We interviewed Noel Gordon, Non-Executive Director of the NHS and Chair of Specialised Services Commissioning Committee, as part of our Leaders Series. After an early career focused on corporate restructuring, Noel was first exposed to social entrepreneurship at Ashoka, where he then became involved in consulting and mentoring a diverse range of social entrepreneurs.
We discussed the major transformations and innovations taking place in the NHS today, as well as how his past experiences in the private sector contributed to his work and insight in the social sector.
About Noel Gordon:
Noel Gordon was appointed as a Non-Executive Director of the NHS England in July 2014. He is also the Chair of the Specialised Services Commissioning Committee and a member of the Advisory Committee of the Accelerated Access Review. In his past Noel worked extensively in the banking and consulting industries. He held the position of managing director of the Banking Industry Practice at Accenture, before retiring in 2012. He has vast experiences with large scale transformation of industries, analytics, big data, and technological innovation. Noel also has a strong interest in social enterprises and is a member of the Ashoka Support Network where he coaches social enterprise leaders of Uservoice and MyBnk.
Educated at the University of Warwick, Noel holds a BA in Economics; as well as a MBA in Corporate Finance from Cranfield University.
Can you tell us about your past experiences in banking and consulting; which skills are most relevant to your ”second life” role as a non-executive director and coach to social entrepreneurs?
Noel Gordon: I started off in banking after graduating and spent most of my career transforming banks in different parts of the world. This led me to think about the role of the financial system in promoting the wider aims and goals of society; how the financial system helps with the evolution of the bottom of the pyramid, as well as the top of the pyramid. Over the course of an entire career focused on corporate restructuring, I became more interested in system change, and especially the role of social entrepreneurs in social change. It was quite an interesting period in my life, when I tried to address the paradox of a professional career by helping large corporations become more efficient, and at the same time, realizing that many of the solutions to social deprivation, financial exclusion, and system inertia lay not with governments and corporates, but with human beings and individuals – acting individually and collectively around a greater purpose.
Were there any personal experiences that brought you into the social enterprise and healthcare sectors?
Noel Gordon: My first exposure to social enterprise was through Ashoka, when I met the inspirational founder, Bill Drayton. He galvanised my thinking around market failure, system change, and actions I could personally take to become, what he called, a ‘change-maker’. I was then asked to mentor two Ashoka Fellows. One was dealing with the issues around the release of offenders (Uservoice) from prison, and the second (mybnk) was involved in financial education for young people who have much less knowledge about how to get the best out of the banking system. From there, I focused particularly on financial exclusion as a theme in Africa and South America, and started to understand the critical role of financial enablement in both changing society and changing economic structures. Without financial empowerment at the individual level, it’s very hard for people to rise up through the pyramid, and get the right sort of jobs, cash flow, and capital to start their own businesses. The experience of coaching Ashoka Fellows on their business plan and organizational structure had unexpected similarities to my old skills in corporate reinvention; I was surprised how relevant they were to much more atomic social enterprises. I think that was my second big insight in transitioning from the corporate world to what I would call my ‘second life’. It’s an extraordinary revelation to discover that many of the capabilities you use to solve problems in large organizations are eminently relevant to solving many of the scaling, funding, and sustainability challenges that you see in much smaller organizations.
The reason I was very interested in becoming a Board Member of the NHS had everything to do with searching for other social purposes which could benefit from these classical transformation skills. Firstly, the NHS is the largest transformation in Europe in either the public or private sector. Secondly, it has some very exciting technology-based initiatives; and thirdly, this is the decade in which medical technology is going to begin making a huge difference to treatment, prevention and care across our whole population. Overall, my second life really consists of three things: my executive directorships, coaching a diverse range of social entrepreneurs, and working with initiatives that drive an agenda in medical, educational and financial technology.
What differences do you see between transformation in the public sector and the private sector?
Noel Gordon: The two big differences between transformation in the public sector (NHS) and transformation in the private sector are two-fold. First, if you make a mistake in transformation of a private sector organization, nobody dies. If we make mistakes in transforming the health system, there is a risk. Second, in the private sector there is a very clear chain of command, from the chief executive through to all of the employees who work for a company. In a public sector organization, it’s much more of an ecosystem in which the organization is not entirely free to execute change unless it builds a huge groundswell of support and consent, not least amongst its public stakeholders. In order to shape a service that meets a hugely diverse range of needs, the public sector organization has to set its course more in consultation and collaboration with a whole range of partners who share the delivery of public sector change, such as taxpayers, patients, clinical practitioners, and the public.
Can you expand more on digital transformation and what it means for the healthcare system?
Noel Gordon: The NHS has a huge information and technology program which is at the core of the whole modernization plan known as the ‘5 Year Forward View’. Amongst the initiatives there are two that I find most intriguing. The first is our own Innovation Accelerator, which was open to applicants from all over the world, for which over 400 SMEs and Social Enterprises applied, and we eventually selected 17 in the first wave of innovators. They are generating some really interesting innovations across both medical technologies as well as care processes, treatments, and prevention.
The second initiative that I find interesting is the launch of our Test Beds. We launched a total of seven Test Beds in the first wave which are bringing together innovations from different sources. For example, two of those Test Beds are going to test the network of connections in ways which address diabetes prevention and treatment through a digital coach, and secondly through an integrated health management system which is primarily technology based. This is primarily targeted at elderly people with dementia. It helps people live in their homes longer using sensors, monitors, wearables, and other technological devices, which combine into a network of connections to help monitor their health at home. This initiative empowers people to take much more control over their health, as well as enabling their caregivers to gather more information about their condition and become more responsive.
What are the challenges and difficulties of implementing these innovative technologies?
Noel Gordon: We found enormous uptake of apps for health, so we know the public is ready. The public wants a lot more technology in both the diagnostic and delivery of health services. I don’t think there is any question that the appetite is there. However, I think we’ve probably got three challenges in meeting those expectations.
The first challenge is delivering solutions in an agile way which will allow us to test and adapt rapidly through successive rollouts. This approach to technological delivery is a relatively new phenomenon for the NHS.
As we build our open Application Programming Interface (API) platform, our second challenge will be to develop solutions which help us in implementing new models of care, known as the Vanguards. These new models rely a lot on people taking more responsibility for their own condition, and on technology-based delivery channels.
The third challenge is the classical challenge of diffusion and adoption; how we roll out and scale up good ideas. The NHS is probably the 3rd or 4th largest employer in the world, and it’s no surprise that adoption and diffusion are some of our biggest challenges in trying to get a uniform best practice across the whole of England. It takes time; a lot of people have to be brought into the process, and it has to become second nature
Who is being brought into this process; are there partnerships with the government, or the private sector?
Noel Gordon: We are looking inside and outside of the UK to try and find the best and most relevant technologies. For example, I led a delegation to Israel just before Christmas, where we met with about fifty Israeli SMEs in the medical technology sector, all of which had ideas that could be very interesting for the NHS to adopt. We are also looking at partnering with large technology services and pharmacological companies, which provide a whole range of drug solutions and delivery devices. We have to pay attention to our regulatory bodies as well, listening closely to the evidence as well as our clinical practitioners. Ultimately, however, we are patient-led, and that is always going to be our main consideration in deciding which technologies to adopt.
What are the big technologies that will help you transform health and medical technology?
Noel Gordon: There are four technologies that I think will help us transform health technology and medical technology. They are: big data; analytics and machine learning; digital distribution channels (particularly to help us with tele-medicine and tele-consultations); and perfecting services in the cloud.
A lot of the health and medical technology innovations that we see don’t just provide more technology, but they provide a technology enabled service. Take for example diagnostic imaging; it doesn’t make sense to store data intensive images in each location. It would make more sense get a very fast computing system provided from a central cloud based facility, which would allow every hospital, doctor, consultant, and nurse in the country to access a historical archive of the patient’s entire history of medical images through an iPad. That would make a massive difference to our ability to do diagnostics faster, do diagnostics better, and integrate some artificial intelligence into diagnosing conditions that a clinician might be seeing in this patient for the first time. Convergence around big data, analytics, digital distribution channels and the cloud are already producing a lot of new innovations and tele-consultations in remote parts of the country.
You are also a member of the Accelerated Access Review, a government advisory committee on innovative medicine. What is the government trying to achieve in the field of medical innovation drugs, devices and medical technology?
Noel Gordon: In essence, I would characterize the objectives of the accelerated access review in three dimensions. The first dimension is to help rebalance the economy from a historical focus on service industries. We need to build a much more powerful biological technology industry by making the UK a great place for innovators in biological technology and pharmacology to do business, to conduct research trials, and to launch new drugs and technologies
The second dimension is to modernise the way that the UK has traditionally evaluated new drugs and developments. Typically it can take around ten years to get a new drug to market. You have to conduct a series of evidence based trials, you have to build up your evidence over two to five years to prove whether a drug works and to understand if the drug has unattractive or unexpected side effects. So there are good reasons why it has historically taken so long, but we want to see whether we can find some fast tracks. The speed with which new drugs and drug delivery technologies are being developed is now much faster than it used to be, but the time it takes to get the drug to market hasn’t changed at all. We have been looking at the U.S system which allows drugs to collect evidence of their effectiveness as they are being used by patients. It’s known as commissioning through evaluation, and is a process that we have already begun to trial on a small scale.
The third dimension is to look at the implications of personalized medicine, and how we can use new technologies around genetic medicine to bring more customized treatments to individuals with rare diseases. First off the blocks are rare forms of cancer, where we are using a number of genome based technologies to quickly develop treatments targeting genes that are known to cause types of rare cancer. The Accelerated Access Review will inform our thinking about how to make personalized medicine happen faster in England, and also make personalized medicine more available.
Has personalised medicine been launched in other countries? Are you working with other countries?
Noel Gordon: Personalized medicine is a worldwide opportunity that has massive potential for helping cure intractable diseases both in children, adults, and elderly and frail parts of the society, so it’s worthwhile having a more coordinated, global research and development program around personalized medicine solutions, because so many people could benefit. We are collaborating with the U.S., China, and I think certain countries in the Middle East to achieve this.
However, personalized medicine relies on incentivizing drug companies to commit to investment in the R&D of drugs targeted at specific diseases. The population of sufferers of these diseases is, by definition, a very small market so we need to consider new pricing mechanisms, such as outcome based payments, to help us realize some of the opportunities that personalized medicine can offer.
What is the role of the Innovation Accelerator?
Noel Gordon: The Innovation Accelerator is really trying to accomplish three things. One is to help social entrepreneurs and SMEs plug and play with some very sophisticated organizations like the Academic Health Science Networks and Research Universities (AHSNs) so they get access to expertise, dedicated coaching, and get to know how the NHS works. Secondly, the entrepreneurs get a very senior coach to help them scale up and grow as professional leaders of their organization. The third thing we are trying to do differently is to look at combinatorial innovation; we encourage innovators to explore collaboration amongst themselves, to join up their innovations and to create something even more powerful. This is quite a different way of looking at innovation in large organizations. We have learned quite a lot from what has worked and what hasn’t worked in the private sector. We are adapting best practices in order to make innovation a much more natural act in the NHS than it has been, historically.