Hancock must apply the brakes – technology in the NHS needs careful consideration

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Former Culture secretary Matt Hancock is fundamentally in the wrong job. This Health Secretary pays precious little mind to the real and fundamental issues of understaffing and underfunding, the positive resolution of which would solve the majority of the NHS’s problems, but instead chooses to spend his time (and your money), on blindly pursuing digital innovation and ignoring the pressing issues that matter.

Hancock’s family business is in software – no coincidence then that his focus is on technology. Transferring his passion and expertise for digital to the NHS, where human contact and empathy are crucial to success, appears to be a difficult leap for him to take. Shadowing a couple of nightshifts and making the right noises over staff wellbeing is cheap talk and will not excuse his lack of action in the other areas that matter. The onus on utilising technology reduces patients to commodities to manage – or worse, to exploit for profit. Hancock’s leadership is characterised by a relentless yet superficial focus on technically efficient data management at the expense of all else. In this sense he fails to address the crisis in the NHS, and deeply frustrates staff and members of the public in the process.

Focus on the basics first

As has also happened in the recent past, the Health Secretary came under fire last week from members of the medical profession for his endorsement of the country-wide rollout of digital application WaitLess. This app enables users to search for the emergency department with the shortest queue using real time information when they are in need of treatment. Hancock said of this initiative that it could ease pressure on the busiest hospitals, but his focus is all wrong. If users are well enough to ‘shop around’ on their phones then its debatable whether ED is the most appropriate option in the first place. Clear to most is that investing in more staff to make all EDs accessible is what is really needed.

Many clinicians have publicly commented that before going headlong into a digital revolution, to merely have an up-to-date, well-functioning and reliable IT system would be a good start.

A questionable partnership

In his latest move, the Health Secretary has chosen to align himself to the right-wing pressure group the Tax Payers Alliance who openly advocate for an insurance-based health system. He has collaborated with them on a report exploring automation in the NHS. The Tax Payers Alliance describes itself as a grassroots campaign ‘to speak for ordinary taxpayers fed up with government waste, increasing taxation, and a lack of transparency’ but this is a misleading description. The source of their funding is unknown and they have the worst possible rating in terms of transparency on whofundsyou.org. Their report claims £18.5 billion could be saved by 2030 across health and social care budgets if the NHS uses more automated services but provides only circumstantial evidence on how this could be achieved.

A privatised NHS is possibly the biggest untapped profit-making resource in the developed world with nearly 70 million users. There is massive potential here to profit from the vulnerabilities and needs of so many people under the guise of assisting patients and staff. Private companies and the digital initiatives/artificial intelligence that they create, if selected by the government, could have free reign to limitless data and markets, the profit-extracting possibilities of which are almost endless. The Tax Payers Alliance report says:

“Automation of health and social care also makes sense from a business perspective. The UK is not alone in having an ageing population. Globally, the proportion of people aged 60 or over was just 8 per cent in 1950, but this is projected to rise to 20 per cent by 2050 … The worldwide medical robotic systems market size was valued at more than $7 billion in 2014. Given the growing size of this market, it represents a significant export opportunity for UK companies, which should be welcomed by the government. It will provide opportunities for companies operating in the UK which will grow the economy and increase revenues for HM Treasury.”

Out in the open, the underlying aim here is not to assist patients and NHS staff, but to back this government’s covert policy direction and go on to extract profits and wealth from patients’ ill health treated as a commodity. The route to saving money through artificial intelligence means widespread job losses, the consequence of the rather ambitious aim to replace humans with robots for personal care tasks by 2025.

The voice of reason

The Academy of Medical Royal Colleges (AoMRC) has much to say about placing too much emphasis on the benefits of technology at the expense of other areas and makes a number of sensible recommendations:

“Politicians and policymakers should avoid thinking that AI is going to solve all the problems the health and care systems across the UK are facing. Artificial intelligence in everyday life is still in its infancy. In health and care it has hardly started – despite the claims of some high-profile players. Clinicians can and must be part of the change that will accompany the development and use of AI.”

AoMRC also highlights how in this brave new world data requires careful handling:

“For those who meet information handling and governance standards, data should be made more easily available across the private and public sectors. It should be certified for accuracy and quality. It is for Government to decide how widely that data is shared with non-domestic users.”

Based on this government’s previous track record with regard to safeguarding personal data, the prospect of rushing through major technological changes and giving private companies access to patient records is a worrying one. One only has to look at the scandal over AI company DeepMind  and it’s breaking of UK privacy laws to understand the potential for leakage of private details to third parties.

A new era of privatisation

Digital technology introduced too fast and without rigorous analysis is the next phase of privatisation. It is a trojan horse that enters the NHS by attacking fax machines and pagers, but unchecked could culminate in selling patient data to the highest bidder and filling hospitals with robots who threaten the roles of paid staff. This is no sensational Luddite thinking – there has been no meaningful consultation with staff and patients prior to these rapidly emerging ideas for a technological revolution, and crucially no tried and tested approach. Understandably clinicians en masse have very little appetite for methods of working/digital applications that have not been subjected to proper scrutiny and peer review.

The Academy of Medical Royal Colleges says:

“External critical appraisal and transparency of tech companies is necessary for clinicians to be confident that the tools they are providing are safe to use. In many respects, AI developers in healthcare are no different from pharmaceutical companies who have a similar arms-length relationship with care providers. This is a useful parallel and could serve as a template. As with the pharmaceutical industry, licensing and post-market surveillance are critical and methods should be developed to remove unsafe systems.”

It is too early to tell whether this style over substance approach and a neglect to focus on the fundamentals first may have backfired for Matt Hancock. Staff on the front line are repeatedly ignored when they tell the Health Secretary what it is they really need with regard to IT and infrastructure. The worst-case scenario means this approach which prioritises private enterprise at the expense of all else has created white noise and potentially turned NHS staff off to the benefits of future technological advances in the process.

Samantha Wathen, Press and Media Officer for Keep Our NHS Public

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