The fortnightly newsletter that unpacks system leaders’ priorities for digital technology and the impact they are having on delivering health services. Contact Ben Heather in confidence here.
Nearly three years ago, the former health secretary Jeremy Hunt gave an HSJ lecture on the pitfalls of digital technology in the NHS.
He called them elephant traps and there were four.
“Let’s be ambitious when it comes to technology,” he said, “but let’s be humble as well. We haven’t always got this right.”
Mr Hunt was speaking in November 2015, before the latest round of tech funding had been announced, before Professor Bob Wachter’s review of NHS IT, before WannaCry.
Fast forward to September 2018 and Mr Hunt’s replacement, Matt Hancock, delivered a quite different speech about digital technology at the Health and Care Innovation Expo in Manchester.
He castigated IT suppliers for putting a break on NHS innovation and the NHS for “overlearning” the lessons from the National Programme for IT.
He would, he promised, bring “unsurpassable enthusiasm for tech to Britain’s health and social care system”.
A comparison between Mr Hancock’s digital enthusiasm and Mr Hunt’s more tempered approach is instructive.
Let’s start with the elephant traps.
The bureaucracy trap
Mr Hunt pointed to the US where high rates of digitisation in hospitals were linked to high rates of (electronic) paperwork for doctors.
Technology has increased the administrative burden for clinicians and reduced face time with patients, he said.
“We need to ensure that new IT systems improve rather than reduce clinician productivity,” Mr Hunt said.
Mr Hancock’s speech acknowledged the current state of NHS IT was contributing to deep frustration for NHS staff.
“Clunky, clunky, clunky” was his overall assessment.
But he was also relentlessly upbeat about tech’s capacity to cut through this frustration, to reduce bureaucracy and save lives.
The NHS, he said, “is the world’s biggest opportunity for saving lives through modern technology, and the world’s most frustrating place to work for its IT”.
In other words, technology may not have worked for clinicians last time. But this time it will.
The accountability trap
In 2015, Mr Hunt raised patient scandals at Mid Staffs and Morecambe Bay as examples of where assurance had become circular
“If the buck stops with six people, it stops with no one,” he said.
And if technology can help connect a team of carers around a patient it can also help dilute responsibility for that patient, he said.
“We must never let shared care records become an excuse for diluted accountability or a lack of personal touch.”
Assigning accountability has got more complicated again since Mr Hunt spoke, with the growing use of machine learning in the NHS.
But Mr Hancock didn’t tackle this risk directly. In some ways, he inverted it.
He spoke instead about the risks of not sharing information, about patient care already being compromised by clinicians not knowing.
“Thousands of databases that don’t talk to each other costs lives,” he said.
On accountability more broadly, Mr Hancock said it was about the centre holding providers and suppliers to account against new standards.
But he also wanted NHS providers to be bolder on digital transformation and, if they made a mistake, know that he “had their back”.
The cost trap
“Computer systems are expensive, and they can also be a total waste of money.”
Mr Hunt said the NHS had learnt this the hard way with the National Programme for IT, which he called “our biggest-ever IT disaster”.
Tech investment should focus on patient experience and clinical productivity, not “improving organisational convenience”.
Improvement in technology should be incremental not “big bang”, he said.
Mr Hancock shares Mr Hunt’s view on NPfIT and improving patient experience and clinical productivity.
But he has been far more expansive on the application of technology in solving many of the NHS’s problems.
And he wants to move fast rather incrementally.
When it came to wasting money, Mr Hancock turned to NHS relationships with “low grade” IT suppliers as a primary source of unnecessary cost.
Too often the NHS got a bad deal with suppliers, he said, ending up locked into long, expensive contracts with bad tech.
“The net result is not just scarce resources wasted but countless hours of clinical staff trying to work broken systems, patients being given suboptimal care because the systems didn’t communicate, and ultimately lives lost.”
The Data Trap
Mr Hunt was deeply concerned that the NHS “has not yet won the public’s trust that it is competent in protecting basic personal information”.
Mr Hunt was speaking six months before the government scrapped its controversial Care.data scheme and public trust in how their personal health data is handled has, if anything, eroded further since.
The Google Deepmind data sharing deal with Royal Free London Foundation Trust (deemed unlawful by the ICO) and NHS Digital sharing patient’s data with the Home Office haven’t helped.
Mr Hancock has adopted a policy, in line with central agencies, of focusing primarily on the benefits to direct care of sharing patient data (“saving lives”), which is an easier sell to the public than the research or broader economic benefits (which is not to say the government isn’t interested in these areas too).
He said “locally-led delivery” (the LHCRE) will help gain and maintain “trust by bringing along the public and care professionals with attention paid to privacy from the start”.
But he spoke less about how these local schemes will feed into a national system for sharing patient data – and more about patients owning their own data.
What to make of this?
Matt Hancock has yet to experience such setbacks and comes into the job with belief in technology that is not only political but personal.
Whether the traps that Mr Hunt outlined will catch Mr Hancock remains to be seen.
But he seems willing, at the very least, to take his chances and expects the NHS at large to do the same.
“I am not looking for people to blame,” he said. “I am looking for people to lead.”
If one of Hunt’s traps snaps shut, Mr Hancock will be hoping the public extends the same courtesy to him.