guide rails in place. we've thought about the different consequences of that but we also need to innovate and iteratively innovate we need to do stuff we need to trial it and test it but be open those solution providers need to be really open to working together because you cannot there's the idea there's one tech out there is just nonsense well this is a great point for us to finish on i think because i saw this you know in inverted commas back in my day when i was at accelerator and and within the nhs is that so often people will solve part of a problem yeah and that's that's a recurring theme because people to understand the full problem and it's too big is it's too big absolutely it's too big the amount of people that you need to speak to to learn from to understand and listen to even to solve a small part of a bit of a problem is a life's work let alone trying to solve it end to end but people like yourself have that vision and i think that's a really important thing that if someone like yourself if startups listening are going into nhs organizations and they're saying well you need to integrate with this you you should get together with them actually the three things this this and this together would solve my problem because you're absolutely right i think the openness in order to work together to solve a full problem for someone and again it comes back to people it's a full problem for someone it's actually that and then that's unique it's not necessarily that that would be everywhere although you'd probably be pretty close if you were doing that you know the likelihood of that occurring in in the same way everywhere but it's yeah solve the problem for the person often as you say it's coming together with people it is and i couldn't and then the only the other thing i would add to that is um over 40 years the more i've learned the less i'm convinced i know reverse dunning kruger yeah yeah yeah i just i'm just like you just know that there's other perspectives of the right do you know what dangly i've got a funny thing on this so i i uh i was asked to just like i get asked all the time to go like go on a panel talk about a thing i for the first i say for the first time like it's been this has been happening for a while i've got less and less confident yeah i was so confident in my 20s i had spoken on a panel about literally anything in health tech i'd have talked about investment never invested in my life i'd have talked about tech never built a piece of tech in my life i'd have talked about this i'll talk about that and i was just so like yeah i'll just talk about anything now i'm like i don't know enough about that i know even if i've got a whole company in it john's about comms i'm like i don't think i know give you a degree i'm not you've built a business jam yeah i don't know i don't really feel like yeah so now i'm like oh no oh now i'm too scared to talk about anything but anyway um well they talk about on a podcast and get other people to talk about it that i will do that's because you you are the expert my last question that can before i let you go obviously we've we we do research on people before they come on and it has not escaped me that um well first of all i have a one-year-old a little boy yeah um and it has not escaped me that you have raised uh a boy yourself who has become the best in the world about something um how does one raise a child to how do i become the father of the best tennis player in the world or the best something in the world or the kindest person in the world or the this person how do you raise the best in the world at something and i'll just declare it it is the best in the world at fantasy premier league as well which there are millions millions of players so what an outrageous outrageous title uh so congratulations first of all on being the father of that person um how does one raise how does one raise someone to become the best i would love to play uh my son tom tom hadley um i had a hand in his uh fpl career as it's growing development if i'm honest with you james i probably you know over the years I said, get off that Xbox.

51:32What are you wasting? Just do something else. I never thought that he would go down this path, if I'm being honest with you. So all the parents out there, it's just luck. It's just real luck. What is really funny, I have two sons, Tom and Ben. The younger one, Ben, this year, Tom was number one in the world last year for a few weeks. And obviously, there's millions of people who play it. And he's now doing lots and lots of stuff on Onyx and Reddit and other groups. But this year, his younger brother, who's been following him religiously, has made a few minor tweaks and managed to get ahead of him in the rankings.

52:16No, it is amazing. I have to say, James, and you'll know this from probably your own parents, it's like understanding social media, understanding how it all moves. is I wish it comes back to our point about the more I've learned the less I understand the less I don't have a hand I can't claim Tom's success he's done it on his own so he succeeded in spite of you rather than because of this fight yeah yeah yeah so follow him he's FPL underscore Tom Hadley maybe just that little bit of resistance just helped him build those muscles maybe that's very very true very true it's it's a modern serena and venus williams story isn't it your two boys so um congratulations to you and to them declin it's been a pleasure thanks for this has been this has been awesome conversation learned loads etc etc if um if people want to learn more from you or get in touch with you or learn more about cisco what's the best way for linkedin is a good way i wouldn't say i'm brilliant in terms of responding but you probably get a few Yeah, and I would just say, James, as we've talked about, just be a little bit mindful.

53:25If you want to reach out, be mindful about how you approach a standard email. Just think about how you're going to connect with me. In terms of Cisco, yeah, by all means, we've got lots of routes. And our partner, we've a really rich ecosystem of partners as well, James, who are also looking for innovative ideas. so yeah start with LinkedIn let's go with that to start with amazing Declan thank you it's been really enjoyable