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In this episode, Helen Thomas, Chief Executive of Digital Health and Care Wales, shares a rare and honest perspective on the human side of transformation.

Drawing on more than 36 years in the NHS, including leading Wales’ digital response during covid, Helen reflects on what leadership really feels like at the sharp end of health and care – making difficult decisions, carrying responsibility, navigating uncertainty and still showing up for others.

We explore why digital transformation is fundamentally a care model challenge, not a technology one, and how getting this wrong quietly undermines adoption, trust and outcomes. Helen also reflects on what the pandemic revealed about the system’s ability to move at pace, why so little of that has stuck, and what leaders can learn from it.

This is a conversation about judgement, compassion and inclusion as leadership disciplines – and what it takes to lead change in complex systems today.

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Transcript

Sam: 0:00

Phrases like legacy modernisation, target operating model, and interoperability can mean that transformation doesn't always feel like the most human of endeavours. Yet at the heart of any change program are people making difficult decisions, balancing risk, carrying responsibility, navigating ambiguity, and still needing to show up for others. 

Today's guest reflects on what leadership really feels like when you're operating at the sharp end of technology, health, and care. 

Hello, this is Problems Worth Solving, the podcast where we meet people transforming health and care through human-centred design and digital innovation. I'm Sam Menter, founder and managing director at Healthier, the Collaborative Service Design Consultancy. If you enjoy listening, you can subscribe to this podcast and the accompanying newsletter at healthier.services. 

So today I'm joined by Helen Thomas, Chief Executive of Digital Health and Care Wales. Helen has spent more than 36 years in the NHS, starting out in finance before moving into health informatics and eventually leading Wales's national digital organization through one of the most intense periods the health system has ever faced. Since 2001, she's been responsible for building a new organization, shaping its culture and helping the system respond at pace during the pandemic. 

Helen often describes herself as an accidental chief executive, driven less by title and more by impact. Helen, thank you so much for joining us today.

Helen: 1:44

Thank you Sam, good afternoon.

Sam: 1:47

So to kick off, how would you summarise the big problem you're trying to solve?

Helen: 1:52

So the big problem is how do we, from a digital and data perspective, improve outcomes for the people of Wales? How do we ensure the NHS is here for our future and is fit for purpose so that it can sustain and look after our families and our children and our children's children?

Sam: 2:08

And what sits behind that problem once you sort of peel back the layers and what makes the problem difficult?

Helen: 2:13

The demographic challenges that we're all facing are putting immense pressure on health services as we know it. So I think that that shift in demographic as we see healthy life expectancy now is what age 60? And we know that life expectancy is, you know, in the region of 80 years old. There's 20 years that people are living with not one, but many are living with more than one chronic condition. So our demand on health services is just rising and rising. So I think there is in amongst that a massive opportunity for digital and data because it is really clear now that we can't keep doing things the way we have been doing them. We have got to change and modernize services, and that's where technology will have a huge part to play.

Sam: 2:59

Where do you see the real opportunity for impact?

Helen: 3:03

So I think that in empowering patients, in enabling patients to be informed about their health and care, for them to truly be a co-participant and to co-produce. And there are lots of kind of grand words there, I guess. But for me, in Wills, we've got a guiding principle of prudent healthcare, and that is about putting the patient at the centre of everything we do. And I think that absolutely is fundamental to the way that we will sustain and improve services. But you can't do that unless you have the data and the digital solutions in place that will connect the patient, the data, the clinician, the service, so that we can actually provide those different options and different opportunities for patients to be empowered and to connect into health services.

Sam: 3:54

When you say putting the patient at the heart of everything we do, can you tell me a bit more about that and what that what that means in the context of your work?

Helen: 4:02

Yeah, so you know that that's about enabling patients actually to interact with the health service as they do with other areas of their life. Because we we know we all walk around with our mobile phones in, you know, in our pockets all of the time they're glued to our arms, aren't they? And we're always multitasking on them. But actually, we don't do a lot at the moment in terms of our health and care journeys and managing that through our own kind of digital devices. There's something about ensuring that things like the NHS Worlds app, which will have all of that, the digital record, that digital information about a patient available in one place securely and available when they need it, but also how we move forward and provide the ability to interact with health services through things like the NHS Worlds app. But it's also about how we design services as well. So putting the patient at the heart, if we look at it through a digital and data lens, actually, how do we understand what it is the patients want from the health service now in the 21st century? And how do we then design those services with patients, with users, so that it's intuitive and it's the whole of the service design, not just that we've got an app that will do a function that we actually work in tandem with patients.

Sam: 5:21

How big would you say the gap is between expectations around what people are used to doing digitally and what they can actually do digitally with health services in Wales at the moment?

Helen: 5:32

So there is a gap at the moment, not all information is readily available, but we've got a plan in place to make sure that we provide the information and actually the opportunity for patients to interact, to book appointments, to look at their record. So that will iterate now and grow and grow over the coming year and years to come.

Sam: 5:53

And what would you expect the impact of those changes to be on health outcomes?

Helen: 5:58

Well, firstly, you'd expect it to be empowering for patients so that patients will have the opportunity to be the expert in their health and care journey, and they can make informed choices about that journey and about what they would want to do to improve. We'll be able to provide targeted signposting for patients based on their medical history, based on their medical journey. So I firmly believe that having that information to hand and having the ability to have more flexible access to health and care services will have an impact of improving outcomes. The other opportunity in that is that if we move to more digital ways of interacting between patient and the clinician, then that also really releases capacity so that we can manage to see patients when we need to see them. I think there's something about, and I don't know about you, I've been around quite a long time, as you said in your intro, and I was started in the NHS before there were really that many computers. You know, it was 1990. So, you know, I can remember quite a while back where actually, as I was the data input clerk, I was the only person with a computer on my desk. Actually, everybody else was paper-based. So when you think back to how health services worked through that time, you needed to have the patient, the clinician, and the paper in, you needed all three things to come together in order for diagnosis, assessment, consultation to take place. Of course, with digital, that no longer needs to be the case. If we've got the digital record and the clinician and the patient both have access, then they don't have to necessarily be in the same place. Sometimes they do, clearly, because this is a human service, it's about human interaction, isn't it? You know, it's about people. But actually, digital uh will provide the opportunities to rationalise and streamline and actually create capacity for when we need it.

Sam: 7:55

The changes that you're you're describing aren't easy. It's a big problem you're you're tackling. What would you say are the things that make this a genuinely hard problem to tackle, even with the goodwill and the investment that's going on?

Helen: 8:08

Change for a start, isn't it? That's one constant in the NHS, actually, is that we have lots of change. I think that change in services and is about people, isn't it? We talk a lot about digital transformation in the NHS, and actually, what we're talking about is transformation because it's about people at the heart of it. So I think what we need to do is ensure that we are designing the digital services with people, for people, and that actually we take them on that journey with us, and I and we do it in an informed way so that it isn't just about the technology, it is absolutely about supporting people through the change.

Sam: 8:45

I'd like to move on and talk a little bit about your your background and your your early influences because I always find it interesting how people have ended up in certain positions in their career and focusing on certain things. I wondered if you could take us back a bit and tell me a bit about your childhood, where you grew up, what was home like, um, what were you passionate about and what shaped how you see work, responsibility, and public service?

Helen: 9:10

So I'm from um a small village just outside of Neath, so I Britain Ferry, very industrial area. I'm from, you know, Neath is a small town in um South Wales, very mining background, industry background. And I grew up with my elder sister and my younger brother uh with my parents. And I think from a young age, actually, they they instantly we saw how hard our parents worked. My dad ran his own business, um, having been a policeman and worked in the oil industry as well, but he he ran his own business. So when we were teens, when we were, you know, working through that, there were there wasn't a lot of money. My mum was a hairdresser, uh, and they worked really hard and there was a strong sense of family. We all had chores, we all had jobs when we were in our teens, you know. It was it was a happy childhood, but it was yeah, we understood that we didn't have a lot of money to go around. And also, I suppose the thing to remember is this was the 70s, so um, it's uh 70s and and early 80s, and of course it was pre-the microchip back then, so perhaps with the last generation, aren't we? Where we remember a simpler time before that explosion in the mid-1980s, so yeah, it was uh it was a you know a really happy time. I um my early influences, I I'm quite sporty, or I was quite sporty, and I played a lot of sport in school, and netball was my passion, so I played for my uh school at McClub County, and even had a schoolgirl cap for Wales as well. And but during that time it was, you know, I naturally gravitated to leadership. I was captain often, I was head girl at school, so I kind of had an inherent sense of responsibility. I I kind of remember that from early days that I would put myself forward, say, all right, okay, there's there's something that needs doing, okay, I'll do it, even if it was something that I felt uncomfortable with. Sometimes I would do that. So I guess that kind of stayed with me, really, and and shaped kind of who I was. And I think growing up in that sort of environment, there's a lot in terms of integrity, in terms of fairness. I was the middle child, remember as well. So fair a sense of fairness was always there with me. Yeah, exactly that. That I I often say that now. I am always the peacekeeper in my family. So so yeah, that that has stayed with me, actually. That is probably how I would uh describe myself more generally in life.

Sam: 11:32

Was there anyone that influenced you early on?

Helen: 11:35

Well, actually, early on in my career, I think, is probably where I'd uh I'd reflect there because I'm one of those people who got a job that turned into a good job that turned into a really good career. You know, that's you know, well, talk perhaps when you mentioned earlier about accidental chief exec, there was never a plan for that. But when I moved out of finance and got the job in um health information, our director at the time was a woman called Debbie Morgan, and she was the first exec director of IMNT at the time, we used to call it then, you know, information management and technology to be on a trust board in in Wales. And she was quite inspiring to me. She also had young family, same as I did, and the challenges of trying to balance that. And I just remember how she spent time with us and and she supported us to develop, but also acknowledged that you bring your whole self to work, and actually it's good to bring your whole self to work. And yes, we all have the challenges about balancing kind of work and family life, and particularly childcare at the time, but it's okay, and it's okay to be your authentic self and to embrace that. So she was definitely um somebody who inspired me and and supported me. Actually, I was really lucky reflecting back how much support she became a mentor to me for for the last kind of 20 odd years. You know, we've we're great friends now, and that that was definitely part of it. And also the boss I had at the time, because I do suffer sometimes with imposter syndrome, with confidence kind of wobbles. And I'd I'd go to see my boss and say, I, you know, I can't do this, I can't, I'm not, I'm not gonna be able to do this anymore. I I need to do something different. I need to say, come on, let's have a conversation about it. You know, you're a star, I have ultimate faith in you. Let's talk it through. And we don't want to get through it, but yeah, knowing you can go and be that honest and raw with the people who you work with, I think, and and you have that level of trust was quite inspirational to me, actually, and it shaped my approach as a leader as well.

Sam: 13:41

I'm definitely surprised that someone in your position talks about imposter syndrome because the the outside perception would be there's someone who's super confident, knows exactly what they're doing, and never falters.

Helen: 13:51

Yeah, no, and at times it can be crippling. So, and it's always been with me. I think there's something about my, you know, my early life where some of that comes through as well, not just being the middle child. But um, I didn't go to university. So I when I started working in the health service, it was just before I was 19. And and then you start to move through the ranks a bit, and you think, well, I'm I'm with all these clever people who've all been to university. I can't possibly be as clever or I can't possibly speak up in this meeting, you know, I can't lean into it because oh, everybody else will have thought of these things, you know. They you know, they're all cleverer than me. So I remember that being kind of the voice in my head, and and it wasn't until I think I did, I did then do my master's in health informatics and you know, I was supported and encouraged to do it. And I thought, right, okay, come on, then back yourself. Let's, you know, go and learn. And I did, and it was amazing. And I learned a lot and actually applied a lot of what I learned through um through doing the master's degree, and that did give me a sense of I'm qualified now to do what I do for a living, even though I was really good at my job, and you know, I'm quite a modest person, so it takes something to say that. But I was very good at what what I was doing, and and I had a level of credibility across the organisation, you know. But actually doing the masters was more for me than it was for anyone else. So it made me feel that, you know, more confident. As I then got into more senior leadership roles, I think that, and the challenges that we've experienced in in the health service over the last kind of definitely the last 15 years, isn't it? You know, in terms of the constraints and the the service delivery challenges, and then you get more senior, you realise that a lot of the uh improvements that you need to make and that you need to lead your organisation through it, it's it's it can be quite daunting. And I don't think I find the challenge daunting. I think the doubt is there is it's the voice in your head, isn't it? Am I an F? Can I actually provide the support? Can I provide the answers to these challenges so that we can work our way and move our way through them? So it's it's it's always there with me. I've got to keep calling it out, to be honest.

Sam: 16:14

So you've spent 36 years in the health service now. Yeah.

Helen: 16:18

This month, yeah.

Sam: 16:20

Amazing. And there must be times where you've thought maybe there are other directions I should be going. I'm interested to know what's kept you here and what's kept you going.

Helen: 16:30

The mission's so important. I'm a health informatician, that's my background. The data analyst is kind of where I started in this field, but I'm a public servant. It's it's all about the NHS for me. It's not about digital and data, or clearly it is, but it's about doing it for the mission. I absolutely believe in the NHS. I feel really privileged to have to have worked here for as long as I have and to have been able to kind of have a fantastic career, to have experienced what I've experienced, to have been able to do the things that I've done and to hopefully have made a bit of an impact along the way. So for me, it it's always been about the mission.

Sam: 17:12

Is there an example of a moment that made you realise how much the work matters?

Helen: 17:16

Yeah, and I come back to Prudent Healthcare again on this one. So this is a guiding principle that the then cabinet secretary set out, Mark Drakeford, at the time. He's been a previous first minister in Wales as well, and is currently the finance secretary actually, before he steps down at the next election this year. But he coined the Prudent Healthcare Principles, which is about putting the patient at the heart, about co-producing, empowering people to be lead in their own health and care journey and to really push for co-production of service design with patients, also calling out variation and how we should look at every opportunity to reduce variation and only do what only you can do. So, this kind of mantra, if you like, it work to so that people have the permission through that to work at the top of their license. So, how do we organize the process and the service so that we are ensuring that our talented, capable staff are actually spending their time doing the things that they've trained for, doing the things that we need them to be doing. So we make their lives a lot, you know, the processes that they're having to follow a lot more straightforward. So that for me, and I remember going to sessions to to understand what this was about back in the well, it would have been the early 2010s, I suppose, maybe earlier actually, and thinking, wow, okay, but we're not going to be able to do this unless we've got the data. You're not going to be able to understand and know where you've got variation. You're not going to be able to provide that information to patients unless you're collecting it in the first place, unless you're able to. So it it really got to the heart for me of bringing the digital and data agenda to life at that point. I was in a health board at the time and sitting there with the senior clinicians right across the organization and trying to get underneath what does this mean in practice for us then? What's this going to mean to our pathways? What does that mean in terms of patient choice? And actually really getting into trying to describe then to colleagues, well, actually, this is where data comes in, this is where digital comes in. And I I think it's the precursor to a value-based healthcare-driven system, isn't it? So that you're focused on outcomes for patients. So that you focused us on ensuring that the things that we are doing, that they count, that they actually improve outcomes and they improve the health and wellbeing of the population. So that for me was quite a big trigger, actually, in terms of where we need to be focusing our attention, particularly in the data world.

Sam: 19:54

Sometimes it can be easy to feel disconnected from the human side of healthcare if you're in the sort of technology. Side of things. Are there moments where you've seen particular human stories? We've done this and it's had X effect on this person's life.

Helen: 20:08

Yeah, there's a couple of examples, I suppose, I'd reflect on. One's a more personal one. But if I do the the work one, a couple of years ago I went to visit, I went on a visit to one of the hospital sites and went to see some of the work that we'd been doing with ward nurses. So the way how we digitize the assessments, uh the risk assessments and the admission processes, and go on to talk to a nurse who's actually come into the end of her career. And she said to me, right, I've been 40 years in nursing, and this is the best thing that's ever happened to me. I come in every day, and this was an unusual event, because this doesn't happen, doesn't always happen, does it, you know, if you're experienced in digital kind of implementations. But she said, I come in in the morning and I know who's where on the ward, I can see the risk assessments, I know who it is I need to be worried about first, I know where my nurses are and where to actually prioritize who they're looking after. And she said, the control it's given me as being liberating. So don't take it away. You know, she said to me, Don't you dare take it away. But that was astonishing to me, to be honest. You hope that's the impact that you will have on your users and that it can really support them to have more time to care.

Sam: 21:26

And that that must be the result of some good human-centered technology design.

Helen: 21:30

Yeah, so so the work with the nurses was was yeah, we worked really hard. We, as part of the programme of work, we also managed to get clinical informatics lead nurses in every organisation to lead this work. So it was led by and designed by the nurses, clearly with the digital expertise around them to support it. And it was also it kind of had all the layers, so we had the policy input from government, from Welsh government, through to what the nurse on at the bedside needed to do. And there was an awful lot of co-production in the design of that, yeah, very user-centred.

Sam: 22:12

And then you mentioned a personal story as well.

Helen: 22:15

Yeah, so so my dad was diagnosed with multiple myeloma back in 2016, so it's a uh a treatable but not curable form of bone marrow cancer, and he went through quite a lot of diagnosis at the time, but a lot of then treatment, which was pretty full on, and he was really poorly, but uh but it was really inspiring for me to see the fantastic care that he received throughout all of the multi-site and lots of different professionals involved in it. You know, he he'll be on chemotherapy for the rest of his life, and and he's got now other issues, not just from that, but for from wider kind of comorbidities and actually consequences of the treatment that he received. But what I I I guess what was really sobering was the fact that so much of this was actually still done on paper, and that there was still the diary on the ward, there was still the the paper letters, there was, you know, when I asked when he was being discharged after having a stem cell transplant, what information has gone to the GP and told, oh well, we haven't it's we're we're writing it up now. And I was trying to encourage that actually you can do that electronically now, is there all you know, so that we can and it's actually I quite like a copy of that so that I I can inform the conversation with the GP about the follow-up care. But it is quite staggering how, despite the fantastic care, that in fairness to to these professionals, they were still needing to do quite a lot of it on paper. And and it it really, I guess, drives you, it motivates you to ensure that the care is joined up, isn't it? And you can only do that through digital.

Sam: 23:53

Did you let on to them that you were slightly involved in the the digitisation of health?

Helen: 23:57

No, my mother did, yeah. Yeah, yeah. Did you end up with a huge wish list? Yeah, well, yeah, something like that. But then also, you know, what you get from your family is don't make a fuss. You know, we're very Welsh about things like that, so it's don't make a fuss, you know. But actually, like, no, we can do this better. Yeah.

Sam: 24:15

It's not easy leading a big organization in a very complex environment. What gives you energy when you feel stuck?

Helen: 24:23

People, it's the people around you. I mean, that you do this for people. I've just talked about kind of it it touches all of us, the health service touches all of us. It's us, it's our families, it's it's our friends, it's our colleagues, it's the people we care about, isn't it? And you have tough days. Everybody does. We're all humans, aren't we? We're all human beings. So it is all about the people. One of our strategic principles in the organization, or our first one, is people first. We put people first, and that means our people in our organization, that's each other, that's our users, that's patients. It's about that. And I'm quite an extrovert person, but I'm also an external thinker, so I kind of need to hear what I think. So I need that conversation, and I need the energy from other people. I'm in the office today, actually, and um it's I've had three conversations with three of my closest colleagues that I wouldn't have had if I was sat at home, remoted into what are mostly calls today. But I've, you know, got on the train this morning, thought I'm going in, and and I feel so much more energy from being around the team and and having the opportunity to have those corridor conversations and a cup of coffee when you've got that moment. But yes, it for me it's that it's about the connection with the people that you work with that kind of helps you through that.

Sam: 25:39

And what what's been the most positive change you've seen throughout your career in the health system?

Helen: 25:45

I think the the onset of digital records is patients have an access to their record, and we've still got a way to go. Not all of this is you know fully available yet, but they will. So clinicians being able to see the record and being kind of organization agnostic so that if you turn up for any hospital or healthcare setting in worlds and you've had blood tests done, you can see the results of that, you can see your extra results, you can see any any documentation that's been shared with the national repositories anywhere in worlds. I think that is fantastic because we need the record to follow the patient, but we also need to ensure that the patient has access to that. So for me, it it is definitely how we empower people to move into that space.

Sam: 26:33

Are there any particular moments looking back on your career that have fundamentally changed how you think about leadership or how you think about the health system?

Helen: 26:42

I'm trying to think of a really good example of that. I suppose COVID will be the uh the obvious one to that. I took over as lead of the predecessor organization to digital health and care worlds. I took over as lead in December 19, and then we had we were trying to work out, weren't we, kind of long after long after that, what was this virus that they were talking about in China, then all of a sudden before the end of March, we were all in lockdown. So I think the responsibility of being accountable for the organisation and the people, our staff in the first instance, that was very sobering at the time and quite scary, actually. It was scary anyway, wasn't it? It was scary for all of us. But um reflecting back on that, that that tests you test you as a it tests us all as an individual, didn't it? Because of the changes that we all had to endure. But it tests your leadership, it tests your your ability to adapt and your ability to respond. I'm very proud actually of of all that we did there because as a as an organization, as individuals, we stepped up. And yeah, it was that was probably one of the most testing times, I think.

Sam: 27:53

Can you tell me a bit more about your experience of working through COVID? Did you realize the role that your organization was going to play in the response immediately, or did it gradually kind of sink in? Oh my god, there's this huge situation that we're a key part of. What did you learn from working through that? It's quite a unique experience that you've had there.

Helen: 28:11

Yeah, no, it it was. I mean, uh, first of all, then we we started having fairly uh frequent kind of catch-ups and calls with with Welsh government and with the wider NHS, and I was asked to take part in those because I wasn't a chief exec at the time, but I was, you know, leading the organisation. So it was like they they asked me to be part of it, and you just you realised something big was going on, you realised that. But then we had to put our plan together. We realized early doors we've got to make sure that we're looking after everyone, we've got to make sure that that our staff are safe and cared for, and we've also got to play our part here. So, what is it that we're gonna do? It kind of played to my strengths as a kind of stepping into an operational director, that response mode. So we put our emergency response structures in place, we ensured that safeguards were all in place for our staff, and then we got on with the plan and we pulled the plan together. I put the um national communication strategy in place, or these almost I think it was everyday to start with. I put calls in with the wider digital leadership across the NHS. I co-chaired that with the lead director in in government, and we really started to motor on prosecuting the plan that we needed to put in place. And you kind of did realise early doors that digital and data were going to be pivotal to our ability to keep people safe or get people well and really drive the response. I mean, we all remember, don't we? And again, I'm you know data analyst at heart, seeing um on the on those the nightly uh briefings and them all putting the the graphs up on the screen, you know, to see our leaders in the UK and in Wales put those graphs up to tell us where we, you know, where we were in terms of the uh the prevalence of the virus at the time, where we were in terms of the vaccine uptake, all of that data, you know, we had a part to play in in providing the systems or providing the data itself. So it was um, yeah, you knew quite early doors. And I'm kind of reflect on a story. So I was on a call with a with a uh colleague, a senior colleague, and um a good friend actually, and I could tell he wasn't well, and I knew that he had COVID. And I, you know, I I I checked in with them to make sure he was okay, and we were we were discussing how we were gonna optimise how we identify the most vulnerable in our population in order to you know ensure that we had the extra support in place and we could share that uh information as it was needed, and it it was really hard. We'd not done this before. I mean, nobody had really been working in that way previously. And I could tell that he was he he really wasn't well. And I said, Look, you you're gonna need to rest because he was quarantined in the back bedroom of the house. The you know, his family were leaving his meals at the door, you know, it was all of that. He was you know he was kind of delirious at times. He he really wasn't very well with COVID. And he said to me, Here, I'll sleep when I'm dead. Now, this is our time. Now is when everybody, the rest of the world, realizes how what we do matters. This is our time. We have a huge part to play here, we can help save lives. And honestly, it really I made sure he was okay and I made sure he had rest. But that sentiment and that kind of sense of mission and purpose really for me epitomizes what we did as an organization and the sort of people that we've got here and why it mattered so much, really.

Sam: 31:39

How did it feel when people were out in the streets clapping each day for for the NHS?

Helen: 31:45

I mean, we've we were all shattered, weren't we? You know, and we're not frontline. Uh some of our teams had to be on site, but most of our organization worked from home for most of it, and we were working around the clock. I mean, that was the reality. But it, you know, yeah, it was lovely. And you know, my neighbours were they were there were a few people who work in the NHS on our street, and they were coming out with their pots and pans everyone, you know, and it was, yeah, it was heart men.

Sam: 32:11

Was there a moment during the pandemic when you felt actually we we've got this?

Helen: 32:17

So I don't it was um it was a bit of a roller coaster, wasn't it? Because at times you thought, oh, we're through it, right, we're through it. And then, oh, you know, you have the different wave, the different new variants or Macron or whatever, you know, there were so many of it. I think there were a couple of things, I suppose. We had to quickly get a contact system, a national solution for contact tracing in place within 40 days and 40 nights. I mean, you know, you're someone who understands kind of digital implementations to go from we've got a problem we need to solve to having a system, a national system to support the pan public sector response that we had in Wales in 40 days was that was quite something. That was a highlight, it was challenging, but you did get the the urgency, created a sense of shared kind of endeavour, collective goal. And because it was a pan public sector, actually that that created some fabulous networks, actually, in terms of people you were aware of that you hadn't actually worked with before. You know, it was we had 30 organizations sign up to a you know joint data sharing agreement to ensure we could do work nationally and support contact tracing right across right across the country. And I think the vaccine response we built out from our uh one of our existing systems, we built out the um the vaccine, the COVID vaccine system, and that got us in Wales to at one point having the best uptake of the vaccine across the world. We we were really were at the forefront of that, and you just thought, right, okay. And I'm not saying it that sounds, you know, just describing, oh, isn't that great? We did that. It's not about kind of having a clap for that, and it was really, really, really tricky to get there, and there was a lot of work. But those are the things where you you know you're making a direct impact on people's lives and whether you know we were going to find a way out of this because clearly vaccine was the way through this, wasn't it, for all of us?

Sam: 34:21

I mean, what was great was just seeing how fast the system could move and the bureaucracy seemed to evaporate and everything happened that needed to happen. But I wouldn't say it feels like that's necessarily stuck as a way of as a way of working.

Helen: 34:36

No, I I think it definitely hasn't. Yeah.

Sam: 34:38

Do you have ideas why why we've slightly reverted back to older ways of working?

Helen: 34:44

We saw the change, didn't we? Because we had to. I mean, the burning platform was there and the choice was taken out of the equation, and we had to get on with what the priority, which was how do we um look after people, ensure that we can treat people and and ensure that we can kind of stop the virus from spreading any further. So we knew what it was we needed to do, and then we did have you know due diligence and assurance processes in place. But yeah, you're right, we stripped out a lot of the bureaucracy and we stopped doing a lot of stuff. Well, we also now are more aware of the wider harms that that result in us focusing just on that. So I think the the challenge with the snapping back to the way that we've always done things is that there's choice again, isn't there? I guess. And that that sounds like I think choice is a bad thing. That's not what I mean by this, but actually we've got a huge amount of priorities, a huge amount of you know, the the health service is huge, isn't it? It's not one organization or one entity, it's a highly complex kind of conglomeration of thousands of organizations and entities. So getting everyone to align behind, you know, the priorities as we see them, and then really focusing in on actually achieving those is quite a tricky thing to do. And people are doing their best with what they see as the things that they need to be focused on and the priorities as they see them. I think the challenge for us as leaders is to see how we can take some of that shared ownership, shared kind of sense of purpose into making some of the difficult decisions about how we move forward together, you know, in in the future. And that's what I'm trying to do with some of the future work that we're doing.

Sam: 36:34

And I guess it comes back to that that you know, change is hard. Change is always hard.

Helen: 36:40

Yeah. It is, especially when there's, you know, it's a highly complex system. There's no linear processes in health, and it's very few linear processes in health. So, how you support people through change, through through the fear factor of that, and we probably don't pay enough attention to that in the health service. For every pound we're spending on um on digital, we should be spending equally on what that's going to take in terms of embedding that service change, isn't it? You know, and supporting people to think differently about how that service should be designed, but that's not kind of where we've been, is it? So that there's some work that we're doing in the organisation. So we're going through quite a big change in the organisation at the moment, and we are, you know, introducing a new operating model that is a product-oriented, that has user-centered design, service design right at its heart. And I think for me that that that amplifies the user and the patient voice in this so that we can actually do the things that they're asking us to do rather than doing the things we think they need us to be doing.

Sam: 37:52

So you've been building digital health and care Wales from scratch, and you must have learnt a lot through that process. I wondered what it's taught you about teams and leadership.

Helen: 38:04

Yeah, so it probably wasn't from scratch. The statutory organization was from scratch, but we were an arm's length organisation hosted by one of the other organizations in Wales. But we weren't, we didn't have any of the statutory governance, we didn't have a board in place, we didn't have all of the it we weren't as visible to the system from where we sat. I feel really lucky, I feel really privileged actually to have had the opportunity to to be involved and lead the setup and establishment of an organization of this nature and to actually be able to build it from uh what's the culture, what's the values that we want in the organization, to be able to choose my own team. Not many chief execs get that opportunity, and I will I would genuinely had that to put in a whole exec team to really set out what the structures are. So, how do we organise ourselves to be the most successful, to do what we need to do? Because we've got quite a big mission here. So that's been I really enjoyed it to be honest, Sam. I really enjoyed it and I sought it as a privilege.

Sam: 39:05

And how do you go about finding those great people and what matters in that recruitment process?

Helen: 39:11

Yeah, so I I cast my neck quite wide, to be honest, and we did compete the jobs openly right across the UK. I had some support, I had some good support to do that, but also I was building a team. So I wasn't just going for individuals who were really high performing, which indeed they were, and I did recruit people who were at the top of their game, but this was about building a team as well, and we're quite an interesting collection as a team, but it was absolutely about building the team. I'll just share. I worked in an organization at the assistant director level where the exec team weren't necessarily a team and they didn't appear to operate as a cohesive team. Luckily, at that level I was at, we actually did have some good relationships and we were able to move things forward. But that was quite an uncomfortable place to be. And it came from the top, didn't it? And I was quite clear to my team and to the wider organisation that we are a team. And whilst my team have their own portfolios, their own areas of responsibility, ultimately we're all corporate directors and we've got a corporate sense of mission. So yeah, that was something that we've I've tried to instill from the beginning. And it's you work hard at it though, don't you? Then so you can't, so it's a constant. You've got to work at those relationships. You've got to work at that sense of team. You've got to take time out to get to know each other, to actually peel back the layers to use a term you've used earlier, so that we are actually open with each other and we do show our vulnerabilities, we understand what makes us tick and what matters to us. So yeah, you've got to work hard at it. But I it really has been one of the best things. It's been a privilege to be able to do it.

Sam: 40:55

What does that look like from a kind of a weekly and a monthly cadence? How often do you come together? How do you collaborate with the other leaders?

Helen: 41:02

So me and my team come together weekly in person because we still we have hybrid working in the organization. So yeah, we come together every week. We also clearly we got the monthly cadence of all of our kind of management processes and our governance processes in the organization. On a quarterly basis, we come together as a wider senior leadership team. Um, and that we've got that coming up this month. And actually, I did a call this morning with our wider senior leadership just to give a happy new year. Welcome back to let's hit 2026 run in this uh, you know, this this is what we got, you know, ahead of us, and this is you know some of the um some of the support, some of the things that we need just to just to be in touch with people, really. But yeah, so you know, we have exec team away days and there are directorate away days. We um we uh and as part of that you have some social time together as well, don't you? I think that's equally important. I'm quite a competitive person as well, although less so as I got older I like to think, but not when we're playing darts in Flight Club, apparently, with my team.

Sam: 42:08

We've done Flight Club. I've discovered how bad at darts I am.

Helen: 42:12

Oh, yeah, no, it's good fun. Good fun.

Sam: 42:19

So part of your role is looking ahead and thinking about a sustainable health system and thinking about what that might look like and where does digital fit into that care model? One of the things you've talked about is there needs to be a care model strategy, not necessarily a digital strategy. Can you explain a bit more about what you mean by that?

Helen: 42:38

Yeah, and it's uh again a live conversation in in Wales at the moment. So what we want to understand is what does the service model look like for the future? And have we have we imagined that through the lens of digital and data? So rather than, which is the more traditional approach, that we think about how we want to, you know, deliver services, and then we think, all right, okay, also now we're gonna need some data and some digital that actually enables that model, actually to take a step back and think about the opportunities now and include the digital professionals in that conversation with clinical service leaders, with operational leaders and managers, with users, with our, you know, with our with the people across the NHS, so that we can start to think about different ways of delivering that. So for me, I think we'll have been successful in transforming the health service through digital, but we're not talking about digital transformation, that we're talking about transformation that, you know, and I do wonder, Sam, whether in any other industry we would be that would be a question. Because actually, when you look at other industries, their strategies start with data. They start with actually, how are we going to understand more about our service? How are we gonna, you know, harness the opportunity that we've got in in the data that we have? And I think that whilst the health services, you know, were quite data-rich, we are still in some areas information poor. And I think that's got to change, and we've got to change the dial on that. So and actually that's the conversation is at the more senior levels now in Wales. We're having those conversations and that support and that belief is there with senior leaders. I still think, though, there's a way to go in how we do that effectively and what that looks like in terms of the join app. We're going at that. That is, we're doing some work to develop the digital blueprint for the NHS in Wales. And that is kind of talking to uh our colleagues right across Wales to understand how they see services being delivered into the future, how we see prevention and patient activation, if you like, you know, patient empowerment actually really starting to turn the curve on kind of the chronic condition agenda. So, so that is quite an energizing conversation at the moment. And we're doing that in tandem with what does that look like in terms of a clinical services strategy for Wales? So quite exciting, actually, that it feels like that we're having the right conversations in the right way. And I'm always glass half full, so yeah, that feels like an opportunity.

Sam: 45:24

So zooming right out and going, well, you know, if we were to design this from scratch, how would we do it? Yeah. And that doesn't happen often, does it? That's a that's a major thing to do.

Helen: 45:32

Well, and it and it's quite uh, and whether we'll get there, you know, but with that, that's the approach that we're trying to take. But um, and it is a challenge, isn't it? Because as we touched on, it's such a highly complex environment and it's really challenging at the moment when you think of the pressure that's on on health and care services and on people. I'm talking about pressure on the service, the service is the people, isn't that? And you know, so trying to think of how you can design it in a different way when you're under so much pressure to deliver and you've got these long waiting times and patients who are at their most vulnerable points often. So it's it is quite a balance to strike you, because there's we've got to fix and improve things in the here and now. But actually, if we only focus on that, we're gonna we're not gonna sustain away, we're not gonna improve or we're not gonna transform. So we've got to be looking to the to the medium to longer term as well, in terms of what that looks like.

Sam: 46:32

And it changes so fast. Just last week, OpenAI launched Chat GPT Health and other AI tools. I think Claude has announced today that they're moving into the health version of Claude. What do what do you think that means for organizations like Digital Health and Care Wales? Where where do you see the opportunity?

Helen: 46:48

Well, I think the first thing is that really people are already kind of go into AI AI, aren't they, to get their health and uh health and care advice. I mean, I don't know about you, but I've done it myself to get kind of uh, you know, uh that that AI or Chat GPT or any other large language model to give us some of that kind of insight and support. But I think that what we've got to do is is work with the population, would set out where some of the um the pitfalls are in this and make sure that we've got the the frameworks in place and that that it's clear or we're communicating well, I suppose, some of the some of the drawbacks in a complete blanket trust in what's generated through these models because they can get it wrong. So we need to, I think, have the frameworks in place, but translate them into kind of you know everyday language that kind of sets out where some of the the issues will be in some of this. But there's a huge opportunity, I think. So what it's gonna do is democratize the health service, isn't it? You know, and in if if we're looking at AI for the professionals, actually, there's quite a lot that we can do to really harness the power of Gen AI in, you know, administrative business tasks so that we can strip back again back to the prudent healthcare, only do what only you can do. How do we make things more efficient and streamline and opportunities in in ambient voice technology that's going to really support, you would hope, our clinical colleagues to spend more of their time with the patient rather than spending more of their time writing up what happened with the patient. But I think there's a fundamental rule in all of this, which is it will be human-led. So the sign-off is the human in that space. So so I think that there's, yeah, there's a real opportunity in it, but we do need to ensure that we've got the safeguards in place and that people are educated, I guess, to understand some of the limitations or the risks involved.

Sam: 48:51

So a typical um business process, you'd gather some evidence, write a business case for a change and make the change. AI and all the changes that are happening with AI are happening so fast that by the time you've done a few months on writing a business case and gathering the evidence, actually the technology has changed. But I was having this conversation earlier with a colleague, and it feels like almost our whole processes are being upended by what's what's going on. And I don't think anyone's got the answers yet.

Helen: 49:16

No, we definitely don't have the answers to some of that. It kind of harks back to the COVID kind of scenario, didn't it? Because the one minute you thought, right, yeah, that's what we've got to do because of that, and then the things changed, didn't they? And you had to respond in a different way. We are not going to be able to predict the future and how fast these things will change. From where I sit in the system and what we need to do as digital and data professionals and the technologists, you know, amongst us, we need to ensure that the digital foundations and the technology foundations actually can adapt and that we can embrace the opportunities when they come. So for me, that is about ensuring that we've got a data-driven architecture for the NHS in Wales. So it's built on standards, on the common standards and you know, international and national standards where they exist, so that the data can be can be used and we can adapt to the really good use of those data that we get, you know, as that develops. So that's that's got to be the key here.

Sam: 50:18

With all the pressure on the system, what are you genuinely optimistic about for the future?

Helen: 50:24

I I think the application of technology that can that can empower both the professional and the patient, I just think that's the game changer here. I'm really optimistic for that. I think that there are tremendous opportunities in our ability to do things differently and not just about simple things like being able to book, you know, an appointment at your GP practice. This is about actually having an informed kind of way of moving forward with your life, your health and care journey, and making different choices where you would want to make those choices. So, and actually taking the pressure off where we can, uh, our frontline staff to be able to have more time to care. And I I genuinely feel that if we do this right and we design this in a way that is flexible and adaptable, that is data-driven, then we will be able to deliver that for for the staff, the NHS and for patients.

Sam: 51:22

What qualities or mindsets do you think we need more of to make this change happen?

Helen: 51:28

We need courage, I think. We need resilience. It's probably one of the the characteristics that's spoken about most in health service leadership at the moment. And we need to be curious. So I think that that's about you know having the being bold and moving these things forward. Uh and we're gonna have to all of us be really curious because there's one thing for sure that the constant cycle of change is that's where we are, isn't it? And things that, you know, we're gonna get hit by more and more of that. And our old ways of responding to that are just not gonna work. So I think that being adaptable as well. And I think there was a phrase that's been coined that you know, to be comfortable with the uncomfortable is absolutely a necessity for senior leadership and how you support those changes on the ground. So we've all got to be comfortable with the uncomfortable moving forward.

Sam: 52:22

To close, Helen, I'd like to ask you to think back. And so after after 36 years in the health service, is there something you know about leadership or life that took you longer to learn than you expected?

Helen: 52:36

I guess to realize that you are enough and that you can actually invest in yourself because compassionate leadership starts with you. You can't be compassionate with others if you're not being compassionate to yourself. So invest in yourself, be courageous and curious. That was really you you've got to be in order to do these jobs. Back yourself and be true to your values. The values piece for me is always, you know, where it centers me, it's where I come back to that fairness, kindness, and compassion. And and actually, I realized that fairly kind of later on that my authenticity and being me is my superpower. It wasn't some, you know, then that vulnerability that comes with some of that. Embrace it. I'm a you know a woman of a certain age, and that's who I am, and you know, I'm not gonna change now. So yeah, yeah. Be authentic, be you. You are enough.

Sam: 53:30

What a fantastic quote to end on. Thank you, Helen. It's been a it's been a pleasure talking to you today.

Helen: 53:36

Oh, thank you, Sam. I've really enjoyed it.