In case you didn’t notice, the Department of Health slipped rather an important announcement out earlier this month: it’s going to effect changes that will, in the words of at least one rather breathless commentator, “make accessing the NHS as simple as [accessing] online banking."
How so? Well, the idea is to push ahead with what’s being called the effective “digitisation” of the National Health Service, bringing more and more of the technologies we use in everyday life (ubiquitous Internet connectivity, smartphones, apps, Skype/video) into where they have for so long been deliberately excluded: the hospital and the GP’s surgery.
The aim: “Better use of data and technology has the power to improve health, transforming the quality and reducing the cost of health and care services. It can give patients and citizens more control over their health and wellbeing, empower carers, reduce the administrative burden for care professionals, and support the development of new medicines and treatments.”
Thus the vision, enshrined in a new Policy paper out of DoH, Personalised health and care 2020: a framework for action. Sounds fantastic, right? But how realistic is all this? Some of the chatter out there on a “digitised” healthcare model is frankly, naïve. In fact, it’s so self-serving and untruthful as to be genuinely unhelpful to us as a society.
Yes, it’s true that a lot of information is on paper and held in isolation at our local doctor’s and isn’t available for you to look at on your Galaxy on the Tube. But that’s to suggest that paper is in some way a deficient, inherently unstable recording media, a sort of floppy disc format that is in danger of becoming inaccessible next week… and despite all the protestations of the ECM (enterprise content management) industry, paper is a perfectly fine storage mechanism which seems to have got us more or less successfully from subsistence agriculture to global capitalism (or did the Victorians secretly have better IT than we knew?).
That’s a suggestion that will scandalise tech-heads, who have as a foundational, theological belief that (to use Nicholas Negroponte’s old binary distinction) bytes are inherently superior to atoms. Perhaps they’re right. What we can be sure of, in this post-Snowden age, is that it’s a lot safer for my personal ‘atoms,’ my medical history, my data, to sit in paper in the doctor’s cupboard than it is to be floating around in cyberspace – which is effectively the same as him photocopying it and putting it on the bus for everyone to read, let’s face it.
At least some of you will have fallen over in shock now: is he saying that we shouldn’t digitise records and have wonderful electronic medical systems that can share data all over the NHS?
Well, yes, Virginia, I am saying that.
The reason I am saying that is that a ‘paperless NHS http://digitalchallenge.dh.gov.uk,’ the Department of Health’s semi-mystical nirvana that will somehow shimmer into existence in a mere three years (just around the time Universal Credit is fully delivered, right?) is a lot more of a sexy, cool thing to talk about than the reality of what the NHS is now, at least in England: a creaking, battered, patched-up, once beautiful old lady on the very edge of losing the will to live completely.
Pushing so radically for e- and m-Health, app health, digital health and so on is purely and simply a way to avoid dealing with the under-funded, ridiculously badly re ‘organised’ NHS Lansley imposed on us (which, let us remember once again, was not in any manifesto or mentioned as a programme of government prior to 2010).
It’s a fantasy. It’s just a way of patching over the cracks… the policy equivalent of ‘Next year in Jerusalem.’ If you don’t believe me, listen to Simon Stevens, the head of NHS England, in his game-changing ‘Five Year Plan’ document: “To secure the future that we know is possible, the NHS needs to change substantially, and we need the support of future governments and other partners to do so… we need to get serious on three fronts: we need to take our own health seriously, change the way services are provided [as well as] ask the next government to support us financially to carry on delivering high quality services.”
And it’s also right up front in that DoH document we started this discussion with, of course: “The health and care system faces unprecedented financial constraint at a time of rising demand for its services. Technology can help people use care services less by supporting healthier lives and transform the cost of services when they are needed. It is key to helping our NHS meet the efficiency, as well as quality, challenges it faces.”
Translation, in case you need it: We don’t want (or really can’t afford) to spend more on conventional health and ‘digital’ – aka make the punters do more of it on their own smartphones - is our Get Out Of Jail Card only way of coping.
Digital health is also the magical solution for non-public health delivery models, of course: “In the future, all-in-one apps will store a patient's health data in one location. That repository could then be easily sent to a person's new doctor, or from one specialist to another, all from someone's phone… a person could track how their cholesterol levels have changed over time, rather than waiting for a scolding at their annual doctor's checkup” is one I picked almost at random from recent press releases by HIT (health IT) companies (though interestingly that particular quote is from a pharma company exec).
But what links both a vision of an NHS as easy to consume as online banking and a smartphone that does all the work of expensive doctors for you is, and don’t be naïve about this: cost.
It’s a self-service model.
It’s the medical equivalent of closing branches if you’re a bank and pushing everyone to use call centres. It makes the user do the work and save you money.
I, for one, would have more respect for discussions about the electronic future of the NHS if it was framed more honestly, like this, than dressed up in lots of handwavium about seamless access, convenience and ability to ‘share’ (read, steal or commercially exploit – qua the whole care.data row we covered earlier this year
And, to its credit, sometimes the government does say it up front: “Dan Poulter said the NHS was ‘embracing technology’ to enable people to take more control over their own care while saving the health service £5bn over the next decade [as] digital technology would support front-line NHS staff to be more productive, cut down on bureaucracy and paperwork, and allow doctors and nurses more time to care for patients” for instance.
But don’t deceive yourself about what “cut down on bureaucracy and paperwork” means, as it means exactly what it means in business when you say make more efficient:
Sack some people and put computers in instead.
If we’re lucky, that also might “give patients and citizens more control over their health and wellbeing”… but they are not the same thing by definition that e-health fans would have you believe.
As we may soon, accompanied by real pain and suffering, find out?
This is the third of three special Health IT reports 24n has carried in November. So go here for our look at whether the NHS is making enough use of the G-Cloud and here for a look at life in the UK HIT market post the National Programme
If you are interested in the issues raised by these pieces, you might like to attend this HIT event in January 2015