The NHS has a notorious track record in modernization. Its legacy computer system is the stuff of legend. The out-of-control NHSX tech quango – which launched the disastrous Test-and-Trace app – isn’t even audited. The latest attempt to reduce its reliance on 9,000 fax machines ended in surreal defeat. The âworst fiasco ever,â Tony Blair’s national top-down program for computing, rightly casts a long shadow. It failed dramatically after encountering a number of endemic issues in the health service, including a reluctance by trusted managers to relinquish control over their personal fiefdoms.
The reform environment is even more hostile to today’s Conservative government. With strong unions aided and encouraged by those who continue to insist that ‘our precious NHS’ is ‘the envy of the world’, even minor reforms have met with street protests. Forty percent of primary care administration could possibly be automated tomorrow, but can you imagine the outcry?
The great tragedy of the NHS ‘retrograde failure to embrace new technologies is that such advances offer the only hope of building a health service capable of meeting the challenges of the 21st century. Beyond the immediate tasks of making it through winter without collapsing and clearing a waiting list stretching as far as the eye can see after 18 months of intermittent shutdowns, the NHS – and the health services of the West – face pressing fundamental questions.
When the NHS was created in the 1940s, its spending was supposed to decline as people’s health improved. The opposite has happened, and demographics suggest it will get worse. An aging population poses enormous challenges, including simultaneously leading to greater demand with relatively fewer taxpayers funding the system.
Squaring the circle – delivering better care when more people need it – will need to be done around the world through technology. The NHS will have to adapt in the future, whatever the painful process, or be passively crushed by the change. In the age of techno-health, even the British reverence of the health service will not survive if it begins to be seriously ignored.
It is safe to assume that the money that Rishi Sunak would have earmarked for faster broadband and the digitization of patient records will turn out, like previous technological efficiency reforms, to be wasted money. But we can already see more bottom-up technologies seeping into and taking hold in parts of the healthcare system. Proceed to online appointments. General practitioners who have adopted online consultation platforms as a pretext to âhideâ from their patients are dancing with the devil. The increased use of apps and other technologies may still prove to be an important step in the path of a comprehensive reform of the primary care system, by referring patients directly to specialists. There is no reason why we shouldn’t extend home testing to non-Covid conditions such as UTI.
The extraordinary potential of the technology is palpable in an article published by the Tony Blair Institute – a Prime Minister much more vehement on healthcare reform than today’s Conservatives. Along with quick wins such as rapid diagnostic centers and more robotic surgery, he calls for a greater focus on patients taking charge of their own health through wearable technology, as well as ‘leveling out’ Â»Smart hospitals.
We are already behind schedule in using the pandemic to catalyze massive change. Internet hospitals are being rolled out in China, with 5G ambulances and online consultation experience right up to prescription. Germany has passed a law allowing doctors to prescribe health apps, with the costs borne by insurers.
It doesn’t have to be like that. In some ways, the centralization of the NHS is an advantage. For example, we have the best data in the world for research. Investors are drawn to its clear priorities, from early detection to remote patient monitoring.
However, the government could do more to help innovators get their foot in the door. Reformers should make smarter use of the NHS ‘vast management stock to nail down bottom-up technology adoption processes. From consulting doctors at the early stages of development to adapting the technology to different clinical settings, a little time and patience, as well as management discussions, will pay off big.
What is clear is that at some point in the future, whether they like it or not, those bureaucrats avidly protecting their outdated Windows Vista systems will have to become outliers in – rather than the embodiment of – the. NHS culture.
Imagine the distant future of healthcare. Your great-grandson uses his genomic sequencer to check his spinach and eggs for signs of E. coli (a routine precaution in the age of antibiotic resistant bacteria). He chats over tea with his wife, who has made a full recovery since her smartwatch detected breast cancer early and he was cured with a treatment invented by artificial intelligence. He works as a medical engineer (they used to be called doctors) overseeing nanobots in the local intensive care trailer park (which is never “overwhelmed”).
At some point in the journey towards such a reality, the resistance of particular NHS interests to reform will be exposed. When that almighty tipping point arrives, the squeaky, tax-sucking public sector Leviathan will be shown for what it is: a system that has trapped the country in an insane hell of cyclical trouble. A health service that for the foreseeable future will retain our freedom to ransom each season of Covid / flu, messing up booster shots and then struggling to treat the resulting cases in understaffed intensive care units.
The front line will remain strapped for cash, as the task of managing its backlog diverts resources to managers. All the while, politicians will never dare to try to reform the holy NHS.
But at some point, technological change will reach the point of becoming unstoppable. If our politicians wanted to do something really useful, they could start fostering a ‘tech culture’, ignoring the left’s paranoia about privatization and taking the first steps towards embracing, not demonizing, change. .
They will be too scared, of course. But it’s good to hope.