Suhail: [00:00:00] Coming up in this episode, I speak with Dr. Ian Gargan, CEO at PHIN, a private healthcare information network, about the role of the independent sector, the critical importance of data for patients and the workforce challenges it faces.

Ian: [00:00:13] If you provide competition in the marketplace and also if you measure all of them and utilise the data to drive better outcomes for patients, then effectively you will have a paradigm shift and an improvement in patient care over the long term. It’s important that healthcare is a nice place to work, it’s a good place to work. It’s friendly, it’s embracing, it’s educational. So those clever people are encouraged to continue their professional personal development and get retained within the NHS and the private sector. I really encourage the population to change their perception about what is public and private care. Don’t think of it as a two-tier system or one is better and one is different. Think of it as a twin track system that runs in parallel and that one can learn from the other.

Suhail: [00:01:05] Hello, I’m Suhail Mirza and welcome to this episode in series two of our Voices of Care podcast. And I’m joined today by Dr. Ian Gargan, the CEO of PHIN, the Private Healthcare Information Network and Voices of Care. We try to get to the heart of the issues facing the health and social care sector and how we can enable the healthcare workforce of the future. In this episode, we’re talking about the role of the independent sector, the importance of transparency and data and its own workforce challenges. And who better than entrepreneur, a doctor and a psychologist? Ian, it’s great to have you here.

Ian: [00:01:35] It’s lovely to be here. Thanks.

Suhail: [00:01:37] It’s a pleasure. Before we get into the detail in terms of the substantive issues, can we step back a bit and look at the work of PHIN and what it does? It’s been around now for nearly ten years, and perhaps you can give us that broader picture because it’s a vital role, particularly to drive patient outcomes.

Ian: [00:01:53] Correct. So PHIN was established, Private Health Information Network. PHIN.org.UK is a mandate established ten almost 11, 12 years ago and then mandated nearly ten years ago by the Competition and Markets Authority, which was the Office for Fair Trading to effectively quality, assure and inform patient choice in the independent sector. So if you’re a patient going to use a private hospital, a surgeon or a doctor working in the private network, then PHIN creates and gathers data and has the architecture to gather that data from over 650 sites around Great Britain and Northern Ireland to be able to give information and transparency so that the patient can make an informed choice about who is the best doctor to choose and where is the best place to go to get their treatment.

Suhail: [00:02:39] And it can be quite a tricky pathway if you’ve never done that before. And I think your website is designed to help people even if they’re first time into the sector.

Ian: [00:02:48] Absolutely. So we have an animated series. We have a lot of information on data sheets about like how what you can expect when you go to a private hospital, what you can expect when you go to a hospital. We work closely with the NHS. So what you should expect from care as a doctor, I’ve always thought of patients, not just as people who are desperately need care and are sick and want intervention, but as customers who should be afforded the absolute highest quality of product. And PHIN is the gold standard and benchmark to be able to provide that information so that the customer, i.e. the patient, can make an informed choice about the product and also understand and be educated about what their journey is going to be like. It’s very difficult for a patient. It’s very stressful when you’re sick. So we want we want to make it as easy as possible on that journey so that they not only get the best care, but also that they feel very relaxed when they’re choosing that care.

Suhail: [00:03:39] And there’s an element of dynamism within the mission as well, because it’s not just about obviously patient choice, but also driving and contributing to clinical improvements is a number of partners that you work with, from regulators to the NHS, as you mentioned.

Ian: [00:03:52] Yeah. So in in our business, the mantra is serve the patient, support the stakeholder and deliver the order, the serving the patient is clear , our stakeholders are the doctors, the hospitals, all the private hospitals and the NHS in some part, and then delivering the order. So the order is the competition and market authority. CMA’s order has to be delivered by June 26th. So we’re there to carry out that mandate. But effectively in if you if you provide competition in the marketplace and also if you measure all of the and utilise the data to drive better outcomes for patients, then effectively you will have a paradigm shift and an improvement in patient care over the long term. And that’s probably my driver as a doctor, while being the CEO and leader of a great team as a doctor ultimately, and our whole team, we want to make patients better.

Suhail: [00:04:47] Absolutely. Now it’s I think it’s a year or so since your announcement. It’s been an extraordinary period of time for you. Just want to look back at the strategy a little bit, because obviously you said PHIN has been around a decade plus. You did pause. You stepped back as an organization in 2022 and delivered a delivery plan for the next four years. Can you expand a little bit on the philosophy behind that and what you learned as an organization? Yeah.

Ian: [00:05:14] So the order was released in 2014 and it while it’s legislation and there it actually underpins what we do but it’s very complicated what we do. I think PHIN did an awful lot of amazing work for eight, nine years, far before I ever joined. But they realised how complex this was and how they’re in quite a unique position as an organisation. It’s not been done in the NHS before. It’s not been done in the private sector before. This is a unique product, as it were, that we’re driving and we realise how complicated it was. So we almost did an awful lot of heavy lifting, but then there was a reset and the reset then allowed us the time to publish the, I suppose the path to delivery by 2026, which will start stage one delivery by October 2024. And we’re very aggressive in terms of what we want to do in terms of delivery in 24, 25 and 26. But also we then published the evidence based assessment, which was underpinned by work done by University of Oxford and the London School of Economics. And it was our reset to kind of have the whole industry and sector, the doctors, the hospitals, everyone agree this is what good quality looks like and this is what the delivery will be by 2026.

Suhail: [00:06:28] Great. Well, that’s leadership. You’ve put your name against the dates. We’ll have a look at that. Taking a broader picture of the independent sector, LangBuisson, who provide a penetrative analysis of it, shows that pre-pandemic levels, the independent sector is 7 billion people, in turnover £7 billion it’s facing here in 2023, the opportunity of historically high levels of demand. So there’s great opportunity. We’ve certainly seen the commentary of a bounce back for the independent sector and new entrants. What’s your perspective? I mean, PHIN has got a unique perspective with its data in terms of activity you’re seeing, is it right across the board self-pay private medical insured day admissions? There seems to be quite a buoyancy in the sector at the moment.

Ian: [00:07:10] Yeah, so self-pay was definitely up. Sale After the pandemic, it increased about 134% in some parts of the country, but more generally by 33% over the whole country. Now it’s beginning to level off back to pre-pandemic levels, but subscription to private medical insurance is going up. So over half a million increase in subscribers this year in 2023 and heading north continue to head that way. We see employers increasingly buying subscriptions of private medical insurance as an incentive to retain their staff, which is amazing. And we’re seeing private medical insurers become more innovative in their product creation so that more people are getting it. So I see with the current challenges in the NHS, the wait lists, the difficulty with the workforce, but also the capacity and capability that we in the private sector have to be able to help our colleagues in the NHS. I can only see it going one way, so the demand will only increase and I’ve seen it in other countries. So it’s inevitable it’s going to happen in Great Britain, Northern Ireland, that private medical and the independent sector will only grow and become far more contemporaneous and more relevant.

Suhail: [00:08:22] That’s a buoyant picture indeed. I wonder, you talked about the workforce and some of the challenges there. I wonder if we can just tarry there for a moment. It’s topic number one, I think, for politicians, we have a very tight labour market. We’ve seen a slew of reports coming out. The General Medical Council in the UK highlighting the wellness and burnout challenges for doctors, The of course the NHS long term workforce plan looking to double the number of training places for clinicians, 300,000 new clinicians over the next 15 years. The Lambertson Report Healthcare Market Review earlier this year still highlights the fact that, like everyone else, the independent sector is in a war for talent. There is a shortage of clinicians. What are you seeing in terms of the independent sector’s drive to innovate, to bring people in and compete with the NHS etc?

Ian: [00:09:14] So I can see in the private sector, first of all, when I was training to be a psychologist first and a doctor second in the private sector, they never had apprenticeships or they never had training for student doctors and a training programme that’s happening now. So that’s completely changed in the last 20 years. So I’m seeing people in the private sector trying to encourage young people to come into the workforce to become healthcare assistants, nurses and doctors. And you know, you’ve got to remember over a quarter of a million nurses in the country, you know, 50,000 doctors. This is a massive part of the population and absolutely important for our I suppose, for the whole community. So it’s very important to plan it in 15 years and 15 years have be gone like that. So, by the way, that’s nothing. You know that. And I know that as older people now at this point, not you and me. So and 20 years goes in a flash, it’s important that healthcare is a nice place to work. It’s a good place to work. It’s friendly, it’s embracing, it’s educational. So those clever people are encouraged to continue their professional and personal development and get retained within the NHS and the private sector. So I’m seeing now that there is that innovation and I’m in a great position, very privileged as a CEO of PHIN to go and visit these amazing hospitals. And I see how the private hospitals are embracing youth and talent and developing that.

Suhail: [00:10:39] And I think on a picture around I know this is an important topic with slightly tangential, but in order to grow the workforce, I think these innovation pathways are important and we’ll come back to that. Again, we have to retain the workforce that we’ve already got and I think a golden thread, if I can call it that, running through all these reports is the exhaustion from the pandemic, the ongoing mental health challenges. I know that’s a personal and professional priority for you. Any observations in terms of what you’re seeing on the ground in the independent sector and more broadly? It’s an absolute imperative, isn’t it?

Ian: [00:11:13] Mental health is so important. The smartest people in the world are the people who optimise their mental health and I believe mental health should be taught from an early age and how to best and optimse your mental health. You know, thinking about thinking is a smart thing to do. I think you’ve got to remember people in medicine, they really don’t go into it for the money. They go into it because they want to help people. They love helping patients and they love taking care of the sick. So I think the best thing you can do to retain your staff is make the working conditions better. So, you know, not as many massive hours. You know, when I was training as a junior doctor, I was on 1 in 4, 1 in 4 weekends. I’d go into hospital on a Friday and I’d come home on a Monday night. Right. And I wouldn’t sleep for the weekend. You just can’t do that. It’s not sustainable to continue that forever. So better working conditions and value your staff, give them some little benefits, make sure they’re fed on the wards. You know, simple stuff. You know, these individuals want to be there and they really want to help people. So why not laud that and make their workplace a little more comfortable and a little more organised? So they also feel empowered. One thing that I see from the data is the constant pressure. People feel that they’re not getting on top of their patient lists. So if you’re just able to get on top of them and feel like you are achieving like getting to the bottom of your list or getting, you know, able to utilise the full capacity of the hospital, getting everyone to theatre, you know, and, and treating and feeling like you’ve done it a good week’s work, then you’ll be able to retain your staff a lot better than you are now.

Suhail: [00:12:51] And in terms of your own background as a psychologist, of course, the array of mental health interventions and opportunity has never been more in demand, and I think that will be a vital element as we look forward, I mean, forever, but certainly for the next couple of years.

Ian: [00:13:03] Yeah. Mental health and taking care of people’s mental health and them having a place where they can go to help understand how they eat, how they exercise, how they sleep. Mental health isn’t always about like a mental health problem, as you well know. So it’s more about how you optimise how you are as a person. So and the fundamentals of mental health are those things I’ve just mentioned also socialisation and talking to people and, and having that resource within the private sector is a given that’s happening because they have there’s a little more finance there and they can do it. The NHS is struggling. There’s actually a big mandate. I was a chair of the Professional Practice board for years and the British Psychological Society and I’m still very mindful of what the BPS are doing and the NHS are going to potentially relinquish all of the mental health supports for their staff because they can’t afford it. And I think that’s I think that’s a mistake really. And but also I think that we can be a bit clever. You don’t necessarily have to have a resource. You can just have a mental health first aiders. You can have people around you who have been trained to be able to be a support and mental health and just to be able to give you direction on how you can get better sleep and how you can be a bit more mindful was very, very important to maintain that freshness and energy in life.

Suhail: [00:14:13] No, absolutely. And talking of growing numbers, we discussed again, as a medic, the NHS workforce plan is envisioning or re-imagination of training and education, shorter degrees, potentially apprenticeship pathways, associate roles. How are you seeing that? How important will that revolution be in terms of the way we train clinicians in order to meet this demand? We’re seeing quite a lot of innovation within the private sector in terms of use of apprenticeships.

Ian: [00:14:39] Yeah, I think that’s really clever and I think there’s a danger when you’ve trained to be a psychologist and a doctor, you got to remember to be a doctor takes you a long time, right? So five years in uni, five years of membership and exams, five years of further training. And then you then you start again as a junior consultant and then you work your way up. So I think anything that can make that a little more efficient and meaningful for individuals is clever. So I know I spent three years in college before I hit the wards in my fourth year and it was a six year degree. Now it’s a five year degree and we’re talking about a four year degree. I think that if you can do that and get the individuals on the wards quicker and have them properly supervised to a mandate, an education plan by the Royal Colleges, I think that would be very, I suppose, inspiring for people who want to go into medicine rather than have to spend so much time on the academic piece. But I think it’s important to understand the academic piece is really important. So you need to have both running in tandem. You know, it takes it’s a lot of knowledge and you’re always learning as a doctor and as a nurse, as any medical professional. And, you know, just to make sure that there’s no shortcuts. I think getting to the wards is clever and the apprenticeship is a clever thing. And I think the PM, I think that was a clever thing for him to potentially introduce. But also it’s important to also note it’s not a shortcut. It’s just that both just the demands would be more. Or even on the individual. They’ll have to be better on the wards, but also continue their academic learning is still important.

Suhail: [00:16:09] And one final element on this whole piece is the there is the allure and the promise of revolution using technology. AI etc. I mean, perhaps at the beginning of that, do you see that as a role that’s going to help clinicians over the longer term? I think shorter term, that’s slightly different.

Ian: [00:16:27] I think shorter term, some of the comments are trite. I don’t think it’s they’re particularly relevant. If you look at pilots, back in the day, their captain was the person who ran the show. And then as their pilots and the air industry travel industry developed, the captain wasn’t the person in charge of the plane anymore. It was the first officer. And the captain was the person who trained everyone. And she would sit back and look at the first officer and then look at the staff and know what to do. I think medicine will go the same way. I think senior doctors will be responsible for administering and training other staff to do various bits and pieces and then influence IT and technology to be able to do some of that work. So you’ll be able to use some of the clevers and the training that medics have to input into gamification, Metaverse. We’re already seeing robotics in surgery. Back in the day I was doing radical prostatectomies and urology. That’s all done by robots now and the outcomes are much better and you’re able to, you know, perform surgery in London on people in Africa because that’s how we’re able to distribute and our knowledge now through that technology. So it’s inevitable, but it just it’s going to take time. It requires a lot of clevers and I think it’s not necessarily AI, but I think I also think potentially in a thousand years, yeah, there will be a lot of robotics and a lot of technology that we do in the work that humans are doing right now. But you know, a lot of faith in human ability. So I kind of think humans will still be involved in some way.

Suhail: [00:17:59] Absolutely. Stepping now back to the raison d’etre of all healthcare. PHIN, which is the support of patient outcomes. I want to focus on data, and there’s been a revolution in data science. Can you elaborate a little bit more in what you’re doing? Because I understand you’re driving research, you work with the LSC, you’ve mentioned that, but there’s some interesting research looking at systems level use of data coming out of the University of Manchester, University of York that you’re involved in.

Ian: [00:18:25] Yeah. So PHIN create the architecture to deliver the order or deliver data about the performance of the private health sector. But that architecture is versatile and is used by the NHS as well. And we are working with the University of Manchester on a project that’s funded by the National Institute of Health Research and to look at the journey of the patient and how to make that journey better. By December, PHIN actually will publish a number of patient reported outcome measures (PROMs) and that’s like outcomes for patients who have had particular surgeries, the top ten surgeries at the moment, cataract surgery, inguinal hernias, knee replacements, hip replacements. And we look at what interventions cause, what outcomes for patients and how the patient has got their mobility back, quality of life, all that. So we’ve created all that tech and architecture to be able to provide that information to the public and to the government so we know what works, what intervention is the best intervention, and then we can. PHIN enables the drive to continue improving those outcomes and we’ve got massive buy in from the colleges and from, like you say, the epidemiology speaks for itself and it’s been validated by Oxford University saying that the data that we publish is really relevant and we have government listening and our colleagues in NHS also are producing equally important data. We’re working really closely together so that you know what was, for instance, very tangible example ten years ago, you needed your hip replacing, You were in hospital for five days. Now you can be in and out in a day and you’re back running a marathon three months. So, you know, that’s, it’s this kind of data that’s driving that change.

Suhail: [00:20:02] And just to mention in terms of the collaboration of data, the adapt programme might be worth us talking about that you’re working with NHS England to make sure that data is across the whole system.

Ian: [00:20:13] Yeah. So we collect data with the NHS. We both have a similar architecture that we’re putting together, so we’re not duplicating work, we’re actually being quite innovative. So it reflects whole practice. So an awful lot of doctors and nurses work both in the public and private sector. So our data reflects their practice in both sectors. So the Adapt program does that and we’re working very closely. It was NHS digital and then then became now it’s all NHS England and we’re working together to effectively harness that architecture so that we can collectively know what the outcomes are for patients if they’re in a public trust. But also then if they move from public to private trust or if they’re just getting private sector work. So yeah, just joined up thinking, really.

Suhail: [00:20:56] Absolutely. I want to finish off, if I may, to look at those labels, public and private. Traditionally, the NHS has sat. In its own silo in perception, independent sector has grown more significant. If you look at the level of NHS work that’s gone to the independent sector over the last decade, it’s been a dramatic increase. The Prime Minister set up the elective recovery taskforce at the end of 2022 to look at the role of the independent sector. Stepping back with all of your experience across health care and the work of PHIN and your access to the data, what is the role of the independent sector, in particular around collaboration around the NHS as we look forward? Because we are seeing patients looking at alternative routes and being provided patient choice. What’s your prognosis about how this will evolve?

Ian: [00:21:42] I really encourage the population to change their perception about what is public and private care. Don’t think of it as a two-tier system where one is better and one is different. Think of it as a twin track system that runs in parallel, and that one can learn from the other. The private sector has capacity, so it can help with waiting lists in the public sector. We are there to support our colleagues and to offer other innovation and new ideas. Like any private sector, good would be compared to a not for profit and PHIN is a not for profit. So like, you know, very experienced in that. But the importance of the NHS work cannot be undermined. Over a million people are employed by the NHS and they take care of amazing acute emergency medicine as well as cancer. And I think that those patients always need to be prioritised. The private sector has capacity to do some of what is, and my colleagues would not like me saying it’s the rudimentary surgery. It’s not rudimentary to do an inguinal hernia or a hip, but it is the simpler surgery relative to some of the emergency trauma work. And they have the. The private sector has the capacity and has the data and insight to know what is effective and how we can help and provide that intervention for cataracts, knee replacements, hip replacements, inguinal hernia, basic cardiology work. So I think we need to, as a population, think differently, be that the private sector is not the enemy or it’s not different. It’s just a hybrid or a different form of the same care. It’s just in a different place, but it’s equally good care and it’s there to support the NHS.

Suhail: [00:23:17] A model of conflict, but model of collaboration.

Ian: [00:23:19] 100%.

Suhail: [00:23:21] On that encouraging note. Dr. Ian Gargan, thank you very much for your time and for your refreshing candour. As always, it’s been a pleasure.

Ian: [00:23:28] Thank you, sir.

Suhail: [00:23:29] If you’ve enjoyed this episode of Voices of Care, please like follow and subscribe wherever you receive your podcasts. And if you want to know how we are truly enabling the health care workforce of the future, please visit newcross healthcare.com/voices of Care. In the meantime, I’m Suhail Mirza. Thank you and look forward to seeing you on the next episode.