Surprisingly, Britain spends more on average on healthcare than many other leading economies, yet produces less than average results, as was pointed out at a recent Spectator health summit. Jane Renton asks: Could technology transform the performance of the NHS?
“Without vision, the people die,” John F. Kennedy once declared. He wasn’t kidding. He could have been thinking about the British people in their current post-Brexit doldrums. We could all do with a bit of vision right now, including - and perhaps especially - anyone ploughing away on the frontline of the NHS.
Fortunately, Health Secretary Matt Hancock - big on vision, big on technology and tipped as a possible Tory party leader - was happy to oblige.
Having declared war on the once ubiquitous fax machine and pager in the NHS, he told his otherwise despondent audience, much of it made up of healthcare professionals, to prepare for bigger and better things.
Moreover, he said, the cash was in place to help the organisation achieve it. The £34bn of extra money a year, something he described as “the longest and largest cash settlement in history” would allow the NHS to plan for the future with the confidence, as well as the technology, it requires.
Rhetoric v reality
However, not everyone in the room shared that vision, or at least felt confident that it was deliverable given current financial restraints. With some 100,000 NHS posts unfilled and England’s 227 NHS Trusts in deficit to the tune of £814m at the end of June, strong doubts were expressed by the Chief Executive of NHS Providers, Chris Hopson, about what was feasible in the current climate.
“We need to connect this rhetoric about how important this is and the reality of what we are doing to fund it because at the moment there is a very significant disconnect between rhetoric and what is to be provided for us to do on the technology front.”
Between 70% and 80% of Trust boards’ time was taken up by just trying to plug workforce and financial gaps, said Hopson.
“In case you hadn’t noticed, the NHS is in rather a deep hole at the moment and I can’t see how we can join this revolution in the way we need to until the service is operationally stable,” he said in a debate following Hancock’s speech.
Shaping change
Yet Hancock firmly believes technology has the power to not only transform the NHS, but also make people’s lives better.
“It’s my firm belief that robotics, personalised medicines, artificial intelligence and genomic sequencing will all, in time, come to be considered a routine, everyday part of healthcare.”
He said the naysayers should stop worrying about technology, which was often initially “imperfect” or rejected on the grounds that current shortages of doctors and nurses were a greater priority.
“Yes, there are important ethical questions. And yes, we must answer these, and yes, we must take people with us. But that should not be allowed to stand in the way of technological advancement,” he said. “We must not stop the clock and reject technology because it’s too controversial or too hard.”
He said groundbreaking and pioneering British medical treatments such as vaccination, immunisation and IVF had all once been viewed as both “scary and unknown” technologies that were now mainstream, with the ability “to save lives, improve lives and even give the gift of life” itself.
Hancock talked about IVF, a treatment first devised by the Royal Oldham Hospital and now a routine medical treatment, responsible for some eight million births.
“It’s become a routine medical practice within my lifetime, but not that long ago serious scientists were saying it couldn’t be done, or shouldn’t be done.”
Similarly, robotics, personalised medicines, artificial intelligence and genomic sequencing would in time be considered “a routine, everyday part of healthcare,” said Hancock.
The NHS needed to catch up with technology that had already transformed lives in previously unimaginable ways. “It is now possible to file for a divorce online - and depressingly 13 did so on Christmas Day - yet it is not always possible to book a GP appointment online,” Hancock told his audience.
Yet technology offers the potential of remotely monitoring the vulnerable and elderly in their own home, video consultations that are more accessible and flexible, as well as wearable devices that track vital signs and gently motivate people towards healthier lifestyles.
“Now some may argue that we need to hold back this tide; that we should resist and fight back. There’s even a modern-day King Canute in the form of Jeremy Corbyn, who wants to tax robots,” he said.
While such impulses were understandable, he said, adding that one of his ancestors was a leading “loom smashing Luddite,” history showed repeatedly that it is better to shape change than to resist it.
It was apparent from visits to hospitals across the country that both patients and staff were keen to embrace technology. “They increasingly expect it to be there … they want to know why their mother can’t get the best cancer treatment, they want to know why their child has to wait longer to be diagnosed.”
Making technology a priority
But, while Hopson acknowledged that yearning for better technology, he made it plain that Trusts were doing all they possibly could within existing constraints.
“However hard they run, they don’t seem able to outpace the increase in demand,” he previously said.
Clearer priorities need to be established, he told the summit: “Chief Executives of hospitals are being told to ‘sort out your A & E, sort out your cancer targets and get your CQC ratings’.”
A point needed to be reached whereby technology could be prioritised over some other really important matters in the same way as attacking superbug infections, such as MRSA and c-difficile had been in the early years of the century, he said.
“When the service mobilises to do the right thing and we properly invest the money and leadership capability, it absolutely happens,” said Hopson.
Another reason why this couldn’t happen in the way others might envisage was the fact that the NHS has been starved of capital over the past five or six years, he said. “You just need to walk around hospitals as I do every day of the week and see crumbling buildings, out of date scanners which we have to unreasonably extend the life of … You can’t drive this kind of revolution unless you absolutely have sufficient capital.”
Hopson made clear that with so many aspects of NHS spending excluded from the current funding settlement, such as provision for education & training, capital investment and social care, all vital components of the Department of Health and Social Care’s overall budget still to be determined by the Treasury’s 2019 spending review later this year, it was hard to see where the money for technology would come from.
Many of the previous improvements in fighting superbugs and reducing hospital waiting lists had been achieved at a time when revenues were growing by 6% a year, compared to 3.4% currently, well below the long-term average.
So while technology has the potential to resolve many of the NHS’s current difficulties, it cannot do so without the appropriate levels of ring-fenced funding to support it.
Perhaps Hancock and Hopson are both right: reality leaves a lot to the imagination.
