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Technology – can it be the magic bullet for the NHS?

September 21, 2018



It seems clear that Matt Hancock has chosen technology as the big idea to mark his tenure as Secretary of State for Health and Social Care. There are good reasons for doing so. There is no doubt about the transformatory nature of modern technology and the health and care sector has been slow in adopting its potential.

Twenty years ago, I was very privileged to have a job leading the implementation of NHS Direct, a service which was a genuine exemplar in the use of technology in the delivery of healthcare. While technology has developed enormously since then, many of the fundamental challenges around the effective use of technology, remain, in my book, the same. I wanted to use this blog to reflect on some of those issues.

Technology can have enormous benefits in improving the quality and cost effectiveness of healthcare. Four things stand out.

First good technology can improve the safety of healthcare by providing clinicians with point of contact information about a patient’s individual history and condition and the best evidence on how to treat it. In addition, when things do go wrong, it can provide a much stronger basis for determining what happened.

Second technology can promote access and facilitate the best use of clinical time, in particular of specialist clinical staff, by reducing the need for travel time and of, some groups of patients, reducing some of the barriers to accessing care.

Third digital applications open the potential to involve patients proactively in their care by supporting self-monitoring and self-care and facilitating peer support. As various approaches in mental health have demonstrated intelligent remote monitoring can help make the best use of clinical capacity, targeting resources on those in immediate need rather than tying up time in routine appointments.

Finally, there is enormous potential in the data generated through the use of technology to help improve care, better target resources and support research into future treatments.

While developments in Artificial Intelligence have perhaps extended the range of possibilities the basic parameters of what technology can offer are very familiar from what I encountered when working on NHS Direct. The bigger question is not what is on offer but what are the challenges in realising those benefits and where are the potential risks in how this is done.

There are again four key questions.

To start with how we are sure that technology is addressing the current need for healthcare rather than just stimulating an additional level of demand? This was always a dilemma for NHS Direct and the challenge is all the more acute in times of more straitened resource. Technology can make it easy to improve access but that will be counterproductive if it generates additional downstream demand which the system is not resourced to deliver. An exception might be if we can target interventions on areas where late identification of symptoms has a negative impact on patient outcomes or costs.

The second question relates to the implications for staff of technologically driven change to their working practices and lives. As anyone who has been engaged in a technology project knows, the technology is the easy part, it’s the people bits where all the real challenges rest. If we are serious about technology driven change we need to invest heavily in staff training and in the effective redesign of care pathways in ways which seamlessly incorporate technology. In doing so we need to be open the very real anxieties which staff have about the impact of technology on their jobs, in particular in relation to issues of control, and, just as importantly, their professional worth. I was always struck by the extent to which GPs felt threatened by the introduction of a nurse led service in NHS Direct.

A third consideration must be the issue of digital inequalities. This can, at times, be overplayed and for some groups, for instance young people, digital applications can offer better ways of connecting with populations the NHS struggles to reach through old fashioned means. (It staggers me, for instance, in 2018 that the NHS still uses snail mail as its predominant means of communication with its younger patients). The trap to be avoided is to take a one size fits all to digital development which sees the world sole through the lens of the middle aged, middle class smart phone user. As a universal service the NHS also needs to keep open a variety of channels and approach based on “clicks and mortar” must be on offer.

The final question relates to where to ownership of digital developments best sits. As with all structural issues the NHS has oscillated between centralism and localism. The National Programme for IT has cast a long shadow and while to drive a certain measure of progress in digitising the NHS did so at the expense of disempowering local organisations, and front-line clinicians. Perhaps there is never a totally right answer but perhaps STPs or ICSs provide a level where, for some issues, you can get the best balance between ownership which is so crucial to service transformation and economies of scale in relation both to cost, but just as importantly the management of resources and contracts.

It is one of those adages that we always overestimate how different the world might look in two years’ time but consistently underestimate the level of change ten years might bring. The current Secretary of State might not be around in ten years’ time but sure as anything technology should be central to the development of health and care.

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