A “pivotal moment” for digital health adoption

Former chief digital officer for the NHS, Juliet Bauer, is now applying her experience to the private sector through video consultation firm Livi. She shares her thoughts on how well the NHS is integrating digital health and what the public and private sectors can do to further boost adoption.

Bauer’s path to working in the NHS began when she spent many months in the care of the health service with a highly risky pregnancy and an extremely premature baby in NICU.

“I was hugely grateful for the brilliant care I received whilst in hospital – but I could also see the huge potential for digital to improve patient access and efficiencies across the NHS,” she says.

Bauer wanted to utilise her first-hand patient perspective and experience in digital transformation to drive positive, long-term change.

During her time as chief digital officer, she led the strategy for digital services for NHS England – which forms part of the organisation’s Long Term Plan.

Leading a large team, her role was to overhaul the organisation’s patient-facing digital service like NHS.uk and innovate the system so patients could access and interact with services seamlessly across both digital channels and physical settings.

She says this meant engaging with developers inside and outside of the healthcare system on delivering “meaningful and personalised health”, to ensure patients received the best possible care – whilst also ensuring the NHS was achieving these targets in a sustainable and efficient manner.

“When I joined the NHS, my main goal was to provide a more patient centred service such as the NHS app,” she says.

“Like most organisations, the NHS definitely had room to increase its digital capacities. Despite this, it was clear that the NHS was willing to embrace technology to improve the overall patient experience. I was lucky that I was working with an experienced team who helped implement innovative approaches to enhance the role of digital across the NHS.”

She says the NHS’ willingness to embrace technology is driven by a similar understanding that private companies like Livi have – that transformation can only come through scale.

“That being said, there is also a mutual understanding that this approach must be scaled appropriately,” she adds.

A meeting of sectors

In early 2019, Bauer moved to Swedish digital health company Livi (known as Kry in the Nordics), which provides video consultation services to connect patients with GPs, and is Europe’s largest digital healthcare provider.

Through its tools, the company aims to boost access, reduce waiting times and add capacity to healthcare systems.

The company is now also looking to expand its digital pathways to include urgent care and mental health services.

“Looking back, it was a big decision for me to leave the NHS and join Livi, and one that I didn’t take lightly,” Bauer says. “Moving over to the private sector gave me the opportunity to bring the patient and system insights I gained to a company that was driving innovative and rapid change.

“Leading change and digital transformation at an organisation like the NHS was certainly a challenge at times. Nonetheless I gained a deep understanding of digital’s potential to transform the way we access and deliver healthcare. My role was to show how it is an essential component in driving innovation – this is definitely something I have been able to bring to Livi.

“I also hoped I could bring the sentiment that underpins the NHS – the drive to provide patients with first class care – and make sure that Livi was enhancing the services available to individuals across the UK.”

Bauer says she also hopes her experience in the public sector will help Livi thrive in a time when closer collaboration between public healthcare and private companies is becoming key to driving digital innovation.

“One of the key things I take from my time at the NHS is that for companies like Livi to deliver high quality digital healthcare, which ensures patients of all backgrounds have access, you have to be willing to collaborate with the entire system, and be willing to constantly find new solutions.

“Technology is the enabler in ensuring both patient access and cost efficiencies, but this only works when you work in partnership – as opposed to in competition – with the NHS. After transitioning to my role at Livi my belief in this approach was strengthened and now I consider partnership as a crucial element of securing long term success for the company.

“After all, our approaches work in tandem – we both believe in patient-centric care, high standards for clinicians and ensuring patient access.”

The time is now for digital health

Bauer says she believes the NHS is improving its digital capacities every year – but despite significant progress over the years, the COVID-19 pandemic has highlighted some of the major hurdles that the health service needs to overcome when it comes to digital, especially regarding healthcare inequalities and variations in access.

The reality, she says, is that patient access to high quality digital healthcare is still dependent on where you live – and COVID-19 has only further exposed the urgent need to address this.

Bauer says the pandemic is a “pivotal moment” for digital healthcare transformation, which has not only accelerated adoption but also changed the kinds of people who are  using these tools – for example, Livi’s demand tripled during the pandemic and 55% of its patients are now over the age of 50.

But Bauer says this will only work long-term if applied at scale and through system-change.

“Digital healthcare is not a sticking plaster, but a whole new way for patients to access high quality care.

“For some patients with chronic illnesses, it is neither safe nor desirable to go to a physical setting for care which they can receive; for others, they are finding it difficult to book a GP appointment in the first place – recent polling shows that 53% are finding it harder to book an appointment these days.

“Clinicians are under increased pressure in terms of their capacity, and many – such as older doctors or those with health conditions themselves – have to ensure they can practice safely as well. Nine percent of all single person practices in England are run by doctors who are high at risk from COVID. Digital can be part of the solution for all of this.”

While healthcare systems have naturally moved to a remote-led service in response to the pandemic, Bauer says that in the future she’d like to see digital being used across the NHS as a “front door” to effectively triage patients across the whole of England.

“I’d love to see system-wide change where patients are treated at a time and place of their choosing, by the right type of clinician – making their experience better, and ensuring efficiency of resources for the individual clinician and across healthcare.

“As well as this, the healthcare industry should have the confidence to go beyond just primary care with digital.”

Livi itself is trying to push for a more seamless, integrated digital journey for patients in the NHS, by joining up its platforms beyond primary care – including urgent care, mental health or integrating with 111.

Bauer says that mental health in particular is an area where she wants to see digital tools having a greater impact.

“Mental health is a significant challenge for the NHS right now. The coronavirus outbreak and ensuing lockdown has had a significant impact on almost all aspects of our day-to-day lives. We’re facing a growing mental health crisis across the UK as many patients often do not feel able to access mental health services, and as a consequence we saw a 20% drop in the absolute number of mental health meetings from March to April overall – despite an obvious increase in demand. Furthermore, we also saw a 36% drop in mental health meetings from men, from March to April 2020, a specific challenge in and of itself.

“During that time digital consultations have proved a highly effective way to ensure patients can quickly access specialist mental health care.”

She again stresses the importance of partnership between different sectors in helping digital health to address these issues – for example, Livi has launched a pilot with mental health service Let’s Talk Hull to ensure vulnerable patients can more easily access mental health care.

Like many, Bauer says she believes that digital will be the preferred choice for many patients, clinicians and the wider system in the future.

“When combined with physical care, digital will create healthier patients, and a healthier NHS. Digital will enable the NHS to overcome challenges that are currently deeply embedded in the organisation’s every day operations.

“Ultimately, organisations like Livi are helping to address the fundamental issues healthcare systems all over the world are struggling with, such as ageing populations, long queues, rising costs and better provision of mental health care.

“We can’t stand still. Digital can unlock full scale benefits for patients, doctors and the wider health system and I am proud to be a part of this work.”

About the interviewee


Juliet is the UK Managing Director of Livi, Europe’s largest digital healthcare provider. Prior to joining Livi, she was NHS England’s chief digital officer. Juliet’s current role combines her knowledge of the UK healthcare system and experience in digital transformation. She is also a patient governor for Chelsea and Westminster Hospital NHS Foundation Trust.

About the author


George Underwood is a senior member of the pharmaphorum editorial team, having previously worked at PharmaTimes and prior to this at Pharmafocus. He is a trained journalist, with a degree from Bournemouth University and current specialisms that include R&D, digital and M&A.

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