Mel and Tom also dig into how the backlog is defined and misunderstood, why chronic patients need a different approach, how linked diagnostic appointments are being managed through pre-validation, and the cultural resistance that proved harder to navigate than the operational change itself. 

The episode explores practical changes now arriving in hospitals - from AI scribes and ambient notes to smarter MDTs and clinician-led innovation - and why this moment feels like a real opportunity to scale better, more equitable care.

They discuss the NHS's organisational changes, the Guy's and St Thomas' merger, the foundation trust era, and the cultural lessons from early clinical computing.

Ian reflects on personal experiences with technology, the convergence of biology and AI, and how we can move forward in the digital health ecosystem.

With Tom, she discusses giving patients options, control and agency through Choice Booking of appointments, as well as the operational and patient experience benefits this has delivered.

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Joe argues the NHS is unprepared for the “demographic time bomb” of ageing, multi-morbidity, and end-of-life care, and that today carers often become the de facto integrators across fragmented services.

They also explore a (not so distant) future where AI assistants reduce admin, support clinicians with triage and summarisation, and enable more care at home.

The closing message? After a long “trough”, the NHS has changed culturally and could lead the world if it regulates for open standards and invests in scaling proven innovations.

Buy Joe's new book FHIR and Loathing in Las Vegas here: https://www.amazon.co.uk/FHIR-Loathing-Vegas-Prof-McDonald/dp/B0FRYDV52G

They explore the “Goldilocks” project size: when budgets get too large, incentives and behaviours distort, and delivery becomes politically driven rather than user-driven, as well as the current state of UK digital health innovation, where we are seeing major near-term opportunities in ambient voice technology (AVT) to reduce clinician admin burden and unlock productivity.

Plus, the longer-term promise of NHS data to enable better treatment decisions and proactive risk identification, cautioning against the ethical risks of LLM-based therapy chatbots for serious mental health needs.

Buy Joe's new book FHIR and Loathing in Las Vegas here: https://www.amazon.co.uk/FHIR-Loathing-Vegas-Prof-McDonald/dp/B0FRYDV52G

In this final episode, we explore how ambient/AI scribe tools, agentic AI and tight EPR integration can remove “grit” from clinical workflows while protecting the cognitive space clinicians need to think. Value won’t come from flashy standalone tools but from small, compounded frictions removed across pathways - referrals, booking, documentation - and from better design and governance.

What is truly needed is pragmatic risk-taking powered by fast feedback loops, simulation, and shared learning across Trusts. The destination is a more personalised, hybrid model of care where patients choose how they interact with their healthcare.

Here's a snapshot of what they discussed:

• Ambient/AI scribes are promising but unfinished: Core capability exists, but the last 5–10% (identity context, EPR data pull-through, admin niceties) determines real value and adoption
• Friction kills adoption: Tiny annoyances aggregating into “marginal pain” that erodes clinician goodwill
• Protect clinicians’ thinking time: If AI drafts notes, we still need to make space for reflection previously embedded in manual write-ups
• Prompt engineering as operating discipline: Prompts are the practical bridge between policy and reality; overfitting prompts to one team harms generalisability
• Pathway redesign > bolt-ons: Why we should aim for standardised capabilities applied across settings and full “vertical” pathway changes
• Risk, agility and feedback loops: Enabling safe experimentation by starting small, instrumenting feedback, and building an organisational “nervous system” to course-correct quickly
• Personalisation at scale: Moving beyond “letters” to structured data and interfaces patients choose (text, voice, avatars)
• Culture is the unlock: Successful change blends operational, financial and clinical rationales, shared learning across Trusts, and design literacy

DrDoctor Co-founder & CEO, Tom Whicher and Oxleas NHS Foundation Trust CCIO, James Woollard and CDIO, Alison Furzer continue their conversation on digital transformation at Oxleas.

They look at why digital change in mental health and community services is less a tech problem and more a people-and-process one, unpacking staff assumptions, the tension between clinician control and patient agency, moving from time-based to data-based follow-ups, and what actually unlocks adoption.

Here's what they discussed:

• Culture > tech: Some of the biggest blockers are actually behavioural, like assumptions about patient preferences and worries about getting things “wrong”

• Patient agency shift: Let patients choose if they want to move to digital, instead of staff deciding who is "appropriate"
• Clinical leadership matters: Successful uptake correlates with senior clinical champions who tolerate a period of double-running and drive new ways of working
• Boots-on-the-ground enablement: Admin teams guiding patients through first-time logins during calls builds “muscle memory” and cuts future phone traffic
• Friction is fatal: Even small hurdles push staff to “least-worst” paper choices; embed access and simplify IG flows
• IG as an enabler: Modern information governance is collaborative, shifting from blocking to pragmatically enabling safe, high-ROI use
• Integration vs surfacing: Technical integration has improved, but the win is where and how information is surfaced for staff and patients 
• From read-only to transactional: Shared care records need to evolve from viewing data to acting on it 

Here's what they discussed:

• Early adopters: How Oxleas became one of the first NHS Trusts to adopt an electronic patient record nearly 20 years ago, setting the foundation for continued innovation

• Co-design and innovation: How Oxleas’ ADHD team co-designed an early patient engagement platform, allowing secure messaging, digital diaries, and feedback tools to engage young people

• Oxcare: What led them to create and ultimately publish Oxcare, a patient engagement platform co-designed with staff and patients

• Partnership with DrDoctor: Why Oxleas chose DrDoctor to power its next-generation engagement tools (starting with digital appointment letters)

• Early results show 44% uptake across the Trust, saving time, money, and reducing paper waste

• Behavioural and cultural change: Why there needs to be a mindset shift when it comes to digital transformation - for the sake of patients and staff 

• Sending a digital letter via DrDoctor costs under 4p versus 84p for postage - tangible savings and environmental wins

• What's coming next: How Oxleas aims to reach 70% digital uptake, from pre-appointment questionnaires to therapeutic self-management content and integration with the NHS App