Changing the NHS – New Technology – 3

In my introductory piece to this series of posts “The Mechanics and Morality of Change in the NHS” I identified six themes that I believe any innovator needs to consider before, during and after the process of introducing change to the NHS. (New readers may want to read that first).


In terms of progress in the use of new technology, where are we in the NHS and consequently. in what we are spreading?

And the answer is – all over the place.

There are a few small locations where services are fully enabled. But they are rare and, if you think about the coincidence of luck that needs to happen for them to exist, you can understand why. A practice needs to be using modern methods of communication and patient relationships. Its GP(s) will have to work with hospitals that have made similar investments and with whom they can interoperate. This repeats for the community trust and the social care provider. All three advanced providers will then need to be part of an ICS that takes interactive technology seriously. For all this to work you will need to live in a very lucky place.

Yet, outside of the NHS, most of us – as we live our lives – think it odd that the spread of technology is a problem at all.

I occasionally commute at about 0730 in the morning and like others I am struck by the universality of the new technology being used by everybody on the train or tube. There has been no ‘problem of spread’ for IPhones and its familiars. During the last decade on the tube – it has become universal. Did this come about because someone clever developed a spread strategy?  No. (if they had I’d be prepared to nick it).

it’s a consumer driven market. People like having and using their phones. More and more people have made the decision to buy one.  In some situations they have become ubiquitous.

(I am aware that the people on my commute are not a random sample of the population. (Unlike me) they are all of working age. They work in London in a higher wage economy. They are mostly commuting, at 7.30 in the morning, to non-manual work. So, it’s a biased sample – but it’s still striking.    And I’ll return to the subject of my last post the digital divide in a moment)

How does this consumer driven market work? Despite the cost-of-living crisis people have decided, in their own budgeting, that a personal phone is important to them. And Apple, Samsung et al – together with internet providers – have met the need.

We can’t make that work in the NHS because we have as a nation (correctly in my view), rejected a market economy approach to providing health care

I believe we can introduce some elements of a drive to spread – such as much greater patient choice – but not given the current paucity of provision in the NHS. I would actively choose a GP (and mine is really getting there) that was totally tech enabled. With sufficient GP provision to make choice a reality, those that provided tech enabled primary care would get more market share.

And the same is true of the hospital I would choose. Again, market share would grow – as would their income.

But we are not in a position where the NHS can allow market failure. Hospitals will not be allowed to ‘go bust’ if they fall behind in developing tech.

So, within the NHS, unlike mobile phone ownership, patient choice will not drive spread completely. But it can do a lot more.

But, as my last post suggested, it will not be able to because the NHS is a universal service – and to use personal tech for that we need to overcome the digital divide. We can’t have an NHS principle stating that we believe in equal access for all if what we really mean is that we will exclude all those without internet access. As with so many inequalities the NHS on its own cannot overcome the digital divide, but as a nation we are going to have to overcome that divide. Not just for the NHS, but for other services.

There are alternatives to market forces.

The NHS is run from the top as if it were England’s last nationalised industry and some people think that spread can happen from the top.

But we know (me more than most) that that doesn’t work. From 2002 onward we tried to implement technology in the NHS using large national contracts with companies. Trusts and clinicians were offered both the technology and assistance with implementation.

What became clear was that local ownership of technological change is an absolute necessity. Making a complex organisation like a trust do something doesn’t work.

So, markets won’t create universal spread, and nor can top-down telling. (Can I just say here that the trouble with performance management is that it doesn’t manage performance).

We need to be a bit cleverer about it all.

The NHS works within a society where consumer choice plays a big role. In terms of tech most patients, and nearly all staff, express that preference by organising much of their lives via new technology.

Many people who want to spread new technology in the NHS see staff as a problem in that spread. I think that’s wrong.

One of my abiding NHS technology experiences is going to a big hospital as shifts changed. Hundreds of nurses walk out of the door and nearly everyone reaches for their phones and start to organise their evening. Their new tech helps them organise their life.

The nurses going into work put their phones away because their new tech does not help them organise their work.

My point here is that nearly all staff are fully tech enabled. That DOESN’T mean that they know what is going on inside their phone. (Why should they? Do they have to know what is going on inside an MRI scanner?)

But we don’t see this staff experience as an enormous resource. What if we asked them much more about their tech enabled lives and how that might help create a tech enabled workplace?

Staff use apps. And here we are in the NHS developing a much wider use of the NHS app. I am pretty sure the NHS workforce could help a lot with the better spread of that app.

Our staff need to be seen not as experts in what is going on inside the tech but as experts in using tech that works for them.

(In this series I have been outlining six methods of how to implement change for each issue. I’m afraid I am going to break that and add a seventh with my next post being about the NEW in new technology and how we need to think hard about how we describe what we are doing.)