S6E3 - Driving Progress: Innovation and Adoption in Healthcare Technology

In this episode of AXREM Insights, CEO Sally Edgington and Future Leaders representative Paige Ward speak with Alan Davies, Executive Advisor to the Kent, Surrey and Sussex Health Innovation Network, about innovation and adoption in healthcare technology. Alan reflects on his extensive experience across health, IT, and AI, sharing how advances in diagnostic imaging—particularly the integration of biomarkers with AI—are transforming early cancer detection. He stresses that while automation in diagnostics offers efficiency and accuracy, maintaining clinician oversight and algorithm transparency is vital for safety and public confidence. The discussion also explores how community diagnostic centres, clearer regulatory frameworks, and better patient education can enhance early diagnosis and equity in access to care.

The conversation turns to the systemic challenges that hinder innovation adoption across the NHS, from complex procurement and fragmented processes to inconsistent regulatory understanding. Alan and Sally discuss how standardisation, collaboration, and value-based procurement could help align NHS and industry efforts for faster, safer technology rollout. They also explore the importance of “appropriate confidence” in AI—balancing trust in technology with human judgement—and how clinician and patient engagement underpin successful innovation. Alan closes with a thought-provoking idea: using autonomous vehicles to support the independence and wellbeing of older adults, demonstrating how technology can enhance quality of life as well as healthcare outcomes.

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Transcript

This Transcript is AI Generated there maybe spelling errors or words missed please use this as a guide to the episode not a complete or direct transcript.

Welcome to AXREM Insights, developing healthcare through medtech and innovation. Join Melanie Johnson and Sally Edgington as they talk with our industry leaders and experts. Hello and welcome to AXREM Insights, innovation and adoption podcast. I'm  Sally Edgington, CEO of AXREM and I'm here with Paige Ward, AXREM Future Leaders representative and global clinical product manager for radiology at Ag for Healthcare. Today we have the pleasure of speaking to Alan Davies, executive advisor to Kent, Surrey and Sussex Health Innovation Network. Welcome Alan and thank you for being on the show today. Let's start by handing over to you to tell us a bit more about yourself, what's your story and how did you end up here today? 

Thank you  Sally and great to see you Paige. Thank you everyone, it's a fantastic opportunity to be able to share a few thoughts over the next half hour, so I'll get into it. So who the heck is Alan Davies? Well, I'm very fortunate to have had a career in IT many years ago and then in management consultancy and then saw the light and got into health and care technology. I did some time as a strategies director at Tunstall, who would call themselves the leaders in telehealth, what I guess we would think of now social alarms and technology for the people in social care. And I was director of home healthcare at Phillips Healthcare in the past and that I guess sort of helped my industry credentials. Before joining the academic health science networks, which as  Sally's just said are now the health innovation networks, the part of the arms earth body that is charged by the NHS with trying to drive innovation and growth at a very local and regional level. I had the privilege of working in Health Education England in the centre before that was abolished in 2023 as director of innovations and partnerships. Part of that work was part of the Topol review, which critically looks at the introduction of digital technology and the needs of the workforce in preparation for that, which is a topic that's very close to my heart, something I still feel very passionate about and will I'm sure touch upon in some of the comments today. For my SINs, if you like, in the AHSNs, I was director of digital and AI. I was part of a movement or group that linked all Dean Health Science Networks in that area and as such, I got the privilege of working with NHS England, NHSX colleagues across a range of programmes from the NHS app through to local health and care record exemplars through to the global digital exemplars. Specifically, I guess on this call, I also worked, I was part of the early genesis of the AI lab that was created in the AI ward and I was part of the state of the nation 2018, a report for those who remember that. Ultimately, that led on to the 250 million fund that Boris Johnson and Matt Hancock put together to create the AI award, the AI lab process. I was an assessor for rounds one, two and three. A lot of my knowledge and thinking on diagnostic imagery and the usage of AI comes from that period of looking at the competitive applications and being able to be privileged to be part of the assessment panel to rate and review them. When I joined HEE, I was then able to join the AI lab board to sit on the other side and actually understand how we allocate the funding for some of those winning applications that have come through. So that's given me a bit of a hopefully useful insight into some of the latest technology, how it's applied and its applicability. Today, as well as being a part-time executive advisor to Health Innovation Network KSS, I'm also a market access consultant and I work with organizations trying to break into the UK market. So I really feel the pain of many ACTRA members trying to navigate the complexity and sadly, the almost chaos of the NHS at the moment given the amount of reform that's happening at so many different levels. So hopefully, I've got some interesting insights to share in a minute. Thanks, Ali. No problem. And Alan, you're definitely qualified for this podcast in order to have a good conversation and obviously, more recently, you've also been in a voluntary role helping AXREM in terms of chairing AI think tanks. So thank you for that. Innovation in healthcare doesn't happen in isolation. It's the result of shared ambition, ideas and practical action. Whether we're talking about faster diagnostics, more targeted treatment or reshaping entire pathways, transformation relies on both technological progress and human collaboration. In today's podcast, I want to explore how recent breakthroughs in imaging and radiotherapy are changing the game and what we've learned from the evolution of imaging networks. More importantly, we'll look at how industry and NHS partners can work together to overcome adoption barriers and how trust, communication and leadership within groups like AXREM can accelerate meaningful change. So I'm now going to hand over to Paige to ask the first question. Thanks, Sally.

 Alan, wow, it sounds like you've had a lot of exposure to new technologies, transformation and change throughout your career so far. What recent innovations in diagnostic imaging or radiotherapy do you think are truly transformative and why? 

Thanks, Paige. A great question. In my experience to date, probably the biggest one, the one that's most interesting and exciting is the linkage between the usage of biomarkers and imagery and particularly diagnostic imagery using AI. The capability to be able to, for example, in colorectal cancer care, so there's sort of diagnostic there of being able to anchor the imaging potential target of an early polyp or a tumor appearing with a really clear biomarker signal that shows that there is a presence of some kind of biological indicator around that really raises the confidence levels in being able to diagnose what's actually happening at early stage. And as all of us know, cancer is a horrible game of time. The later the stage we find things, the less the chances are of a positive outcome. So anything we can do to become more accurate earlier in the process has got to be a good thing. And that fascinating connection between the biochemistry that's going on, molecular biology that's going on and the imaging that we're able to do and the way that we're able to learn using our AI algorithms to see what's going on within that image plate, that does give us that higher level of confidence that we haven't had before in the past. I think there's a lot more work to go on in that area. There's a lot that we can do. But for my mind anyway, that's the most exciting innovation that I've seen in recent years. 

Thanks, Alan. That's a really interesting example and use case for AI and a recent innovation. If we think historically, I guess clinicians are usually the people to pull that data together, you know, the biomarkers and the imaging. Do you see much automation happening in this space or do you think that's something that's more emerging now and something that will be increasingly adopted in the future? That's a great question again, Paige. I do think there's going to be quite a lot of automation going on in it. But one of the interesting observations I had for my time as an assessor at the AI lab, very few of the applicants actually advocated transparency of algorithms and indeed put time aside or suggested emphasis on training radiologists to be able to, if you like, decrypt or understand the transparency of the way that the technology had come to its conclusion. So I'm going to answer your question in two ways. I do think that we've got the potential to automate. That means efficiency in terms of speed and critically given the scarcity of any radiologists around, you know, never mind excellent radiologists, although they are all very good. We have the capability to augment those individuals and therefore to improve our capability to deal with the demand that we face. But I think we need to be really, really careful and we can return to this at other points in the conversation to keep the human in the loop for multiple reasons. One, I don't believe that as a general public, we have the confidence yet to truly accept that the technology has made a selection process or come up with a diagnosis. I think we're still a little bit wary of that. But I also think from a clinician's point of view, and there's some very interesting issues around liability and who's responsible for making those decisions. We need to keep a level of transparency that allows our clinicians to be able to operate and understand why the technology is coming up with its recommendations and to be able, if necessary, to spot outliers if there are bias or there is some drift going on to say, hang on, I'm not comfortable with that. I need to dig down a little bit lower. Thanks, Alan. I guess you raise a good point. As we see more AI technologies adopted, you know, in every day in the clinical workflows, this is potentially going to make clinicians' lives more challenging because obviously each AI algorithm is going to generate different results. So to truly understand how an AI algorithm came to a certain conclusion and that level of transparency, that's something clinicians are going to have to understand for each AI algorithm. So it sounds like a great opportunity, but still some work to be done. It will improve that workflow, but let's be careful not to lose that transparency and that capability to just be sure that we understand why it's making the decisions and we're comfortable with that.

 So Alan, what do you think has been the biggest transformation and lessons learned in the imaging networks and diagnostics pathways? 

I think that's a great question as well, Sally. I think the creation of the community diagnostic hubs and our community diagnostic centers have been incredibly important and I think we're still on a journey in there. So there's something about bringing the equipment closer to the patient that's really important, but I would also advocate for patient activation and the ability to educate patients to have more of a say and more of an understanding of what that image is saying and what it means and how they can prepare to then work with the health service to do something about it. So I think if I were to summarize, increasing the clarity around the ask or need, I think has been really important. So that we've made big strides in trying to be clearer about pre-op processes to make people understand as they come in what's expected of them, what they need to do, et cetera, say, and dealing with people, diversity of culture and language as well nowadays, not just in English. We live in a diverse community in the UK, and we need to make sure that we deal with our whole population in that sense. I say preparation in terms of change readiness, building appropriate trust and education so that people come in, prepare to take images, be that, for example, breast cancer or prostrate or otherwise, and then do something about it. Transparency around regulations and standards. I think that's a huge issue for us going forwards. We're getting better, but we've got to get better still. It's very, very difficult for industry to build and to invest in technology if the goalposts are changing or, in fact, the goalposts are not clear at all in terms of what's required. There's an emphasis there on colleagues from NICE, MHRA and HRA to work together to continue to make sure that those regulations are clear. Simplify the procurement frameworks and processes. Sally, you and I have talked about this many times. I'm just catching up with some colleagues on the rule-based pathway. In fact, it's on Friday and the new innovator passport they're talking about. The question is always the same. Great to have these kite marks. Is it actually going to make a difference to what commissioners decide to do? If it isn't, how can we make sure that we help them and guide them to make the right decisions about technology that has been fully evidenced and is coming to you with a clear return on investment? There's work still ongoing on that, but we're working on that. Lastly, to bring the diagnostics closer to the people who need to be diagnosed through devolved access. That's the final point I'd probably make. The way that primary care works and the way that acute and community diagnostic hubs work. Again, the same story which we're trying to deal with through the federated data platform is how can we make sure that whole thing is transparent and there's connectivity between where the images are taken and ultimately the conversation between the, if it's a GP or an advanced practitioner, the conversation with the individual that says this is what it means and this is what you need to do about it. We've got some work to do in that area, but those are the biggest areas of transformation that I would recognise and pick up for the moment.

Alan, you have picked up on so many key points there. I mean, community diagnostic centres play so nicely into the 10-year plan hospital to home. I see that CDCs have an even bigger role to play and it doesn't need to just be imaging and testing. So much more could be done in a CDC. When I've been to attend one myself, they seem to have capacity to be able to deliver a whole lot more. So I hope that CDCs do become that kind of central piece from hospital to home. And it's kind of, when I look at CDCs, it kind of reminds me, we've done like a full circle. I remember community hospitals that are now, the estates have been sold off and most of them are apart and some things like that. But actually it makes so much more sense. And I think since COVID, obviously keeping people away from main hospitals, if we can, is only good for the patient, for the NHS and everything else. I think as well, you touched on another very key point here and one that we've spoken about before in some of our meetings and that's the regulatory piece. And I think that the uncertainty around regulation is causing industry a massive problem. I have had AI companies come and speak to me about joining AXREM where they've successfully deployed their AI algorithms in other countries. They then come and look at the UK and I'll speak to them a month later and they say, no, we're not coming. We just, it's too much of a minefield. So I know that earlier this year, the MHRA did publish what AI as a medical devices will look like. But I think that then we need to see, I suppose, more detail. And I think actually what I'm saying and what you're saying plays in very nicely to the next question. So what are the main hurdles to adopting innovation at scale in healthcare and how can industry collaborate to overcome them? And what role do you think AXREM plays in bridging the gap between industry innovation and NHS adoption? And that's three big questions all in one there, Alan. Yeah, no, very good questions as well. 

Thank you, Sally. Yeah, what are the main hurdles to adopting innovation at scale in healthcare? I think the one that we've just been talking about understanding the regulations and standards that are applicable is just huge. I mean, it's so difficult for organizations to be able to set up an evidence base to invest in doing real-world evaluation or trials, collect information if they don't have a common and clear understanding of the regulation standards that are applicable to that particular classification of technology. And also, it cuts both ways. It's not just industry, but it's also got to be, as I say, commissioners at all levels within the NHS and doctors and users at all levels in it. They've also got to understand the relevance of that and the difference. Again, just popping back to the rule-based pathway, and I did some work when I was at AGE on digital health therapeutics and a pathway for that. And we were trying to get a series of stage gates where technology had sufficient evidence that from a policy point of view, the centre would be happy to suggest that that was used at a local level where more evidence had been collected and there was more confidence around the economics of it where it was suggested by the centre policy-wise that it would be worth scaling it at regional level. And then ultimately where there was full confidence in the technology and indeed a preference for it to be rolled out at speed, because it clearly could have a big impact on population health or on other targets the NHS was aiming at to go national with it as well. And then on the other side, actually, we were also saying, and where technology hadn't reached that, the contra recommendation would be that it wouldn't be scaled and it might be decommissioned, if you like, in favour of technology that had been commissioned properly. So we were trying to create a proper process that would actually accelerate technology through without the real frustration for organizations of having to go to each individual trust up and down the country on bended knee and beg them to actually take their evidence or re-evidence it locally, et cetera. We've got to get beyond that, Sally. I mean, it just kills innovation. And as you've quite rightly said, it drives industry overseas because why would I bother? It's just too hard. So we've got to be clearer on that. We've got to work together on that. It's why I've really been privileged to help chair that AI think tank that we've got, because it brings together people who want to make a difference on both sides, from industry and from the NHS, who recognize there's real benefits to gain if we both work on trying to make this process as smooth as possible. So certainly understanding regulations and standards is really important. Ensuring that there is appropriate evidence on return on investment information, which is linked to that as well. So it is appropriate evidence. It's evidence that is appropriate to this market and this country, not just overseas. It is important to have the evidence overseas and we shouldn't turn our noses up or close our eyes towards evidence that's collected in other countries, but it does need to be appropriate to our health system over here. And that's really important. Communicating the practicalities of implementation and integration, being able to communicate that back is also really, really important so that organizations that are wanting to implement this understand that they're going to need to provide resources to do that. Maybe it's implementers within their particular area. They need to maybe backfill some of those people if they're in permanent posts and certainly provide some check. The next point is sufficient change management support. Make sure there's change management around that. Don't just chuck the technology in and wonder why it won't necessarily integrate with existing systems or into the pathway and the way that people work. There needs to be a level of integration and implementation support thought through. And then finally, my favourite hobby horse is simplifying procurement process and frameworks. The NHS did have something like 36 different frameworks that the NHS commercial team had come up with. Under Jackie Rock, the attention was to try and get it down to two or three. I'm still at the moment trying to find out where we've got to in that process, but clearly we've got to improve on that because we want to present commissioners and industry with a relatively simple process. It needs to be based on a dynamic procurement system, so it's not something that you get into once every four years and then you're locked out for another four years. It has to be something that has scope or change as new technologies come on and as organizations announce new innovations and are made unable to actually evidence that successfully. But we've got to do a better job at making it clear, less complex and easier for industry to get onto. And also from a commissioning point of view, to be really clear that these are the technologies which we want to be implementing at scale as quickly as we can. And as you were going through your first few points, I'd written down more standardization, more simpler procurement and tender processes and leverage one NHS. And I was in a meeting yesterday where our members were saying that these procurement processes, like 150 questions, each trust is asking the same question in a different way, so you can't give necessarily the same answer. And when a company does a procurement process, it might take them a couple of weeks to complete all the papers, but they're not guaranteed to win that contract. And then there's been scenarios where something's gone out to tender and then the tender's just being pulled after a company's put weeks of effort into it. 

So we do need to see a lot more standardization. I don't understand sometimes with the NHS. It's an amazing organization that does some amazing work. Why are we not learning best practice from things that are working well? And why are we not leveraging that one NHS? And I sound like a broken record at the moment because there's all the individual trusts doing their own thing, but actually as one NHS is so much stronger. And I just think we need to see that leveraged from a procurement and a purchasing perspective because that adds more value to the taxpayer as well, which we all are and we're all patients, so we want the best of everything. I hope the idea of the innovator passport, if that works properly, the conversation I had on Friday was talking about a kite mark of some sort. You can imagine that it's been checked, don't redo it all over again, guys. That's great, but it needs to be backed with some teeth. So at the local commissioner level, what happens if you ignore that? What does that look like? So what's the incentive for them to adopt these new processes and policies the center is coming up with? 

So we've got a ways to go. And traditionally, as you will know, the center provides policy and advisers. It doesn't mandate. And therefore the problem is the one somebody once told me, Sally, I can't remember if I'd said to you that the NHS isn't like a big ocean liner. It's a flotilla of little ships that sometimes are floating in the same direction. I thought that was a really nice analogy. Not always floating in the same direction, but sometimes floating in the same direction. So how can we make that a little bit more like a supertanker, a little bit more like everybody working together? So we've got some work to do in that area and watch this space. The people I was talking to, and this is my recurring message, there are really good people in the NHS that are trying to drive change. They really want to drive it in a way that will be better for industry and better for patients, but it's a very big organization, unfortunately. Yeah, it's a cross-section of societies. And I'll say that in saying otherwise, people will understand. The last bit I was going to say on the procurement side is, what was I going to say on that? Yeah, just to say that it will be important to be able to evidence some kind of return on investment because it shortcuts a lot of the silliness sometimes that happens at local level. Therefore, what we're saying is there's no standard sense, for example, of what a particular product and service is. It varies depending on its applicability and the implementation circumstances going in. But working with, in future, it's likely to be nice acting on behalf of NHSE or DHSC to help give some sense of investment to return should help that process of streamlining for commissioners and actually ultimately help the organizations themselves. But it is complex because who wants to surface their confidential pricing and all the rest of it in front of competition. So I'm not pretending it's easy, but I am saying that we still need to keep working on that because it removes that stage where potentially local commissioners are still able to say, well, no, no, I still need to do some evidence collecting myself and therefore I can't take what the national say because I don't know, et cetera, et cetera. So anyway, that's a little piece on that. And then the last bit on the NHS at the moment, obviously, we've heard about the center NHS England being abolished, which is likely to happen in the next two years. The regions were being de-emphasized in favor of the 42 ICBs, but with the recent 10-year plan, that's reversed a little bit and the regions have got a little bit more responsibility around strategic. The ICBs themselves have been in the process of being consolidated from 42 down to probably 26 or 27. But there's massive implications on an organization that's been around two years when you start cutting 50% of the headcount and 50% of the budget. There's a huge grief in there. Also the fact that redundancy payments haven't been agreed. So I guess what my heads up to everybody listening to this is don't expect anything to happen quickly because you're dealing with organizations at ICB level that are in extreme flux at the moment. And lastly, back to your point there, that still leaves the trusts paddling on with responsibility at the front line for delivering services. So they're more autonomous in that context and therefore more likely to make their own choices free of anybody helping or advising them above. The HINs are doing their best. We are doing our best to fill some of that gap around transformation, but it's a system in extreme flux at the moment. I spoke to many colleagues have been in the NHS at senior level for 30 odd years and they've never seen anything quite as bad as this. It is really hard at the moment as a market to work into. So just that's my little plea. Don't give up on it. It's still worth working on. It's still something we all believe and trust in, but it is going through extremely hard times at the moment. 

So there's a need to be patient and there's a need to do what we're doing now, which is to work together with colleagues in the NHS who are trying to drive change through this to make change happen. Absolutely. And just on the other final thing on procurement, I think it would be wrong not to mention value-based procurement. That's something that the Department of Health and Social Care are officially launching next end of March, beginning of April time. AXREM have been involved with that and I think that it will be encouraging for value-based procurement to be rolled out more widely where it's not just about the lowest price, it's about the right product at the right time. And obviously that's going to help make sure that patients are diagnosed quickly and put onto the right patient pathways. I'm now going to hand back over to Paige. 

Thanks, Sally. Alan, earlier you mentioned scaling new technologies and evidence from other parts of the world. So that evidence needs to be relevant to our healthcare model and practices. 

What's interesting is sometimes when you look to developing areas, they can have emerging technologies that are perhaps more sustainable and more accessible because they've had to work with less. So we can learn a lot by looking elsewhere in the world. Now when it comes to adopting new technologies, how important is clinician buy-in and patient trust when introducing new tech? And how can collaborative groups like AXREMs, working groups help accelerate safe and effective adoption? Thanks, Paige. I think you make a really valuable point about emerging, sometimes emerging countries being forced through reality or through extreme poverty or other circumstances to develop treatment pathways that are sometimes far in advance of the ones we've got here, just because there's no other choice. And we can learn from them. I totally agree with you. When I was at Philips, I was thinking back to we had a product called EICU, which was aimed at secondary care and it had been extremely well evidenced in the US. Something like 4 million patients had gone through it. So we had a lot of data and we had about 400 hospitals that had adopted it. It had an amazing evidence base. And the bottom line was that in using quite simple AI, that was able to take multiple vital signs monitoring information from beds, pull it together and then identify deteriorating patients. And it had a kind of a promise of 20% improvement in mortality. One in five people monitored by that system would live versus people who did not do. And in the US, it was quite fascinating. People were going to hospitals who had that kit rather than going elsewhere because that kind of stat, if you're going in for something major, is pretty important in terms of safeguarding. So you would have thought slam dunk, that goes in easily into the UK. I can remember when I was at Philips, we introduced it to guys, and Tommy's one of the biggest trusts around, obviously. And it took us three years. During that period, I learned a couple of things. One is it's really important to get your clinician buy-in and make sure they're on board. The trust had bought it. The board were supportive and wanted to get it in, but the consultants had a problem in terms of their terms and conditions at the time. And that hadn't been resolved in terms of a financial settlement and a shift road to settlement. Unfortunately, in introducing EICU, the requirements were really to have a 24-hour shift pattern and rotate people around. You could do it at home, but you'd have to have somebody. This is back to the human and loop we were talking about Paige. You'd have to have somebody keeping an eye on the AI. And it was kind of the straw that broke the camel's back because nobody had fixed the problem of consultants' shift hours as it was. When you arrive with a shiny new toy and say to people, by the way, we're going to push you now to a 24-hour road, guess what? They went, fine, you can stick this and everything else that goes on. So we had a real problem trying to win them around to actually implement this technology. So there was a bit of learning for me and there was a bit of learning for Phillips at the time in terms of the need to deal with the human factors. Don't just look at the technology and the process piece. And the reason I also mentioned that was when we did get to lift and shift it over and we did get the consultants on side, a lot of the processes that underpinned the technology were US-based processes and they did not comply with our nice guidelines in some areas. And therefore, even then we had to unpick them and then rethink through how we needed to make things work, how we needed to show some of the vital signs indicators and other bits and pieces to fit the UK standards rather than the US standards. So that was a combination of a technology change and a process change. And again, it's something I've never really forgotten.

 So just coming back to your example there, there's lots we can learn from overseas, but we need to be really careful not to be complacent about bringing tech and just lifting it into this country or indeed other countries, because there are subtle differences sometimes in the regulations and standards. And that also comes back to the topic we talked about earlier. We need to be really clear about those regulations and standards and be able to surface that early to technologists so that they can understand what they're building against. I can't remember if I've answered your question. I've just waffled on. Let's have a quick look.

 No, I think that was really good. The other pillar, the other part of my question was around patient trust. So, you know, especially when you've got new technologies being implemented, how do you, I guess this goes back to transparency when you mentioned what you mentioned earlier, how do you build patient trust and I guess communicate the benefits of these new technologies to patients?

 I think that's an interesting challenge. I was going to say what I've written down in my notes. When we were at HEE and we were looking at work, we were working on the follow-up to Topol around AI. I worked with a fantastic medical physicist and data scientist who's known to AXREM called Mike Nix. He's at Leeds Teaching Hospitals. And Mike and another colleague, Dr. Annabel Painter, did two reports, one called Developing Appropriate Confidence in AI and the other one was Understanding Appropriate Confidence in AI. And they coined the phrase appropriate confidence, not trust. And I really have taken that to heart myself and shared that with other colleagues since. Appropriate confidence means that we have confidence until we don't have confidence. It means that the human in the loop reserves the right to dig in and to look further at why the algorithm has said what it's said and therefore to choose to follow or not follow. The analogy, which again, I sort of make about AI is it's a little bit like in that context. Anyway, it's a little bit like reversing sensors on a car. I reverse backwards. I hear it can choose to agree with what the technology is telling me or I can override it and go further. It's my choice. It's still my choice. And if you think about that from a clinician's point of view, that's incredibly important because they have to carry the can in terms of making the decision around that particular patient or that particular diagnostic. So it's important that we don't lose that in terms of that. If we think about it from a patient's point of view, they need to have confidence in their clinician. And we get that through, as you and I are talking, through empathy, eye contact, a million different myriad of body movements give us that empathy and that sense of, I think I have confidence in this person. I believe what they're saying. The same is kind of true in this context as well. But if we introduce a technology, we need to be able to do that in a way that the patient feels that they have appropriate confidence in what is being prescribed or what is being diagnosed to them. So that need for transparency, that need for evidence, as we've talked about, the need for preparation. If we're talking about an operation coming up and education and activation of the patient is very, very important in and around this subject. You raised it, I think your analogy of a car and the reversing sensors. I was actually, when I was driving the other day, I thought, how did I ever not have these? And then you get bad weather and the reversing sensors don't work properly and you've got to look over your shoulder. And I guess we can liken that to becoming reliant on technologies, not just in healthcare, but in any industry. Maybe you don't have to answer this question, but something to think about. I know when I'm talking to clinicians, radiologists and other people in healthcare, how do we learn from technology, but not become overly reliant on it? You see the same things in university and schools. There's the emergence of chat GPT, and I think this is really, really important, especially for people that are still training in healthcare. Very, very true. I could waffle on and tell you more about that as well, but I won't. 

So if you could fast track one idea to implementation tomorrow, what would it be and why?

 So here's one that we'll get colleagues on this podcast. Are they chortling or scratching their heads or otherwise? Another hobby horse of mine. It would be page autonomous vehicles for elderly people and people with disabilities. As in vehicles on the road? Yep. 

Okay. And that's, that's very interesting. I didn't think you were going to go there. When I'm thinking about innovations and like, so my question was fast tracking one idea, I should probably better phrase that. What problem would you like to solve? So when we, when we think about solutions, they have to be accessible and creating a solution halfway to creating a solution is to clearly define the problem. So what is the biggest problem that you see there? So what problem would that solve? So the problem that we have, and we can do a medical one as well, but let's do this because it's a, it's a population one is that in this country, in recent times, there's been quite a lot of attention to over seventies and their ophthalmology, their ability to see properly. There's been some well-documented cases, sadly, tragically, of people that have been killed by people still driving who self certified that they're okay and can't see further than the steering wheel. Now that's really dangerous. It shouldn't be allowed and we need to do something about it. But the reaction that we've seen from government and the solution that we've come up to that problem. So the problem, sorry, let me characterize that problem again, page. We have a wonderful problem in many ways that many of us are living longer. I'm 61, I'll be 62 coming up. So, you know, I'm an example of somebody that in previous years, maybe would be coming to the end of their life and hopefully I'm still going to be expecting to spend another 15, 20, whatever years around. So if we have a society where we've dealt with a lot of diseases, we've talked earlier about some of the cancers and other bits that we're doing, but if we've dealt with a lot of diseases and we've got an aging population, how do we make sure that we take advantage of that, but also manage that population because the population shape and the population shape that we are going to is going to have quite a fat elderly population and a relatively slim younger population because we haven't had such large families from this country. So we're down at I think 1.6, 1.7 per. So we're not big in terms of that. So if we've got that in place, we're going to have these older people around. So what are those older people going to want to do? We understand in studies around longevity and older health that mental health is important and the ability for people to be able to relate to other people to have a purpose, but also to be sociable is really important to their mental health going forwards. Now we have, as we're doing right now, we're talking on Zoom. We have the wonderful technology now post-COVID of Teams and Zoom has been much accelerated and we can take advantage of those technologies. I can remember Bill Gates in Microsoft many years ago in the 90s saying that in the future we wouldn't have to go anywhere because we'd have great big walls of screens and we would all just communicate with each other. We're almost kind of there in some ways, but this technology is still limited and it's better for us to be together face-to-face and to have that human-to-human contact that we can only do when we're physically in each other's presence. Is mass transportation the answer to that? Well, in cities, yeah, you can do that in London, you can do that in Manchester, you can do that in Birmingham. That's great. But if we look at our population, our population is not principally urban based. There are significant urban centers, but we also have quite a dispersed rural and urban community. I live a little not too far from Grantham in a little tiny village with 450 houses. We have roads, we don't have much of a bus service, so elderly people around here walk, take lifts, or don't go anywhere. So back to my problem statement. If we have people that are over 70 who we want to reduce the risk to the rest of us on the road because their eyesight's failing or their hearing's failing, or let's face it, we live in a very condensed world now with lots more cars on the road, with lots more people driving around, so reaction times have become much quicker and elderly people's reaction times are slower. Isn't that a perfect use case for AI, for a technology that can basically react to senses and basically choose decisions that will augment an elderly person's failing eyesight, failing hearing, or failing reactions to actually do it? My argument for autonomous vehicles in the introduction is rather than sopping people's licenses and saying you can't drive anymore and I'm afraid that's it, and then having a tsunami of mental health problems, why don't we look at the intelligent limited usage of autonomous vehicles for that cross-section of society who would benefit from that augmentation? I'm not even going to pretend that it's not problematic. It would be if we had a perfect system, everybody, and I don't want this by the way, we would all be in autonomous vehicles and the vehicles would be controlled and therefore every vehicle, like any train, every coupling would be managed in terms of its spatial orientation. The problem in a messy system is when you've got random humans and computers trying to interact together, so I'm not saying it's not an easy thing. There are certainly plenty of problems, but if I had one idea I could move forwards, bearing in mind the demographic challenge we've got with these elderly people, that would be it. Let's look at what we can do with autonomous vehicles. Let's look at what we can do with AI to give them the capability to have some freedom from their particular place of dwelling. And do you know what? I think with an ageing population, the difference that that would make to the health and well-being of elderly people, and I talk from a little bit of experience, I used to be a caseworker implementing disabled facilities grants throughout Northamptonshire and often I would be the only person that that person had seen for weeks. So being able to allow people to still get out safely actually is a fantastic idea. I'd love to see that and maybe it might be in my lifetime or my children's lifetime, but I absolutely think that that is something that will happen in the future. I think so as well. 

I'm going to change things up a bit now, Alan, and we always end our podcast with one of our quirky questions. So my quirky question to you today is, if you could swap lives with a celebrity for a day, who would it be and what would you like to do? 

That's a great question as well. Here's my thought. So I would probably swap with Lewis Hamilton. Why would I swap with Lewis Hamilton? Because I think that Lewis can show that success doesn't have to be win-lose, that sometimes success can be win-win, and I mean that. I think he's had a hard ride in recent years. He's risen to the dizzy heights of seven times world champion and everybody adoring him and saying he couldn't do anything wrong, and then he has done almost everything wrong in the last couple of years. Yet he still kept going and he still kept trying and he still kept chipping away. He, for me, models the kind of competitor in the market that doesn't feel that you have to be completely cutthroat, that it has to be a win for me and a lose for you, but it can be a win for the team. It can be even, sadly, sometimes a win for my teammate if it fits the other side of the race tent. I think that's really important. I'm a real believer in collaboration rather than competition where it doesn't need to happen. I think we're stronger together and that, for me, sums up, if you like, bringing it back to AXREM and why AXREM is such an important organization, because you bring together the members and you bring together the members to give them a bigger voice, a bigger share, a bigger way of talking, and all the intel coming together. For me, it's Lewis. It's that win-win I would share with that. Mind you, it would be nice also to have his cars and his life and all the rest of that. We'll just leave it at that. 

I think it's because you want to live life in the fast lane. That's what it is, Alan. That's a fantastic way to end what has been a really, really interesting podcast. I think we found out a lot more about Alan and some interesting insights and views into innovation and adoption. I want to say a big thank you to Alan for joining us today and to Paige for being my guest presenter again. I'd like to thank all the listeners. Thank you.