Professor Sultan Mahmud, director of healthcare for BT’s Business unit, talks to Healthcare Leader’s editor Victoria Vaughan about how the communications company is playing a role in the way AI is used in the NHS.
Victoria Vaughan (VV): We hear a lot of hype about AI but what potential do you think AI has for healthcare?
Professor Sultan Mahmud (SM): We’re living through the fourth industrial revolution in terms of digitisation informatics. We buy houses, book holidays, do banking, and all sorts of things through our smartphones, computers and technology. AI has grown exponentially, particularly over the last 12 months.
We think AI has huge potential in healthcare because it has the machine ability to analyse large quantities of really complex data. But trust is the most important thing, and we take a very ethically led approach – rigor is very, very high. The approach we take at BT is to make sure it’s clinically robust, it’s technically safe, and it fits in the workflow as well as having patient confidence.
If you think about AI, there are different sorts of trust. There’s technical trust – how have these algorithms been built and what’s their construction, and what assurances do we have that we can trust the maths behind it? Then there’s a settings-based confidence – so, is the technology accurate, how does it interact with the clinician and how does it integrate into workflow? Before anything goes out to real life situations, there’ll be thorough testing on a clinical user interface, and a settings-based user interface.
And finally, do the patients have trust in it?
VV: BT’s Vanguard programme is about setting things up from the clinical perspective, rather than designing tech in isolation and then finding it’s not workable. You’ve got an NHS background yourself, so how does that approach work?
SM: Normally, with product development, people come up with an idea and they develop the product. And then it’s presented to the NHS: ‘I’ve got the best thing since sliced bread – would you like some?’
But my own experience of being in the NHS – I came into BT during the second half of 2021 – is that it works a lot better if you co-create with the NHS. You really understand the specific problems and then find a solution and iterate.
So, we’re working with a range of partners and NHS organisations across the four nations, really getting into pain points to look at what’s causing problems. We have an ecosystem of partners – people who will work with us to bring solutions for real life problems. We work with specific partners to find solutions and build propositions to help systems. We’re calling them Vanguards.
VV: How do you come up with the solutions?
SM: We identify one or two problems, and we’ll look at them through different lenses. We use our clinical advisory board and we have a lot of NHS people now employed by BT. Each of us, as you will imagine, has a slightly different lens. Even within our clinical board, there are different specialties amongst the clinicians, so we’ll look at it from a particular lens and then we get together and the problem statement emerges.
Then we think, okay, right now, what tech is available to address this problem? Some of it will be in BT and some of it will be from a partner. And then you put together the proposition based on what’s out there.
VV: So, how are you using an AI in your solutions with healthcare at the moment?
SM: We are looking at AI and its ability within a clinical setting to think about primary, secondary and community care. We know that patients are increasingly emboldened by technology – our surveys have shown that 75% of patients think that technology can give them better access.
One thing we’re working on is a Care Close to Home programme – remote monitoring technology in primary and community care form the basis of that. And then, from that, there’s anticipatory care where we have AI-enabled devices and applications looking at datasets and contextual factors.
So, if we use Mary as a case study, we can start to make some predictions about her. The clinician can decide whether this needs an anticipatory approach – for example, do we need to give some prompts to Mary’s carer, Bob? That might be around a particular situation or explaining that if this happens then do that. Or do we send out a healthcare professional in advance of the patient arriving back at A&E or GP practice?
We are also looking at diagnostics in secondary care. That has always been a bottleneck and now the waiting lists are at a record high. That’s because there’s the usual demand and supply issues of access to tests and access to clinicians’ processing information – these things take a lot of time and effort. We put diagnostics into our strategy because it’s got huge potential to save clinician time and workload and provide better access. It’s a priority area for BT health, because it’s amenable by technology.
As I said, we work with partners to build solutions and, in the diagnostics area, we’re working with a company called Deep C on a radiology AI platform that can help clinical professionals access multiple valuable AI tools to help in the diagnosis process. AI-based diagnostics is a means to test what we think is going on and then the action is done by clinicians themselves.
We found that it’s got good data. We know that it’s positive in terms of workload reduction for breast screening, for example. And it helps in chest X-ray analysis with faster reporting times and, with fracture detection, the sensitivity is increased. So, there are lots of promising areas around diagnostics. We’ve got live trials in two places at the moment at big NHS organisations.
VV: When could the diagnostics product be ready as an actual offering to the NHS?
SM: I wouldn’t want to give a timescale because when it’s something as new as this, there are so many things to consider – is the input data of good quality and so on? We need to understand the bias in these systems and how they work. That’s for us to work through together with our NHS partners.
I wouldn’t say it’s going to be years and years, but equally we’re not going to rush through it. We want to get this right and test it. We need to see what creases come out that need to be worked through with patients and clinicians before deciding to take it out further.
VV: What are your plans around the use of AI in healthzare?
SM: Yes, we certainly do have a plan. I’m not going to tell you everything for commercial reasons, but I can talk about some of it.
For example, there’s huge opportunity around medical imaging in terms of image analysis, detection of diseases and improving the accuracy and speed of diagnosis. We want to take that out to a broader audience.
Patient interaction is another area. We’re developing a solution to help patients communicate with various parts of the NHS, from their GPs to their hospital consultants. It’s a patient concierge system, if you will.
We’re also thinking through how we can educate by using AI powered chatbots and virtual assistance. We see communication as being really important for engagement and education; we’re a communication company, after all, and we are in more than 30 million homes. As well as patients, we are also thinking about how we can educate clinicians, and system leaders.
Then there’s remote monitoring technology and anticipatory care, which I’ve already mentioned.
VV: What services does BT provide to NHS organisations at the moment? And how do you think that will change?
SM: BT has been with the NHS for over 75 years in Scotland, Northern Ireland, Wales, and England. We provide a wide range of services across the breadth and length of the NHS, from the centre, ICSs to GP practices. In terms of infrastructure and connectivity, we provide 34% of the main connectivity in the country.
Increasingly, the NHS wants us to be a trusted partner – an interface between some of these clever things that are coming out from businesses and the NHS. And we’re proud to take on that mantle.
We find SMEs and startups that are developing really clever stuff with AI and they are looking for an organisation to help take them through to market. And our vision is, yeah, absolutely, we’ll do that, but you’ve got to comply with NHS clinical and operational standards, and you’ve got to abide by our ethics and delivery policy.
We have an ecosystem of partners – people who will work with us to bring solutions for real life problems. And we’re looking at how that fits with infrastructure and connectivity. As demands for data and connectivity increase, we need to make sure that the resources and infrastructure needed are ready.
VV: Are you getting quite a lot of approaches from these SMEs, then? What are the common things that the tech industry – the people creating products – misunderstand about what the NHS requires?
SM: That’s a good question. I wouldn’t say that they misunderstand. It’s just that, often, product development happens and is then presented to the NHS, as a kind of decision. On the tech developer side, we need more co-creation – more understanding of the problems and working with the NHS. It needs to be more of a two-way thing.
So much of what we do is bottom-up. It’s driven by our customers. For example, we put diagnostics into our strategy because it’s got huge potential to save clinician time and workload and provide better access.
We also need to think about how we expedite the things that we know are working. The speed to market is really a problem. We need to get them into testing fast because it’s only by testing them in real life that we can work out if this is actually any good or not. Things move quickly and people are forging ahead in countries like Estonia, Israel, and China. And they’ve got doctors, nurses and systems too.
The sweet spot in the middle is when we have appropriate and safe regulation, and innovation. That’s not an easy path but it is a steady path.
VV: Is the regulatory process in this country stopping things from moving faster?
SM: Specific to AI, there’s a lot of work to be done. The regulation needs to be really smart. We need to understand where regulation ends and delivery happens.
When you develop technology, it needs to combine workforce strategy, operational pressures and future demand. I think we need a digital transformation strategy that understands the workforce is in a difficult place in that there are lots of gaps and vacancies. And one that takes on board what’s going to happen in the next 10 or 20 years in terms of multiple comorbidities and patient cohorts because demand is going to increase.
If you’re going to develop a national strategy around making this really tick, you need the best brains in the world in tech and healthcare working together. One of the things that the NHS could learn from companies like BT, Google, and Microsoft is that we have lots of capabilities. We can help with knowledge transfer into the system. And you can only do that with things like the Vanguard programme and co-creating together.
VV: One of the things that concerns people is whether their health data is secure. How will you reassure patients that the data they give you is secure and won’t be used commercially?
SM: You’ve got to be really clear about the specific purpose of the data. So, what is the application going to be used for and what are the exclusions to make sure that you’re fully compliant with all the regulations that are there to protect everybody?
And it’s more than just complying. It’s taking the additional step – it’s what I call ‘the pub conversation’. Explainability is really important. You need to be able to speak to patients and explain it to them. And, of course, patients and clinicians always have the choice to opt out.
There needs to be a really strong communication engagement programme around this.
VV: How are you working with integrated care boards and NHS system leaders? Do you want them to approach BT? How do you see that relationship developing?
SM: We’re really committed to the NHS and we want to hear from integrated care boards (ICBs) leadership about their problems.
We know that adoption of technology can feel hard at the start – the funding and how fast it moves – because there’re so many headwinds facing people. We have taken the FTSE 100 on transformation journeys every single day for a number of years, and we do it very well.
We’re open for business, but we’re also massively open to serve and working in partnership. It’s not just about profit for us. We want the NHS to succeed and, whether it’s AI or any other technology, we’ve got some really sharp minds here.
Our approach is to understand before being understood. Across the country, we have account teams that, for the first time in a generation, work purely with the NHS. They don’t work with commercial organisations like the financial sector, for example – it’s only the NHS. So that kind of in-depth knowledge and focus is the way that I want BT Health to progress. It’s a focused specialism.
And then as you develop relationships and understand, you continue to co-create and iterate.
VV: You’ve talked about everything coming from the bottom up so that specific problems are solved. That makes sense and it’s a practical approach. But at the same time, the tech needs to be able to speak to other bits of tech and eventually it all needs to work together. What is BT’s role in that interoperability space?
SM: I think BT’s role is to reinforce the message. Where BT feels very strongly is that when organisations develop something, they need to comply with certain rules.
We can’t say that everybody has got to be on the same system – that creates market problems in the sense that you’ve got vendor locking. We live in a market economy, there are multiple players.
At the same time, if there are hundreds of systems, and they don’t talk to each other, the patient’s going to say: ‘I thought you were one NHS? And you’re being paid by the taxpayer’.
The NHS has got standards. So, if you’re being paid for by the NHS, you’ve got to open up your data channels to make sure that that happens. There are things we can do in procurement and contracts to make that happen in the NHS. As we develop things with our partners, we will make sure of the interoperability standards as well as the data and ethical considerations. So, it is given equal attention.
Interoperability is also something we deal with in Vanguard organisations. That’s one of the key things; what are the interoperability issues, what interfaces and what needs to happen? Do we need to build a specific engine to make sure it works together or do we need the vendor to do something different? It’s a live problem that you have to address at each point in time.
VV: There have been a few stories recently about rural communities and access – basic things like connection to a network. The more we become digitally enabled, the more connectivity becomes a health issue. Does BT Health do any lobbying to make sure that rural areas have the high-speed connectivity they need? Is that part of your role?
SM: When it comes to connecting for good, it’s always part of our role. So, if we’re serious about remote care, anticipatory care and care close to home then we need to make sure rural areas are connected. If your connectivity is giving you suboptimal access, that needs to be gathered from the administrative side of the NHS as well.
We are working with the health economies in rural areas and listening to their concerns and, when we have the opportunity to speak to the Government – or anybody who has influence in that area – we make the case. But it’s important that the case is made together because it mustn’t be seen as BT saying things for its own benefit.
How do we address these problems? We must think about the investment needed. If we think about our infrastructure investment, it is in keeping with the demand. But, especially with new technologies, that’s only going to go up.
So yes, we are lobbying but it needs more. It’s about needs assessment and the problem statement. So, if you were to say, that the top 5% of patients who were using 50 to 60% of resources across primary, secondary and community services could be addressed with better connectivity then that’s a case easily made. We’ve got to work together to build that case. If anybody wants to work with us on that, we’d be open to it; having two data points to create a narrative would be very helpful.
VV: BT is known for its entertainment – phones, TV and so on. Is healthcare seen as a real growth sector for the company?
SM: Health is one of the biggest priorities for the company. And it all flows down from the idea of connecting for good. The health of the nation is of paramount importance and we take this responsibility very seriously.
But there’s also growth in terms of BT helping the NHS customer base. BT is punching its weight in health care, which perhaps it hasn’t done in previous years, but there is also the educational piece. There is a huge educational agenda around the value of health tech. You know, we have countries that are accelerating past us, despite our asset base of some of the best clinicians in the world and some of the best data.
Our clinicians – doctors and nurses, and allied health professionals – put in huge effort every day but digitally, we seem to be falling behind slightly. So, we need to have that ‘what can it do for your health’ educational piece with the country.
I see BT as a connector of human beings, machines, phones and systems. We are taking our responsibility seriously, but a lot more needs to be done in combination with partners, big companies, SMEs and the public.
Professor Sultan Mahmud is director of healthcare for BT’s Business unit. This interview is part of Healthcare Leader’s latest report AI, digital and data in Healthcare.