Keeping problem solving at the heart of public services

Caroline began her career as an engineer before moving into consulting, bringing together what she describes as an engineering and consulting lens and the “problem solving kind of mentality” that comes from both.

Her experience in public services also reinforced to her the importance of leadership. In organisations predominantly made up of people, Caroline argues that effective leaders need to provide clear direction, bring others with them and create the conditions in which people can thrive.

That leadership is particularly important because of the complexity of public services; healthcare brings together different conditions, patients, settings, clinical specialisms and rapidly changing technologies. External factors can have profound effects on such systems, but their complexity means those effects can take time to work through and don't always produce the outcomes expected.

Looking beyond capacity to understand flow

One practical example is how we think about pressure on healthcare. Caroline argues that discussions too often focus on adding capacity – more beds or more clinicians – rather than understanding flow through the whole system. Looking at where bottlenecks occur and how patients move through care can reveal different solutions.

She recalls one hospital adding another ward in response to pressure. The additional beds filled in less than a day, without addressing the underlying constraints or increasing the nursing workforce needed to manage them.

As Caroline explains, digital technology creates opportunities to think differently too: could the expertise of an individual clinician be spread across a broader group of patients, improving access and supporting better flow through care?

Health data needs a purpose

The same problem-solving principle applies to health data. Having previously worked at Health Data Research UK, Caroline has seen significant effort go into making health data accessible, high-quality and usable. But she argues that the “demand side” deserves equal attention, “Are we asking the right questions of the data?”

Without a clear understanding of what data will actually be used for, there is a risk of creating increasingly sophisticated stores of information without realising their value.

Real-world adoption also requires thinking beyond research; regulation, commercial models, clinical workflows and how patients and clinicians actually use information all matter when translating promising research into practice.

From episodic appointments to continuous understanding

That challenge is central to Caroline’s work at Kneu Health, an Oxford University spin-out focused on neurological conditions including Parkinson’s and dementia.

Kneu uses patients’ own smartphones to collect information through existing sensors – measuring areas including gait, reaction time, tremor and cognition. This can provide a richer picture of what is happening between clinical appointments, which may currently take place only every six or twelve months.

Caroline compares this with her early career in control systems engineering, where sensitive industrial processes were monitored to fractions of a second. In healthcare, by contrast, months can pass without observing how a person is responding to treatment.

Better continuous data could allow clinicians to understand not only an individual patient's changing condition, but across a population, "which patients need care when."

Turning technological opportunity into change

The technology alone, however, isn't enough – introducing new tools can require changes to whole care pathways rather than simply adding technology to existing processes. Caroline also identifies internal governance and decision making as significant barriers to adoption, with processes sometimes taking many months without changing the eventual outcome.

Looking towards the next 20 years, she nevertheless sees significant reasons for optimism. AI, better data and accelerating developments in treatments could have profound implications for conditions such as Parkinson's and Alzheimer's – improving outcomes and quality of life for patients and their families.

Her final message is therefore about people as much as technology: public services need extraordinary talent, optimism and a willingness to try things that may not always work.As Caroline puts it, "there's a lot that needs to be done." 

The Next 20 is a celebration of 20 years of The PSC making public services brilliant. We're looking at lessons from the past, while also considering the biggest challenges in the next 20 months, and the biggest opportunities in the next 20 years. Explore our other episodes on your preferred podcast platform.