It’s been something of a meteoric rise for Caroline Lamb, with a rapid ascent mostly achieved during lockdown. While it’s remiss to say anyone’s having a good pandemic, for the new chief executive of the NHS in Scotland, her star has shone brightly during the Covid-19 crisis.
Formerly head of NHS Education for Scotland, Lamb was installed as director of digital reform and service engagement in the twin health and social care directorates at the Scottish Government in 2019. And as the coronavirus hit last year, she was redeployed to oversee the Test and Protect programme, and more recently the rollout of the vaccination programme, which is into its stride after a faltering start. With her latest appointment in January, she has landed the most high-profile public sector job in Scotland, one that is divided between the NHS, where she has an operational focus, and as director general of health and social care within government, where she advises ministers on policy and strategy. She must be a glutton for punishment, I quip, as we connect on a Teams chat. “Or was I just sitting in the wrong place?,” she says. “Maybe it was, ‘Oh, we need someone to do this, I know, Caroline can do it!’”
She adds: “But I’m really excited about it. People have said to me, ‘Gosh this must be the worst time ever to come into this job’. Well, no it’s not actually. Yes, we are still managing a pandemic but I have been at the heart of that for 12 months, so it’s sort of like business as usual.”
It’s a very much sleeves rolled up, no nonsense, let’s get on with the job, kind of answer but before we talk about the kind of leadership she wants to bring to an organisation with a £15bn budget and 140,000 staff, she emphasises her gratitude for a worn-out workforce.
She says: “People are tired and we have a huge backlog of annual leave that hasn’t been taken because of their commitment to the service and I’m hugely grateful to all of them. But we need to give people time to decompress and recover because we can’t keep running as fast as we have been doing.”
In terms of her vision for the organisation, it’s little surprise that she seems to want to take things slowly. There will be a time for laying out grand plans but for now, she wants to set a course for getting through Covid.
“We are not out of that yet,” she stresses. “We are going to need to retain a very strong Test and Protect function, we need to continue with the vaccination programme, but also there’s the planning about probably having to get into delivering booster vaccinations once we get into the autumn. This is a vaccination programme that we expect to continue for some time, so we are going to have to maintain that whole response to the pandemic.”
She adds: “At the same time we have to recognise the harm that is being done by the pandemic and that is to the people’s health and wellbeing, in terms of those people who are on waiting lists, and those people who haven’t presented because of their concerns going through the pandemic.
“So there’s a huge backlog there that we need to start to tackle. And at the same time I think we’ve got the opportunity to rethink how we build back our health and care services; for me some of those principles at the centre of that is about involving people in how we design and re-design the services that they receive.”
Lamb welcomes the recently published Feeley Report into adult social care, in terms of what needs improving – and how – in often forgotten parts of the system. It has been well received in government, and its focus on delivering person-centred care sits well with her enthusiasm for digital technology, which has brought substantial benefits to many during lockdown.
“I am passionate about what digital can bring to improve health and care services, enabling people to get more access and make choices about how they use services,” she says. “Essentially I’d like for people to be able to interact with health and care services in the same way as they do in any other aspect of their lives. But I would caveat that with digital exclusion and the need to make sure there are alternative ways for people who don’t want to engage digitally.”
She adds: “There is always a huge place for face-to-face services. One of the things we are all suffering from over the last year is that restriction of contact with people, which is so important.”
Lamb led NHS Education for Scotland through a successful digital transformation programme, and although she was redeployed from her role in digital reform for health and care, she wants to bring that technology experience to bear.
There is currently a debate about how much actual digital transformation has taken place in healthcare services during the pandemic; some argue Covid-19 sparked a profound acceleration in the digitisation of services that has revolutionised treatments. Others point to projects that have stalled, or been cancelled entirely, owing to the pandemic.
There are undoubtedly standout successes. NHS Near Me – a video consulting platform developed by Australian company Attend Anywhere – has seen weekly usage rise from 300 to 22,000 consultations at the height of lockdown.
Lamb says: “I am really proud of everything that colleagues have done to deliver digital infrastructure over the last 10 to 12 months, and we can really build on that. It does provide us with a strong legacy and foundation.”
One of those building blocks is data, which she believes is key to joining services up. The national clinical data store, developed by the NHS’s National Digital Service (NDS), is at the heart of the Covid vaccination programme, providing vital linkage between GP IT systems and the NHS. Although you might expect GP surgeries and NHS to work on connected systems, the reality, for historic reasons, is that they don’t. NDS has therefore been working in the background to provide what Lamb describes as “coherence and connectivity” between the two realms.
“One of the things that we have been able to do is to develop a national clinical data store, which is being used as a single repository for all vaccination data in the Covid programme,” she says.
“If your vaccination is recorded on GP IT systems we’re able to pull that data out of GP IT systems into the national clinical data store. We had a gap because there wasn’t any other way of collecting data about vaccinations other than on bits of paper, which is not ideal frankly, so we built the vaccine management tool which is tablet and cloud-based and is in use in all our other vaccination centres other than in GP surgeries.”
She added: “The advantage of that is that it’s instantaneous feeding its data into the national clinical data store all the time, it means we can join that up with GP IT systems and link it to testing data which enables us to then start producing the analysis that we’ve seen in the press.”
It’s difficult to have a conversation about digital and data without talking about the model upon which services are built. Health and social care integration, though mandated by law, has been “patchy” according to Lamb. She believes the key to success is not dry legislation, nor the overhaul of organisational structures, but rather the need to get “leadership, relationships, and cultures right” and to seize on the “unity of purpose” brought about by Covid. But she does concede that there has in the past been an “implementation gap” when it comes to translating government strategy into effective delivery on the ground.
She is about to consider the government’s response to phase two of the primary care inquiry at the Scottish Parliament, which pulled no punches when it said: “The health service must now embrace new technology, stop talking about what they are going to do and start delivering a 21st century system to patients.” In the report, MSPs called for appropriate levels of funding for technology, and also for an update on progress on the 2018 national Digital Health & Care Strategy, for which there should be clear delivery timescales attached.
Lamb said: “We’ve got some excellent legislation in Scotland, but sometimes our gap is actually how we go around about making that real and that it’s a genuinely lived experience of people.”
She added: “And that’s not to be overly critical because achieving transformational change in many of these areas is immensely complex given the landscapes, just to take digital. In which we start with a whole host of different systems operating across health boards, across primary care, across local authorities and social care systems. And the absolute requirement that they all need to be maintained and kept running at the same time as we start trying to make some incremental changes that will start to pull those together.”
In reference to the strategy, she does believe progress has been made in joining up different systems and making data more easily accessible, which in turn supports the adoption of cloud-based services, but she says there is a need to strike a balance between maintaining legacy systems and developing new ones, and the resource and cost implications of doing so.
I ask, then, whether the recommendation to invest a much higher rate of turnover into IT spend in health and care, will be followed. In the report MSPs highlight that a, “lack of strategic investment in IT appears to be one of the factors behind the lag in modernising IT infrastructure, with only 1 to 3 per cent of the health budget being allocated for IT. As a comparator, countries such as Estonia and Finland are spending between 5 to 7 per cent of health budgets on IT.”
Lamb doesn’t commit to a figure but says: “I think that investment in digital is really important as is being clear about the value that you expect to get and the benefits that you are going to get out of digital. So, it’s not just investing in digital for the sake of it and it has to be very much about how you support patient pathways using digital technology and we’re probably facing quite tough times financially ahead of us.
“But I do believe that digital is one of the areas where we have got the opportunity to use it to create more sustainable health and care services going forward. We need to invest, but we need to invest in a way that will help us to have more sustainable services in the longer term.”