The experience of private sector businesses trying to introduce innovation to the NHS is often an unpleasant one. At best they will be required to navigate labyrinthine bureaucracy and wait an age for every decision. At worst they will be treated with the kind of suspicion commonly reserved for politicians (and journalists) and subject to the sort of hostile questioning which might make Jeremy Paxman blush.
It is for this reason that Babylon Health – the company behind the smartphone app GP at Hand – often attracts sympathy from those who want the NHS to hurry up and join the 21st century.
The new health and social care secretary Matt Hancock is clearly among the sympathisers – in an interview with The Daily Telegraph last week he appeared to specifically endorse GP at Hand, the Babylon-powered digital GP practice, stating he wanted it to be “available to all”.
HSJ suggests the strength of his public commitment is misplaced and that, unless the health service in general and Mr Hancock specifically proceed with more caution when dealing with Babylon, then the cause of innovation may be undermined.
Why so? There are three main reasons.
Firstly, digital primary care is a fast-developing, complicated, and potentially lucrative arena. Rather than the government picking a winner – one with strong political connections and marketing flair – HSJ suggests the competing services should live and die on their merit. Mr Hancock did eventually stress the need for competition in this space – but only after significant criticism on social media and while standing in front of a Babylon logo.
The second reason is one of priority. The people who use and like GP at Hand (as with other very similar services) are the relatively young and fit, and prioritise convenience over continuity of care. They deserve to have their needs met, but it is other groups – primarily the co-morbid, old, and frail – for whom the NHS’s existing service models are currently falling desperately short of what is needed.
By putting too much emphasis on serving a group who place relatively little demand on the NHS, Mr Hancock risks looking naïve, while wasting capital fighting the wrong battle.
The final reason, and one especially relevant to Babylon, is the kind of behaviour the NHS should expect to see in a partner. In the past year or so – as Babylon has become more prominent and active – it has demonstrated a pattern of behaviour which, if seen in NHS providers, would be rightly interpreted as an inward focus on maintaining reputation.
The company’s typical response to scrutiny is to threaten or launch legal action.
Letting the media know that any mildly critical story will be responded to legally is a tactic journalists know well. Few editors like explaining to their publishers why they have bust their legal budget, and many choose to pursue less costly causes.
But it is not just sections of the media who have run into Babylon’s defensiveness.
When it learned that the Care Quality Commission planned to publish an inspection report on its service – one which was not hugely critical, but clearly not as glowing as Babylon hoped – it first sent emails trying to shake the regulator into budging; then took it to court.
When a clinical commissioning group’s board papers documented doubts about the strengths of its product, its initial response was to get angry about the recording and reporting of this, rather than proactively and openly explaining its own interpretation of events.
Babylon has also sought to exclude what it sees as potentially critical voices. The health and social care secretary was due to expand on his comments at an event hosted by Babylon. A quick call to Babylon’s press office made it very clear that HSJ was not invited. Technology correspondent Ben Heather was dispatched anyway and – after Mr Hancock said he must be allowed entry – was able to report on the speech.
There have also been concerns about how Babylon’s offering is described. The Advertising Standards Authority has informally resolved several complaints against the company’s more ambitious claims about its products (also see this Financial Times report “High-profile health app under scrutiny after doctors’ complaints”).
The NHS badly needs better access to innovative services and technologies. Ongoing controversy over GP at Hand will damage by association other businesses who wish to make similar offers to the NHS. The Babylon modus operandi is fuel to the fire being stoked by the burgeoning “NHS privatisation” conspiracy theorists.
And if Mr Hancock wants to champion innovation (which he does and should) then the health and social care secretary must choose his bedfellows very carefully. He knows he will get flak, but handing opponents sticks to beat him with – such as backing Babylon before the NHS England commissioned evaluation is complete – is only going to slow the health and social care secretary down.
There is no reason why the UK and NHS should not lead the way in online consultation and other areas of technological innovation. HSJ has no doubt consulting a GP remotely will be a mainstream part of the primary care offer within a decade. HSJ also hopes that innovative firms do very well out of helping this become reality.
The firms which succeed in this arena will be woven into the NHS’s fabric, by handling data, relationships and algorithms as core to delivery as any clinician. Both government and the NHS should consider carefully the behaviour they expect from businesses that are placed in this privileged position.