Why Tech Makes Care More Human: Sir David Sloman’s Lessons from the NHS

Phil Sobol: 

Welcome to the Cerecore Podcast where we focus on the intersection of healthcare and IT, from practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities. Today we are honored and to welcome Sir David Sloman to the Cerecore podcast. Sir David has devoted over 40 years to the UK's national Health Service serving in senior leadership roles at the hospital, regional, and national levels. Most recently, he was chief operating officer for NHS England and previously led as NHS London regional director. His career includes more than a decade as CEO of Royal Free London NHS Foundation Trust among other hospital and primary care leadership posts. He has guided the NHS through transformative change, including navigating successive waves of the COVID-19 pandemic, and has been recognized with a knighthood for his services to the NHS in 2017. Today, he continues to influence healthcare globally as a senior advisor to companies such as Siemens and Jacobs, and as a visiting lecturer at University College London and Imperial College London. Sir David, welcome to the podcast. 

Sir  David Sloman: 

Yes sir, Philip, it's great to be here. Thank you so much for inviting me, and I look forward to chatting. I look forward to talking. 

Phil Sobol: 

Yes, indeed. Now this is going to be a special one just given your breadth of knowledge, not only in the UK but also around the globe, so very interested to get into that a little bit here. 

Sir  David Sloman: 

Sure, that'll be fun. 

Phil Sobol: 

Excellent. Well, for our listeners, David, who might not be familiar with their background, could you share just a little bit about your journey in healthcare and maybe some of the roles that you have held with the NHS and internationally, and really what drew you to healthcare in the first place? 

Sir  David Sloman: 

Sure, sure, I'm very happy to share, and what I'll try to do is not repeat the very kind and generous introduction you gave me, which is greatly appreciated. But where you're right, in September 2023, I retired after 40 years worth of service in the NHS. So, I joined in September '23 and left 40 years later in September. And I'm sure there are people who were listening to this who weren't even born when I joined the NHS. It's that long a shift that I did, and I loved it. I enjoyed every second of it and I was incredibly proud of contributing. And so others can judge whether or not that contribution hit the [inaudible 00:02:52], but nobody can say I didn't turn up and work [inaudible 00:02:55]. As you said, my last job with the NHS, I was the chief operating officer of the NHS for England, overseeing the performance of about 165 hospitals and mental health trusts, about 39,500 family physicians, GPs as we call them, with shared corporate responsibility for a budget of about 175 billion pounds, covering around 56 million lives. 

So, it was a substantive job, and that was after I did the London job for a number of years, which was a similar role covering about 10 million lives within a 20 billion pound budget. And as you said, before that I was the chief executive of the Royal London NHS Foundation Trust we called it, which is a big large teaching hospital in the North of London where we were part of University College of London Academic Health Science Centre. So, it was a big London complex teaching hospital. And while we were there, we were accredited actually as a global digital exemplar by the NHS. We built what was and is the most digitally enabled hospital in the NHS, which was a fantastic experience. We're all privileged to have had that opportunity. And we started, we were early on starting to experiment with how we put AI to work in the NHS. It was taking the early steps. 

Since then, in the last couple of years I've developed a bit of a portfolio career. I'm on the board for AXA for the UK and Ireland, which is a major insurance business. I'm the vice-chairman of Spire Healthcare, which is the second-biggest provider of private healthcare in the UK. And I do some global work, as you say, with Boston Consulting Group as the senior advisors and others, and I am a senior advisor on the IHI. So it's been fantastic. It's really interesting. And, coming back to your question, why have I enjoyed it so much and what's brought me to it? I think there are two things, actually. One is the thing about healthcare is it really matters. It really does matter. And the second thing about it, it is just incredibly complex and I think what curious people enjoy are really complex things that really matter, and that's constantly motivated me throughout those, well, more than 40 years because I'm still going. 

Phil Sobol: 

Yes, you are. 

Sir  David Sloman: 

And I'm not going to stop for a while. 

Phil Sobol: 

You're not slowing down either. 

Sir  David Sloman: 

No. That's going to be my story today, and I've never lost my passion for that actually. It really matters. It's really complex. And so it's exhilarating, it makes you curious, and it makes every day, it makes you want to try and improve things just a little bit and move things on just a little bit further. 

Phil Sobol: 

Oh, that's absolutely brilliant. I appreciate you sharing that, and it always fascinates me to hear the stories of how folks got into healthcare in the first place and then what kept them there in [inaudible 00:05:54]. Just those two components there are brilliant and I think that's certainly very, very well stated. And you talked a little bit about just that expansive experience, not only from a UK standpoint, but also internationally. And so maybe tying into some of that experience, healthcare is facing a myriad of challenges today and perhaps, regardless of geography, what do you see are some of those common challenges regardless of what company you happen to be working in? 

Sir  David Sloman: 

I think you're absolutely spot on, Philip, actually. Wherever I go, wherever I work, whoever I talk to, broadly speaking, there are six global challenges which everybody is grappling with to a greater or a lesser extent. The first one is about the rise in demand, increased demand for healthcare services, and that's just a consequence of two things. It's firstly increased life expectancy. We're living longer, certainly in the UK between 1961 and 2021, life expectancy in the UK increased from 70.9 to 80.7 years, and that's a phenomenal achievement when you see. Now I always use 1961 as a benchmark year, Philip, because that's the year I was born. It all started there. 

Phil Sobol: 

We all have to have that anchor benchmark, don't we? 

Sir  David Sloman: 

We do, we do. And the second thing, of course that is compounded by the increase in morbidity associated with lifestyle. Obesity is the obvious one to point to. And you put those two things together, and globally that is really increasing the demand on health services. The second thing alongside that is of course the relentless march of technology, new drugs, new medicines, new therapeutics coming out of the pipeline, which means there's a third global challenge which is patient and public expectation. They all want all of those new medicines, all as those new therapeutics, and they want them right here, right now. So it's patient and public expectation, and there's another element to that actually, which is about the retail offer. 

So I think people want them right here right now on my terms and I don't want to have to fit in at the convenience of the clinic or the hospital schedule. I want it all about me, actually. And if you compare the way healthcare has responded to that change in customer or consumer expectation compared to banking, we're behind. We're just behind. We're behind in that space. So the next challenge is of course the global workforce shortage. I think the World Healthcare Organization around the world has suggested they're going to be short of about 10 million healthcare professionals by 2030 which, for me, that will be the biggest internal disruptor. I think we have a model of care which is predicated on a workforce supply chain that actually isn't there. So, its just [inaudible 00:08:56]. 

The fifth one, and again this is again genuinely global, is post-COVID recovery. Health services have been slow to get back to levels of productivity that people were performing at pre-COVID. Certainly in the UK there's a real productivity challenge with doctors, nurses seeing about something like 20% fewer patients than they were pre-COVID. 

Phil Sobol: 

Wow. 

Sir  David Sloman: 

Yeah, and it's 21% in Finland, 16% in Canada. This is not, again, just a UK issue. There's the whole post-COVID. And final thing, if you put all of those things together, is how does a nation afford a healthcare service for its citizens? Now, to a greater or lesser extent, everybody is grappling with those six challenges and, as far as I can see, nobody is cracked it. We're all trying to learn and find our way through, but those are the big global challenges. 

Phil Sobol: 

Yeah. No, I think you're spot on there, and it is interesting. Having looked across, and you've been a part of a number of these, I'm interested to get your take on the why around the slowness of the recovery post-COVID from a volume standpoint? 

Sir  David Sloman: 

Yes, it's a good question. So I don't think anybody knows the answer to that question actually, but the one thing I would say is the delivery of healthcare services often does rely on discretionary efforts and people going over. So, they'll go over and beyond because, by and large, the people that join the healthcare industry are compassionate, caring people who want to do the best for their patient and they will slip another one on the list and they'll go a little bit further and go a little bit more. But I think societally people have taken a big step back after COVID and those issues about the work-life balance have come more to the fore. And the other thing is, if you look at occupational absence from work for mental health reasons, it has seen a material increase post-COVID around the world. 

So, I don't think it's just about health. Certainly, if you look, some of the work I do with some of the companies in the city, they're struggling to get people back into the office. They've got to come back there too. So is this all part of the same thing, Phillip? My instinct tells me probably. There's a different world order, I think. 

Phil Sobol: 

You can draw a logical conclusion and correlation there for sure. And, certainly, that's one of the things that I think I always think about in the context of the health system there in the UK is very different than the healthcare system here in the US. However, there's some similarities- 

Sir  David Sloman: 

There are. There are. 

Phil Sobol: 

... in those challenges and, again, getting folks back in the workforce and what is that not only in the workforce but also just in the office and then having that human interaction on a day-in and day-out basis, and what has that meant to mental health? And I think it's one of those things that time will tell. 

Sir  David Sloman: 

I think that's right. We don't know, do we? We don't know yet. 

Phil Sobol: 

No, we don't, but we're seeing hints in the market, right? And we're seeing hints with just where those charges are coming from, where people are presenting, and it is a challenge, and we are in a new era. 

Sir  David Sloman: 

We are. 

Phil Sobol: 

And I'm not sure we've got an answer yet for it. 

Sir  David Sloman: 

Well, some people would argue that we're actually in year six of the global pandemic and this is what the sixth year looks like. 

Phil Sobol: 

Yes. Well, then it's an interesting time to say the least, right? 

Sir  David Sloman: 

Yeah, it is indeed. It is indeed. It is indeed. 

Phil Sobol: 

So, we've got the challenges. Maybe we pivot a little bit and talk about perhaps some of the innovations. You talked a little bit about tech and that and the adoptions or innovations, maybe even strategies, or so. That the systems they're using, regardless of UK, US, or elsewhere, that are driving improvements, that are driving efficiencies. 

Sir  David Sloman: 

Yeah, that's a great segue in. So, in the UK, and I'll just use the UK and I'll lift it up, there's a very, very senior experienced and I think internationally well-regarded surgeon, politician, leader, Lord Ara Darzi. He writes reports about the NHS and what he thinks that we need to do to address these issues. And he talks about the three shifts, and those three shifts are the shifts from sickness to prevention, from hospital to community, and the comprehensive shift from analog to digital. So, those are the shifts. Now, I could be cynical, Phillip, but I could say that when I was training 40 years ago, the shifts we needed to make were from sickness to prevention, from hospital to community. 

Phil Sobol: 

Yes. 

Sir  David Sloman: 

But my big argument would be those days we didn't have the data, the data mining skills, and the digital channel shift opportunities, and also the drugs and therapeutics to enable those things to happen. And so, as an eternal optimist, I think this might be the time to make those big shifts. Now again, although I'm talking about Lord Darzi and the Darzi report, again, these are really generalizable. All healthcare systems are looking at how do you shift from sickness to prevention? 

Phil Sobol: 

Absolutely. 

Sir  David Sloman: 

How do we give people more agency? How do we encourage people to make greater use of looking after their own health? There are things that we're all doing already. The story on that is six years ago not everybody knew how to stick something up their nose and waddle it around and put it on a piece of plastic and tell if they had an infectious disease or not, and that now everybody knows how to do it, globally. We know how to do stuff at home that we didn't do before. So there's some quite breakthrough moments there, actually. I think we underestimate that, actually. The behaviors we learned in COVID are behaviors which we now have become accustomed to about home diagnostic, home testing, shifts to care at home. 

So, on the prevention stuff, I don't know about you, but every day I'm looking at my watch, looking at how many steps I've taken. I'm looking more at my own health. I'm now used to curating my own data on my app, on my phone. So all this from, and I think we now, I led the COVID vaccination program for London, and London is a population of 10 million people. It's twice the size of Norway is how I always describe it. So, it's kind of a nation-state. It's got a very, very complex population. It's about 42% are from black and minority ethnic backgrounds. It's 5% younger than the rest of the UK, and it churns. It doesn't move. It's like servicing jelly is how I always describe it. 

Phil Sobol: 

That's a great analogy. 

Sir  David Sloman: 

But this time around we had the data and the data mining skills to know how to really target those interventions to communities that we got to that we never got before. The other thing I learned, Phillip, actually is the importance of faith leadership in getting into some of these communities. So I think we've got some medicines and we've got some data mining techniques and we've got some popular... This is population health management, isn't it, is what I'm actually talking about to really get into that. And of course we've got just as big an opportunity in the secondary prevention space, arguably a greater opportunity than in the primary prevention space, to really stop disease progression and not just prevent disease upstream. 

The second thing is the shift from hospital to community. I struggled for years of my career to see, could we get people having their outpatient appointment done virtually rather than tracking into the hospital? And suddenly, within three weeks we were there. 

Phil Sobol: 

Poof. That's right. 

Sir  David Sloman: 

Poof, as you say. And also, in the NHS we opened I think just over 12,500 virtual care beds where people were cared for in their homes using remote monitoring technology, basically some very cheap white, disposable white goods sent to people's homes. They're tracking their stuff on their phone. They're much happier. There are fewer complications. And, as you and I both know, Philip, if a person is admitted to hospital, particularly someone who's older, it is often the gateways to long-term institutional care at great societal cost. So the societal benefits of these models, and as I say this stuff is there, it wasn't there before. And so I think there are... And, again, globally, people are really looking at what this... 

And of course I don't suppose we should end this conversation without using the word or the letters AI should we? I suppose we have to [inaudible 00:18:32]. And I think there will also be some efficiency stuff in there, won't there, about back office processes. I think the ambient voice technology stuff really does look like it could make the clinician's ability to perform at the optimum of their potential, the top of the grade we say over here, there's bound to be stuff in there. So I think, as you can see, I'm an eternal optimist. 

Phil Sobol: 

You are. 

Sir  David Sloman: 

So this is a really great moment to embrace this stuff. 

Phil Sobol: 

I absolutely love it, and it's been fun to watch the journey of transformation over there in the UK, compare it against the US, and see how different models work based on a number of factors. Certainly reimbursement, how healthcare is paid for is a huge driver in some of the delta and some of the changes in that. And then also you mentioned the use of AI and ambient and all of those sorts of things. Bottom line is everyone here from a US perspective looked at ambient and said, "This is great, the doctors can see more patients and therefore we're going to have more throughput and all that, and so we're going to implement ambient. Great." 

Well, that's not what happened, right? The output was such that, hey, there was a couple of things. One, you got to have more face time and interaction with the patients, which was a more personal thought process going on there. Secondarily, the notes were a lot more thorough. The documentation was a lot more thorough, which led to things not getting overlooked or missed after the fact. And then third, and this is interesting, was every single physician talks about cognitive load, and they all said this reduced the cognitive load that we carry on a day-in and day-out basis. And so the adoption has been tremendous in the States. The outcomes, very different than what was predicted, but no less beneficial. And I think that's the fun part about what's occurring with us right now from a healthcare standpoint with technology is that we are seeing those benefits. They might not be the ones that we thought we were going to see, but benefits nonetheless. 

Sir  David Sloman: 

Absolutely. I'm old enough to remember when we started implementing computers. So we have to go back to the days when computers were going to replace jobs, there will be no jobs left, it's all going to be computers. Actually, my suspicion it's exactly as you described, it won't play through in the way that we think. 

Phil Sobol: 

Of course, of course. But, again, the leaders of the health systems have to be flexible, right- 

Sir  David Sloman: 

Absolutely, yeah. 

Phil Sobol: 

... as we move forward. So I know we've talked a lot about what's going on, some of the things that are transforming from a healthcare perspective. Let's talk just a little bit about leadership. And you've made mentioned earlier of the fact that there's been some churn, certainly a lot of folks leaving the workforce that have been in and around for a period of time, but leadership, as we all know, it drives the culture, it drives that workforce. Maybe talk a little bit about some of the shifts that you're seeing in regard to that in the NHS and elsewhere and some of your thoughts or your thoughts? 

Sir  David Sloman: 

What I would say, there were some things which I think remained constant. So I think the leadership challenge in healthcare is always about three things, actually. It's about remaining relentlessly patient-focused. And I would change that sentence now as we move into population health stuff to remain relentlessly patient and citizen-focused, and probably citizen and patient-focused in that order is probably the way I would potentially [inaudible 00:22:56]. 

Phil Sobol: 

Sure. 

Sir  David Sloman: 

We'll still have to look after individual patients, but thinking about cohorts of populations and populations of patients I think will become more important, actually. The second thing, and you'll be shocked and surprised to hear me say this given what I've been saying so far, the next thing is you need to be eternally optimistic. So, as a leader, you absolutely need to be optimistic and paint the picture of those uplands because what we do is hard. Health is hard, actually. And, as leaders, we have a responsibility to give that optimism, to paint that future that we will be leading people towards. So I think optimism is really important and that hasn't changed. And the third thing is about making decisions and doing difficult things. And you've got to call it, sometimes. You've got to call it. If you're the boss, your job is to call it. 

Phil Sobol: 

That's right. 

Sir  David Sloman: 

And actually it's kind of easier not to, but you got to do it. If you're really going to make the progress, you've absolutely got to do it. So I think those are things that I'm confident are remaining constant. But the other bit I think more about now is the importance of humility, I think realizing as a leader actually that we haven't got all the answers, that we need to listen. And I think there's two sorts of listening. There's listening because you're waiting for somebody else to stop talking so you can start talking, and then there's actually listening. 

Phil Sobol: 

Yes. 

Sir  David Sloman: 

When you're actually trying to listen to what... So I call that leading with humility, but the other side to that coin again for me is the importance of conviction. You should demonstrate humility and conviction. And when you've listened, when you've thought, when you've brought those views to the table, you then do need to call it, make the decision, and lead with conviction. But I think the days of the heroic leadership, I think we've moved through and I welcome it. I welcome that more inclusive, more democratic approach, but you still need at the end to make the call and lead with conviction. 

Phil Sobol: 

Indeed, indeed, because otherwise you're stuck. 

Sir  David Sloman: 

Yeah, that's right. 

Phil Sobol: 

Analysis paralysis, which is never a good place for anyone. 

Sir  David Sloman: 

Yeah, and the other thing I think is when you make that decision, [inaudible 00:25:39] and you do something, it goes a bit wrong, you put it right, and then you do the next thing because the only thing you know is it'll go a little bit. I implemented an EPR, actually a big electronic patient record system in the hospital, it would be one of the last things I did actually. It was the second time I've done it, and I was at my board and the board meeting said, "Right, David, you've asked for this. Can you guarantee me that nothing will go wrong?" And I said, "The only I can guarantee is I'll make a totally different set of mistakes to the ones that I made last time around." 

Phil Sobol: 

Brilliant. 

Sir  David Sloman: 

Well, that's the truth, isn't it? 

Phil Sobol: 

Indeed, indeed. I think that's great. Yeah, so you brought up EPR and I know certainly the NHS has been undertaking a significant digital transformation, putting a lot of effort into that over recent years. And so perhaps enlighten our audience from your seat, from your perspective, what are you seeing as some of the key takeaways of that journey for the UK? 

Sir  David Sloman: 

Right. I think in terms of what I've learned, if you like, what I've learned about implementing EPR is, firstly, do not under-invest upfront. And of course, at the end of the day, it's a load of software and hardware. That's not going to drive the improvement. It's going to be the people and the processes and the changes in the way that you do things, and then it is about how you codify that into your workflows to make the delivery of care effortless for the clinicians and the patients. And I think the way I've seen it go wrong is when they haven't involved the clinicians upfront from the get-go, you need the clinicians at that table. Clinical leadership is key to this, that you understand, that you think it through. So really putting the investments upfront, if you don't invest properly upfront, you will repent that later. It's worth putting it upfront. 

The second thing I've learned is, if you're really unlucky in your career, you have to do this once. So, get some help from people who've done it before. There are organizations, there are people who can help you, seen there, been there, seen it, done it. They know, they can hold your hand when it goes a little bit wrong, and it will go a little bit wrong, by the way, is- 

Phil Sobol: 

Always. 

Sir  David Sloman: 

... what I'd say there. And what I said to my team when we were implementing that EPR, I said, "I will judge you all on one thing, which is how we behave when it all goes wrong," because that is actually when the rubber hits the road. How do you behave- 

Phil Sobol: 

That's right. 

Sir  David Sloman: 

... when it all goes wrong? The other thing I've learned and is when I first implemented an EPR, I thought go live was the cup final, that was Super Bowl Sunday. And once we've got that done, yes, it's all over. That's the beginning. That is the beginning. That means you're out the qualifiers, you're out the qualifiers and the real work starts then, so really driving at that return on investment. Of course have a party when you go live because it is a big moment. There's a lot of work there. 

Phil Sobol: 

Of course, I agree. 

Sir  David Sloman: 

Put up the bunting, but that is not the cup final. That's you getting out the qualifying rounds and the hard work starts there. So those are my big learnings, invest upfront, get some help from somebody who's done it before, and remember, go live, it's what I call it's the end of the beginning. 

Phil Sobol: 

Yes, that's right. 

Sir  David Sloman: 

Because then you start. As I say, it'll go a bit wrong, but the lesson I've learned in life, if it doesn't go a little bit wrong you weren't ambitious enough. No matter what you're doing, aim high. 

Phil Sobol: 

I love that. I love that. It's interesting because the software vendors, the pinnacle is go live, right? They'll say, "Oh, no, it's going to be great," this, that, and the next thing thing, because they want to get the sale, they want to get things moving. And there's something to be said for that, but I think you're spot on with putting in the work up front, especially when you're going to a fully integrated EPR off of, let's just say, another 30 systems or whatever that didn't necessarily talk. So all of a sudden decisions that used to be made in this silo can't be made that way. They have to made in connection with the entire workflow. And so putting that work up front makes all the difference in the world, saves a lot of rework on the back end, and certainly leveraging a group that has seen it before a time or two makes a big difference. 

Sir  David Sloman: 

Yeah, it's a huge difference. It's quite interesting, I had the great misfortune of one month ago today I stepped into a metal band that was loose on pavement and I lassoed myself and went down on my elbow and smashed my elbow into four pieces, four pieces. And so I ended up in the ER of a very good hospital in central London, and the nurse saw me and she was using EPR to look at the X-ray of my hand. And I said, I won't give the brand name, "How is this for you?" And she said, "Oh, it's been in two years now. When it came I hated it, but it's great. It's fantastic. It's changed my life." And this was an old stager. This was somebody- 

Phil Sobol: 

Oh, sure. 

Sir  David Sloman: 

... [inaudible 00:31:42] and the consultant was standing next to her smiling, actually. It was a great, great little story. But it brought it back home to me, the work starts then, that work on optimizing the investment, getting your return on investment, and it never stops actually. My general view is it's the journey, as they say, is never-ending. 

Phil Sobol: 

Well, let's talk about that never-ending journey, and I'll ask you to kind of put on your forward-thinking lenses. As you look towards the future from a healthcare standpoint, what are the trends? What technologies do you believe are going to have the greatest impact on health systems globally? 

Sir  David Sloman: 

I'll point to a few. However you want to address it, there's lots of different, people talk about this in different ways, but genomics and precision medicine is clearly going to be profound, as we start to get a better understanding of people's predisposition to disease, predisposition to illness, our ability to intervene right up front and, as I say, keep people well. Either prevent the disease from occurring or at minimum slow down disease progression, I think has got enormous potential. And our ability to curate data at meta population levels to do that is really, really exciting. 

Now the other side to that, Philip, is I think that's not going to come cheap for a while. One of the things we have to think through is how we don't perpetuate what are already quite profound inequalities in access to healthcare and life outcomes and longevity. We need to think through how we actually service. But I think that genomics, precision medicine is going to be big. The next thing is I do think globally there will be a much greater expectation on people taking more personal responsibility and having more personal agency for their health. And I do think more of this will be tech-related. I come back to we all had to test at home, didn't we? 

Phil Sobol: 

That's right. 

Sir  David Sloman: 

I, along a lot of people, now know how to take my blood pressure daily. And the great thing about that is I'm a great believer in the nudge stuff. I'm competing with myself day-in and day-out for those extra 200 and you realize that I'm a sucker for it. It's really interesting, the psychology of it all. So I think that an expectation that there is more agencies as both as a patient, as a citizen, but also probably as an employer. I think we will look at what is the role of the employer in supporting people to stay both mentally and physically healthy in the workplace I think is going to be another trend that we will certainly see more of. 

And then the final, I won't go onto what will be the relentless march of new medicines, new drugs, new therapy. If we look at what the obesity medicines are potentially, we don't really know what all that can do yet. I think there's more to come in that space. But then the other generic piece will be, I think, the digital channel shift. I think we will end up receiving more of a... Well, I think that will vary. I think by and large I always talk about polemic between people who place a premium on convenience and access and those who place a premium on continuity of their care. Now I'm on a few repeat medications. Frankly, I don't care who I see. I just want to order it on my app and if I want to order it at 6:00 in the morning or 11:00 at night, I don't need to see the same, I'm assuming somebody else is making sure that the medicines are regulated, but that's all being looked after. 

On the other hand, my mother had the good fortune, she made it till 96. She had a good innings, my mum. But at the end of course, for her continuity was more what mattered, seeing the same people. So if we can free up our clinical teams to offer continuity to the more complex multi-morbid people, while people down here are getting most of their stuff through the digital retail offer which they're used to in their other lives around shopping or banking or whatever it is, I think those trends, again globally, healthcare is heading that way. 

Phil Sobol: 

Yes. No, that's fascinating. And certainly the one constant is change. I think it's happening more now so than ever, and I look forward to it. So, you've talked, David, an awful lot about optimism, and so I always like to wrap these sessions with kind of a final call of wisdom, but perhaps we'll spin it a little bit and maybe just a final call for optimism in healthcare and in what we're doing? 

Sir  David Sloman: 

So there's a great line, I think, in the Bible. It's, "Without the vision, the people will perish," so I think really giving people a vision, a clear articulation of where we're going. And the second thing is it's always difficult. There's a very famous book by guy called Nick Simmons who wrote the story of the NHS, and he said, I think it's on a particular, something like, "The 5th of July 1946, the NHS was created, and on the 6th of July it fell into its first crisis." So I come back to what we do, it really matters, but it's really complex and nobody has got an answer. But I come back to, it matters, it's complex, we care about it. And so there is something about as leaders remaining relentlessly optimistic about this and making those difficult decisions along the way. 

And especially, I don't know if it's a metaphor that crosses the pond, but you don't make an omelet without breaking a few eggs is what I would say. But what you've got to keep an eye on is the eggs-to-omelet ratio. That's what I say. Keep an eye on the ratio [inaudible 00:38:44]. 

Phil Sobol: 

Fantastic, fantastic. I love it. I love it. David, thank you very much, first for your partnership over the past several years, but then also your time today and your insights. I've thoroughly enjoyed our conversation. 

Sir  David Sloman: 

Yeah, me too. It's been great to meet you. As I say, thanks for inviting me along. It's been fun. 

Phil Sobol: 

Excellent. Well, thank you. Thanks for listening to the Cerecore podcast. We hope you enjoyed this conversation. Follow us on your favorite podcast platform. For more episodes, connect with us on LinkedIn, visit our US website at ceracore.net. And for those abroad, visit ceracoreinternational.net, learn more about our services and find resources. At CereCore we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24/7. Let's help make IT better. Here's to the journey.