Digital is about connecting information and people: right treatment, in the right place, at the right time

Darrien Bold, Head of Elective Care at NHS England and Digital Health Leadership Programme cohort 4 alumni talks about the alignment of his digital transformation journey and significant impact on stroke services across healthcare in England.

I have never considered myself a tech-person (I can just about work a Kindle). To me, “digital” is about connecting information and people.

Having fallen into digital health almost by accident after many years in operational management, I applied to join the Digital Health Leadership Programme to bolster my skills and knowhow. Having been accepted into Cohort 4, the course kicked off around the same time as I started a new role, as the national lead for the digital transformation of stroke care at NHS England.

A stroke is a serious life-threatening condition that happens when the blood supply to part of the brain is cut off. When someone has a stroke, it is estimated they may be losing around 2 million brain cells a minute - so urgent treatment is essential.

In recent years the NHS has made significant progress in implementing new technologies that can help to streamline and enhance care pathways and deliver faster diagnosis and treatment.

More recently, the introduction of artificial intelligence (AI) decision support software is a powerful example of how new technology is being deployed alongside clinical expertise to improve outcomes for patients.

The AI software significantly reduces the time it takes to process and interpret brain scans, supporting clinicians to make faster treatment decisions, which in turn enables patients to receive potentially lifesaving treatment earlier, improving their chances of a better outcome.

Just a handful of stroke units were using this technology when I started both the role, and Cohort 4. I was tasked with leading a rapid national rollout of AI, as part of a national optimal stroke imaging pathway, in stroke services across England.

Each part of the course neatly aligned with my work and proved invaluable in formulating a national strategy for rolling out AI, applying standards and frameworks, creating a community of practice to share learning, and evaluating success. From the get-go the course supported me in developing the mission statement, vision, core values and aspirations for such a significant national digital transformation programme.

I was particularly inspired by the modules on implementing strategy, leadership and transformational change. John Kotter and Etienne Wenger (no relation to Arsene, I checked) have no idea how influential they have been! The creation of a guiding coalition of clinical and management leads was a key step in gaining the momentum required to roll out AI software further and wider, allowing more patients to get the right treatment, in the right place, at the right time.

The first part of the course offered the opportunity to cultivate a process map, providing a fulcrum on which an array of regulatory, transformation and clinical expertise could be brought together to implement decision-support software effectively and rapidly.

Further modules provided the tools with which to convene the huge expertise and experience of key collaborators along the AI journey, increasing the delivery of best-practice care where rapid assessment and treatment are of the essence.

This enabled my team to engage with people who may not have been so close to the subject matter yet were considered fundamental to the pace and breadth of adoption required. Using the national community model, we could address key clinical and operational challenges at scale, improving early diagnosis rates and saving time.

I am delighted to state that as of late 2024, every stroke centre in England (107 sites in total) is now utilising the technology, meaning AI is already playing an important role in improving the care of around 80,000 people who have a stroke in England every year.

An early-stage analysis of this AI technology has shown it can reduce the time between someone presenting with a stroke and receiving treatment by more than 60 minutes, and is associated with a tripling in the number of stroke patients recovering with no or only slight disability - defined as achieving functional independence - from 16% to 48%.

Lord Darzi wrote in his recent report on the current state of the NHS that “there must be a major tilt to technology to unlock productivity.” In times of unprecedented pressure, the stroke community has transformed frontline care to improve both patient outcomes and efficiency.

Things are not going to get any easier. We must continue to use information and technology seamlessly, safely, and quickly. We must continue to be flexible and innovative, and to prioritise the quality and safety of care.