The challenges the NHS faces have been well documented – and are not something you need reminding of in this article. Faced with these problems, and working within the many constraints the service works within, it seems that the Health Secretary Matt Hancock is determined to use technology to transform services – whether those working within the sector think it’s a good idea or not.
The tech focus shouldn’t come as a surprise. Hancock, former secretary of state for Digital, culture media and sport (DCMS) and the first MP to proudly launch his own app, used to work for his family’s software business. He also told the BBC shortly after he replaced Jeremy Hunt in the role: “One of the things I’ve done in different parts of government is make sure that it’s more tech savvy and digital.”
The good news for Hancock is that there is every opportunity to transform tech within the NHS. Amazingly, the NHS is the world’s largest purchaser of fax machines – and government attempts to upgrade technology have failed in the past. Then there’s the ever-increasing use of ‘new’ technologies such as Artificial Intelligence (AI), Internet of Things (IoT) and machine learning. Plus, of course, there are smartphones (more on that later).
If Hancock’s quotes to the media and his keynote speech at the recent NHS conference is anything to go by, those technologies are firmly on his radar. In that speech he outlined his vision for NHS-wide IT standards and closer collaboration with tech companies, as well as encouraging in-house teams to develop innovative technology. But amongst experts in health IT, the reaction to Hancock’s grand plan has been sceptical at best.
Commenting to Wired, Phil Booth, coordinator of patient privacy advocacy group medConfidential responded to the speech by saying: “What does this announcement do to reduce pressure on the NHS this winter? How will it make February better for the frontline? What will help someone who wakes up at 3am struggling to breathe when they’re afraid and deciding whether to call an ambulance? There’s nothing that reduces demand in the system either. NHS IT has many examples of misplaced ministerial priorities via methods that can’t deliver the best care for patients. Matt Hancock is bringing his DCMS experience – that the market will sort it out – to the NHS. We see how that’s going in news and democracy…”
That scepticism is shared within a concerned primary care sector – and with reason. For example, he infamously urged GPs to do more to adopt innovations such as virtual consultations via video, and the use of artificial intelligence, extolling the virtues of GP at Hand, which uses artificial intelligence to assess symptoms and offers smartphone consultations.
Last month he criticised NHS attempts to block use of such schemes, saying every patient should be able to benefit from such services. This, with every reason, fuelled a backlash from some GPs who said the service run by private healthcare firm Babylon has not been properly evaluated, with fears its systems could miss serious symptoms.
Few would argue that technology has a role to play in modernising primary care and the wider NHS – and the drive to adopt digital is nothing new.
Take the example of NHS-wide data driven IT systems. The principle was identified back in 1982 by the Koerner Steering Group. A fully computerised NHS has been the goal of government strategies published in 1992, 1998, and 2001, while attempts to deploy IT systems have proved incredibly costly and usually failed. 2003’s National Programme for IT cost close to £12bn before being scrapped in 2011. More recently, 2013’s care.data programme cost the taxpayer £8 million before it was scrapped in 2016. Costs for the currently deployed General Practice Extraction System spiralled from a predicted £14m to a final £40m.
The problem with these is that they were ill thought through, poorly planned and, crucially, failed to engage the very professionals they were supposed to help. This brings us back to the problem mentioned above that Hancock is trying to let the IT sector sort the problem out.
More worryingly, Hancock told a Conservative fringe meeting that the NHS cannot afford to wait before rolling out new technology, suggesting that delays could carry greater risks.
“People say … we’ve got to make sure it works perfectly for everybody before we roll it out,” he told a meeting with the RCGP. “No, we don’t, we have to roll it out for people who can benefit while making sure it is clinically safe. But clinically safe means up to high safety standards.
“There’s an analogy here with driverless cars. If driverless cars, autonomous cars, can reduce the risk of an accident compared to a human by 90 per cent – but it still hits the headlines when one of those 10 per cent happens – then that’s still an improvement.”
Unfortunately for the minister, new technology such as GP at Hand, isn’t exactly loved or backed by the sector. The service also fell foul of the Advertising Standards Authority, which banned adverts for GP at Hand for failing to make it clear that users must leave their current doctor and need to wait up to a week or more after registering before they can access the service. This thread on the Practice Index forum is well worth a read.
It’s time to get it right
The above, rightly or wrongly – time will tell, encourages primary care professionals to question Hancock’s judgement and, crucially, his understanding of general practice. And that’s going to make his job harder when it comes to rolling out new tech. The NHS is fed up of years of failed IT project difficulties and failures, so Hancock needs to win back the trust of those who matter – NHS staff. That means taking a step back, working hard to get the tech right and producing digital solutions that actually make a difference to every stakeholder.
In conclusion, rather than forcing ill-informed technology on GP practices and the wider NHS, which will be destined to fail from the get-go, the health secretary needs to take a step back, build a thorough understanding of what is actually needed and deliver solutions that outperform expectations and build respect. Only then will practices fully embrace the much-vaunted digital revolution.