News
Michael Holland sets the analogue to digital vision
Our Chief Executive Officer, Michael Holland, recently presented the opening talk at the annual Cavendish Square Group Conference which focused on one of the NHS 10 Year Plan‘s key shifts – ‘analogue to digital’ – and what this means for NHS mental health trusts.
Michael opened the session by framing the urgency and opportunity in digital transformation across London’s health services. Emphasising the scale of need across the capital, and highlighting that the challenges are shared by all nine NHS mental health organisations in London, including legacy infrastructure, variable digital capabilities among staff, and financial constraints.
Michael argued that digital transformation should no longer be viewed as optional or experimental—it is essential. Success hinges on understanding not just the technology, but also the human elements: staff needs, their fears, and beliefs around digital tools. He stressed that to reduce risk and improve outcomes, digital tools must be embedded into core functions like clinical governance and quality improvement, replacing labour-intensive manual processes.
Michael called for collaboration across organisations—leveraging shared systems, reducing duplicated effort, and aligning on digital strategies to serve London’s 8.8 million residents more effectively. He concluded by warning that if the NHS doesn’t lead in trustworthy, evidence-based digital health solutions, others will fill the void with less reliable offerings, putting patients at risk.
Read Michael’s full speech
I’m really delighted to welcome you to the 2025 Cavendish Square Group Conference. It’s fantastic to see so many colleagues here—many of whom I know from the past and present—as well as seeing wide system partners gathered here to listen and think about digital in the context of today, and how we plan forward for the future.
We’ve really come together at a critical moment in our journey to think about digital transformation. Crucially, this is not just about talking about technology for technology’s sake. It has to be about how it can be harnessed to better serve our patients, support our staff, and build more resilient, efficient, and equitable systems.
So this is where I am in some respects. Many of you may recognise the Walkman from your days. Some of you, looking around, might not recognise a Walkman. But at the time, it was a technology left for a generation who had “nothing to say”—that’s how Der Spiegel reported it.
The Walkman was thought to lead to antisocial behaviour. So much so that, when it was first invented, the first model released had two headphone sockets, not one. It didn’t sell.
That’s where technology has been, and that’s where technology is in some respects. There is a lot of fear about what’s coming and what’s currently in use. We’ve got to get through that fear—because it’s used all the time. We have our phones in our pockets. We are using this technology routinely, every day, and we need to think about how we harness it daily to help our patients.
It is going to be as ubiquitous as the Walkman. AI is here. ChatGPT is here. We need to think about how we use this routinely to help our patients so it doesn’t become harmful for them.
We know London is a very diverse, growing, and complex city. We continue to grow at about 1% population growth per year. By 2035, we’re going to be 9.5 million people living in London.
We’re also growing in disparity, and we have to address that inequality—especially across London. We need to think about how digital can bridge that inequality for our children and everyone living in London.
I really don’t need to tell this audience about the mental health needs in London. We experience this every day. Just yesterday, a psychiatric morbidity study showed an 18.9% increase since 2014—from 18.9% to 25.8% in 2024—in mental health conditions for young people aged 16 to 24.
Mental health needs are significant across all ages, and we struggle daily to meet them. Yet every year we are making improvements in access, working to address inequalities and needs. But these needs are growing, and we need to act faster than we’re currently changing.
Within London, we’ve seen significant increases in demand:
- 67% increase in people sent out of area
- 24% increase in adults accessing community mental health services
- 25% increase in adults accessing NHS talking therapies
These are constantly increasing. We need to start thinking very differently about how we address this.
If we don’t, we’re going to struggle to deliver a successful mental health system for London.
This is the backdrop for our conversation today. This is what we need to bear in mind for all the discussions: How can we use digital to address these growing needs?
There is hope that technology will be part of the solution.
But we don’t want today to be just about electronic patient records. We’ve learned the lesson: poorly designed and implemented technology can reduce productivity and make working lives more frustrating, not less.
As I was writing this, I remembered—not too far away (not as far as Camden, I hasten to add!)—that just a few years ago, as a clinician, if I wanted to see a face-to-face patient, I had to log in four times for that one appointment.
If I wanted to see them online, it was six logins. It took me 20 minutes to start the clinic in the morning just to go through all the logins. That is where technology has been—and still is in some places.
But it’s changing.
Now, we know that technology can improve clinical productivity. We’ve seen technological solutions that reduce time and improve efficiency. Let’s get to a point where we use the power of regional collaboration to solve shared problems, once for London, rather than eight or nine times.
Psychiatry and mental health have been at the forefront of using technology. Telehealth has been around since the 1960s. I used teletherapy back in the 1990s, and I was involved in some of those clinics.
This is not new.
Using Teams for patients is not new. We’ve talked about the problems—what do you do about safeguarding, not being able to see below the neck—we talked about all of that in the 1990s.
Virtual reality? Been around since the 1990s. Back then, it cost tens of thousands of pounds. Now? Several hundred. We need to think about how we use it routinely in practice.
Everyone here is probably carrying a smartphone. While they’ve brought difficulties, especially for young people’s mental health, smartphones and the internet have also brought significant potential—for detection, diagnosis, and management of health issues, including mental health.
Add in sensors and wearables—cheap and accessible—and we further augment that potential.
There are digital mental health apps offering tools for self-care, mood tracking, medication management, CBT, meditation—you name it.
We know Oxleas are using Lumeova. When technology is gamified, people use it to support their mental health.
I’ve got an app on my phone I used to use more—Open Evidence. Anyone here using Open Evidence? It’s fantastic: New England Journal of Medicine, JAMA, Mayo Clinic. You ask a clinical question—it comes back with an answer, evidence-based, with a treatment plan. It takes minutes. It’s free for doctors to use. It’s already being used by junior doctors—it’s replacing their old handbook.
Colleagues are using VR too:
- Aileen O’Brien in Southwest St. George’s is trialing VR in psychiatric intensive care for relaxation and de-escalation.
- King’s College and SLAM have done exposure therapy in virtual worlds.
- Oxleas are trialing VR for skills development in forensic services.
- In Birmingham, they’re using VR for staff wellbeing.
We need to think about how we embrace this.
AI—this is going to come up a lot today.
Think of it not as artificial intelligence, but as augmented intelligence.
It augments how clinicians work. There is significant potential in mental health.
We’ll hear today about a trust already trialing ambient voice technology. This isn’t new either—it’s been around 8–10 years.
Where it’s going: integration with systems like Open Evidence to give clinicians clinical prompts. It orders appointments, orders tests, does booking—for you.
This is already happening in the U.S.
AI can analyse video and audio. Tools like:
- BlueSky AI – facial analysis
- MoodCapture – predicts mood disorders from facial expressions
So as people log in to their phones, the tech can detect deterioration. This is happening.
Chatbots are being used in Singapore to deliver CBT interventions. Adolescents are using them. They’ve reduced demand on mental health services.
Where are chatbots in our services? Nowhere.
ChatGPT—people are already using it to gain health advice. It’s not great advice, but if you’re aged 20–30, it’s one of the most common use cases—as a life advisor or coach. People use it to manage moods, stress, anxiety.
But it’s not giving evidence-based outcomes. We need to step in.
Technologies like ecological momentary assessment, digital phenotyping—also being used to predict deterioration. Singapore uses them to prevent serious mental health crises by identifying issues before they require hospital care.
But technology won’t do it on its own.
We have to think about culture, practice, and the processes behind it. Learn from other industries—banking, airlines—who design user-centric, trusted tech.
We need to improve engagement with staff and patients. When patients see their feedback is valued, that it’s incorporated, they trust the system.
We need to get to a point where this becomes the norm. We must understand our staff’s needs and address them. This isn’t just about understanding technology—it’s also about understanding people’s fears and beliefs around it. We need to use this understanding to reduce organisational risk.
With AI, for example, we can support clinical governance and audits without manual effort. It allows us to shift quality management into an entirely new domain, away from the manual processes we currently depend on.
There are three big shifts that we’ll hear more about from Emma and Tom, and again next week in the context of the 10-year plan. These shifts are:
- From sickness to prevention
- From hospital to community
- From analog to digital
These challenges aren’t new—they’ve been with us for decades. Consider the early population health trials from the 1960s. They failed, not because of poor ideas, but because they didn’t have the technology to deliver data in real time. They couldn’t adapt quickly enough to meet the population’s needs. The first trials in Lambeth failed because the data was being gathered manually, weekly—far too slowly to influence clinical practice.
Technology is now deeply embedded in every part of our lives. We can’t move toward preventive, community-based care without investing in the technology, people, and processes to make that shift from analog to digital.
Emma will also speak later this morning about the mental health strategy for London, where digital will play a key role.
I hope this introduction has helped explain why we’re focusing on digital today. The potential is enormous. If we don’t engage with it now, others will. If we don’t lead and build trustworthy, evidence-based technologies for our patients, they’ll end up using tools that may do more harm than good.
We must step into that space and take ownership.
I want to emphasise that we have far more in common as nine organisations than we have differences. Many of us use the same EPR systems, face the same infrastructure challenges, and deal with legacy technology and technical debt. Our staff have variable digital skills, and some spend hours typing notes. They struggle to adopt new technologies, often because they’re overwhelmed by outdated ones and don’t have the time to engage in meaningful co-design of new tools.
Meanwhile, our financial pressures are growing. The cost of change—given our legacy systems and skill gaps—is high.
We must break this cycle.
That’s our challenge: to realise the immense potential that digital technology offers the 8.8 million people who live in London.
Let’s use today to think about how we can harness the power of regional collaboration to solve our shared problems. Let’s work toward delivering solutions digitally—just once—for London, instead of eight or nine separate times.
Thank you.