Maverick: Why top-class pilots matter in the NHS

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Itzik Levy

Itzik Levy is the CEO of Ummanu, a digital health company empowering telehealth using intelligent automation to improve system productivity in delivering remote consultations, at scale. Before joining Ummanu, Itzik co-founded a digital health venture which developed a SaaS platform to manage and monitor post-acute care plans in a shared digital space for the patient, doctor and caregivers. Prior to that Itzik was head of the National Digital Projects Sector at the Israeli Ministry of Health and led the globally acclaimed digital transformation of Israel’s healthcare system.

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Dr Fay Wilson, MBChB, FRCGP

Fay trained in Birmingham and has practiced there as a GP there since 1985. Her extensive national and local portfolio includes: NHS HA Non Exec, GMC fitness to practise chair, and associate postgraduate dean at Health Education West Midlands. She has served on the council of the BMA and other bodies. Fay brings people together to develop new models of care, a notable success being the Birmingham Multifund co-operative, a pioneering nurse-led walk-in centre and a prototype GP provider-at-scale ahead of its time in the mid-1990s. Dr Wilson is medical director and co-founder of Badger, a GP social enterprise since 1996 providing out of hours and urgent primary care. Covid-19 introduced her to systems engineering, new people and new ways of thinking. Her ambition for the last decade has been to slow down.

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Prof Terry Young, BSc, PhD, FBCS

After 16½ years as a research Engineer, Divisional Manager and Business Development Director, Terry became a professor at Brunel University London for 17 years.

He has a BSc in Electronic Engineering and Physics, a PhD in laser spectroscopy both from the University of Birmingham, UK. His research has been in health technology, health services, and information systems. He has taught information system management, project management and e-Business. His awards include the Operational Research Society’s Griffiths Medal, 2021, for analysing the return simulation methods offer when used to improve healthcare services. Prof Young set up Datchet Consulting in 2018 to support innovation on the borders of academia, health and industry, of which the project reported here is an excellent example.

Early on August 4, 2022, a cyber-attack on Advanced took out systems nationally, including Adastra, which provides staff working in emergency care settings access to GP records and interoperability for a GP collaborative, Badger (Birmingham and District GP Emergency Room). However, instead of a disaster for this out of hours provider, its partnership with Ummanu – a healthcare technology company driving efficiencies in delivering telehealth at scale, – saved the day by turning a pilot into a sustainable innovation.

It’s a highly unusual achievement, so what was so special about Badger, Ummanu and the way they worked together?

Badger had been innovating with patient pathways under lockdown: the references at the end tell the story, explaining the track record and how it was achieved. By February 2022, Badger and Ummanu were running a pilot in parallel with Badger’s mainstream care delivery of out of hours and urgent care to trial Ummanu’s virtual waiting room concept powered by intelligent process automation. This meant that when the main system went down the entire patient cohort – in real time – could be switched through the virtual waiting room.

The missing piece in many health information management stories is how to relate knowledge and process management on the one hand, to the delivery of better outcomes, on the other. This has been a long-standing challenge for the NHS (see article by Avison & Young below), most notably with the National Programme for IT in the early noughties, which was eventually abandoned (although it delivered some lasting legacies, especially in management of radiological images).  The NHS is picking up the problem once more with the advent of Integrated Care Systems.

Unusually for an NHS pilot, in this case the pilot was located alongside ongoing care provided by a team used to harnessing advanced information systems and turning them into better and more timely care. When disaster struck, it posed questions that the pilot could answer with measurable results: could pooling all the patients into a virtual waiting room deliver care as good or better than was being delivered before the outage? Would it increase system productivity and improve patient experience? The answer to both was a resounding Yes! Would it take a long time? No! Could staff make the transition smoothly? Yes! Was the end solution better than the original? In many ways, Yes!

Pressing on, what else can we learn about pilots from this example?  Both Everett Rogers’ Diffusion of Innovations theory and Clayton Christensen’s The Innovator’s Dilemma suggest reasons why good pilots are unlikely to spring up in mainstream environments.  There is an element of the maverick to a good pilot (not too much because it has to demonstrate mainstream performance) and disruptions – to appeal to Christensen’s language – tend to come from the edges rather than the centre of the system.

As a social enterprise (delivering NHS care but managing its own staff and finances) and by being a small part of the health system, Badger was at least a step away from mainstream delivery and represented the sort of ecosystem of independent thinkers and effective delivery that might spawn innovation. This was, therefore, a particularly promising partnership and pilot.

The unexpected bonus in this case is that by using the virtual waiting room as a sort of lifeboat, it was possible to trial the next level of innovation (by necessity rather than choice), when disaster struck.  It was also possible, in the throes of a crisis, to monitor the safety and effectiveness of the solution. In this case, safety was assured throughout, while clinical staff were shielded from the worst of the disruption and were able to respond to a steady patient flow and carry out remote consultations efficiently.

So then, the right pilots, with the right partners, can prove out strategies that improve system productivity and swallow up patient backlogs – particularly important right now – if you set them up right!

Notes and references:

Background to the Badger story:

●        Rapid access care: how to make your call centres really work (NHE, July 2022)

●        Driving innovation: a case study using a simple evaluation tool (ICJ, June 2022)

●        Getting to zero: why it can’t work (ICJ, May 2022)

●        The flywheel: Silicon valley, Nightingale Hospitals and the health data system of the future (Chamber UK, April 2022)

●        Agile care in a time of lockdown (Health Estate Journal, April 2022)

Other references:


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