Interested in finding out more about what it’s like to work at YHEC? Or maybe you have an interest in digital health technologies and are wondering what a career in this area is like? In this blog, we interview Robert Malcolm, a Project Director at YHEC. We find out how he got into this role, what his day-to-day work looks like, and what he enjoys most about being part of YHEC.

What is your name, role and workstream?

I’m Robert Malcolm, a Project Director working in digital health technology and population health evaluation.

Tell us about your qualifications and career path up until this point

I chose to do economics at A-level on a bit of a whim because I thought it sounded quite interesting… luckily it was, and I enjoyed it enough to do a degree in economics at the University of Leeds. As part of my course, I completed a placement with the Government Economic Service, working on the impact and enforcement of the national minimum wage as part of the labour markets team. This gave me some really interesting insights into inequalities in the UK, which ignited a bit of a passion in me. I always wanted to do something meaningful using economics, and health economics seemed the perfect avenue to try and make a difference, so I followed up my undergraduate degree with a Master’s in Health Economics at the University of York.

From there, I joined YHEC, and I’ve been here for over five years. I’ve worked on all sorts of projects in that time, including working with pharmaceutical companies, medical devices, public health initiatives and even health economics for pets!

Tell us more about your role and where it sits within YHEC

There are several different strands to the work that I do. One of them is the evaluation of digital health, including evaluating artificial intelligence (AI), which comes with its own range of challenges, such as evidence generation, challenges with defining the comparator, and the downstream consequences of introducing AI to care pathways. I also assess public and population health, and this includes work around system redesign, the optimisation of spending, and equity. For example, we’ve evaluated interventions and services for smoking cessation and people with a gambling disorder, and the complex health and societal issues linked to those. I also lead some of our work as an External Assessment Group for the National Institute for Health and Care Excellence (NICE), supporting committees with an evaluation of medical devices, digital health technologies, and diagnostics in England [1, 2].

I work closely with a wide range of other colleagues at YHEC. For instance, collaborating with reviewers to produce detailed reports for NICE; partnering with statisticians who analyse clinical study data or routinely collected patient data to feed into economic models; and working with researchers with expertise in sustainability on areas such as the NHS net zero targets (with the aim to integrate health economics with sustainability to support more informed decision making) and optimising care pathways.

Tell us more about the impact of your work

Our work has a direct impact on the healthcare system, so it’s important that we are producing meaningful, comprehensive and useful evaluations to support decision making. Our work with NICE is a really good example: it is used by committees to make recommendations for a technology’s use in the healthcare system, so it has a direct effect on policy. The decision makers must balance a range of factors that they consider important to decisions, such as value for money, equity impacts, sustainability impacts, clinical need, and patient preference, and our work helps them to make well-informed and transparent decisions.

Our public health work also fits into national policy agendas, such as the NHS 10-year plan, with its focus on prevention rather than cure [3]. An example of this is our evaluation of decentralising NHS smoking cessation services, investigating the implementation of services alongside NHS targeted lung cancer screening [4]. Lung screening is offered to current and past smokers aged between 55 and 74 years via mobile units in local communities, places like supermarket car parks and sports stadiums. Many users of this service are current smokers, so there is a great opportunity to offer on-the-spot smoking cessation support and advice, at a time when they may be more receptive to it. Because smoking is linked to so many health conditions, there is potential to have an enormous impact if we can reduce the number of people smoking, which goes back to that idea of prevention rather than cure.

Although I’ve been talking a lot about NICE and the NHS, our work has an international impact too. Our equity work spans across many countries, and we have completed digital health intervention projects across Europe and the US. We also have the benefit of being able to partner with other organisations; for example, we’re a founding member of the Minerva network, which has given us a fantastic global resource of experts and experience to draw on.

Our work with digital health companies is really rewarding too, as we help move products along the development scale. We can be involved at any stage, be that early on, where we could be identifying the potential value of a device, or later, when we might return to support a business case in a larger scale cost-effectiveness evaluation. Although the specific impacts will vary according to the client we’re working with, we’re always focused on helping them to make informed decisions.

What do you love most about your role?

It’s the impact it has on the healthcare system. I grew up in quite a deprived area and saw the impact of health inequalities, so I’m aware of and passionate about improving health and evaluating the impact of healthcare decisions. I always really enjoy and specialise in the public health work that we undertake, and I also really enjoy the work we do with NICE.

In terms of the work itself, I like getting stuck into the ‘messy’ stuff, like atypical data sources or analyses. I can give you a couple of examples of what I mean across previous work we have done as a company. For example, we’ve done some work on home testing for sexually transmitted infections, and it’s really interesting thinking about how this changes the testing population and how that would affect the study population for evaluations, where the intervention and comparator arms have a different population, and how to deal with this in the evaluation. Gambling is another good example: it’s something that has such complex impacts and it’s interesting figuring out how to piece together the evidence to provide a useful and robust assessment. Or take wound care, a really wide-ranging field, and considering how you would investigate price and quality, how to evaluate, and how to review all the different features that are associated with hundreds of different wound dressings. Similar to this, I recently led the health economics piece for NICE, estimating the cost-effectiveness of bed frame features, which may sound trivial, but we are expected to spend over £600m on bed frames in acute settings over the next 10 years. With these kinds of projects, you won’t always find a really precise answer, but I love the process involved in providing a useful assessment using the evidence available, based on a range of plausible scenarios, and piecing the information we do have together to tell a story.

What are your favourite types of projects to work on, and why? Or perhaps you have favourite methods?

You’ll already have realised that I’m interested in the evaluation of equity. On all of my projects, I think about the impact that the intervention will have on health inequalities, and there are some really cool pieces of analysis that can be done on this front. For example, we know that epilepsy is more common in children and that there is a higher prevalence in more deprived areas. A condition like epilepsy can affect a child’s school attendance, which can lead to academic difficulties and, ultimately, impact their life opportunities. By tying all these pieces of information together in our analysis, we can better understand the full picture.

Methods-wise, we’re lucky at YHEC because we get to use lots of different methods in our work. Sometimes simple methods are best, but other times more complex methods are needed. I like that there is opportunity and flexibility to use both and that, when conducting a piece of work, it is about choosing the most appropriate tools and methods to meet the client’s needs and ensure our analysis is impactful and useful.

I’m really excited by our recent work on robotic-assisted surgery and the potential it has for improvements in evidence generation for these technologies, as well as influencing NICE guidelines for soft tissue procedures. There are no long-term evaluation assessments yet, but there could be advantages for things like cancer surgery and opportunities to increase laparoscopic surgery, so it will be really interesting to keep an eye on this area over the next few years.

What do you enjoy most about working at YHEC?

I love the fact that the people I work with are really driven to help improve the healthcare system: it feels infectious. My colleagues have passions in different areas of research, which really contributes to always feeling motivated and enthused, and we’re continuously trying to improve methods and evaluations.

I also really like the range of clients that we work with, from large pharmaceutical companies, through public health bodies and med tech innovators, to small one-person operations. We’ve always had international variety in our work and, more recently, we’re starting to work more with clients in middle-and lower-income countries, which is something else that is really gratifying.

Finally, I love that we’re continuously learning. YHEC has so many great opportunities, not least our close relationship with the University of York, which means that we can be at the forefront of new methods and that we’re always interested in developing new approaches.

What does a typical day look like for you?

There’s not really a typical day but there are common themes: there are a lot of questions, thinking and meetings! I already mentioned that we work with a broad range of clients, so there will almost certainly be client meetings, often with opportunities to work with new clients or explore new ideas.

I lead on a lot of projects, so I will be steering the work and ensuring that we produce a high-quality evaluation. I also deliver a lot of training courses and volunteer for teaching opportunities: I love talking about health economics and the associated challenges, so they are definitely a highlight for me.

How do you see work in your field developing in the future?

AI, and the evaluation of AI, is still developing and it will be important to evaluate the safety and unintended consequences associated with using it. One example is the use of AI technology to identify abnormal nodules in lung screening, which can indicate the presence of cancer. In this scenario, AI could also identify non-cancer abnormal nodules, so an unintended consequence might be that more resource is required for investigating or treating these nodules, which wouldn’t otherwise have been treated. There are some real challenges in evaluating AI, but I’m glad that YHEC is at the forefront of overcoming these challenges.

What’s your favourite thing to do outside of work?

It’s got to be football: I love playing it, watching it, talking about it…! If I’m not doing that, I enjoy walking, and I’m a keen video gamer too.

Tell us a surprising or fun fact about you

It’s probably my resemblance to Peter Crouch. In fact, when I was travelling in Vietnam recently, the guide nicknamed me ‘Peter’ and referred to me by that name so much that they forgot my real name!

How can our expertise in digital health technologies help you?

The YHEC team are experienced in undertaking a wide range of projects for digital health technologies, across all stages of the product lifecycle. Get in touch with us to find out how we can help with your project.