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).
The third change that the NHS needs is a recognition that there would be very considerable health gains and healthcare productivity improvement if, over the coming decade, it moved into the most advanced 25% of English services in its use use of new technology. This is a considerable step up from its present position. It will involve change in the practice, not only of every NHS staff member, but also the activity and experience of every single patient. This is a very big deal
If on the other hand the NHS remains where it is in comparison with other services, we will lag behind – not only in staff and patient experience of the use of technology in their lives, but also on how new technology can be used to relieve millions of peoples’ pain and distress.
How do we persuade NHS clinicians that this is an activity that they should carry out?
Persuading clinicians to use new technology is a complex change process. Complex because some of the clinicians you are trying to persuade are ahead of you. They are passionate about the cutting edge of change and have been involved in developing the technology you are trying to persuade them to adopt. So, for them it’s not a problem.
Others are convinced that the way in which they were taught and the way they have been practising is the right one. They resist the change you are talking about – sometimes vigorously.
Many of them do so because they are convinced that the way they practise their skills is the best for their patients. They resist change partly to protect what they see as their patients’ interests.
It is very important not to disrespect clinicians who are resistant to change – they are often doing so with patient care uppermost in their minds.
And there is a long history of this.
I remember, 20 years ago, visiting Carol Black when she was appointed as the first woman president of the Royal College of Physicians. We used to have breakfast in her office at RCP headquarters in that beautiful modern building at Regent’s Park. As I walked through the lobby I looked at the paintings, some of which went back if not to its foundation in 1518, then to the innovations of many centuries ago. It was clear from the artwork that the RCP and other colleges have been arguing about clinical technology for centuries. Some in favour – some against. And, to state the obvious, at the time technology was NEW technology.
While I believe that the next decade will see faster technological change than previous decades, let’s not pretend that there have not been centuries of arguments about the introduction of new technology into clinical practice.
It has never been without conflict. Some of the changes are very simple. (Watching the play Dr Semmelweis about the enormous conflict in Vienna over the suggestion that it was important to wash your hands after postmortems and before delivering babies was both scary and instructive of how clinical science moves forward.)
I make this point to underline that there have always been conflicts about new technology and how clinicians see themselves in relation to the process of change.
Some of the emotion in these arguments will be about how clinical judgment is being supplemented by machines. Over the next decade Artificial Intelligence (AI) will add its power to clinical decision making – but for some clinicians they will experience it as a machine taking power away from them.
Again, this has happened before. All the technology we have now has both added to and subtracted from what clinicians did before. Before MRI and PET scans clinicians made judgments about what was happening inside our bodies. Some personal clinical judgements have been taken away by the scanning machines. Previously clinicians had to make judgments and did. Now the machine gives us information. I think this adds to a clinician’s power, but machine input can also be experienced as diminishing it. The same will be true of AI.
There will be arguments about clinical judgment being replaced by machines.
But even more significantly will be the capacity of new technology to help patients and non-clinicians engage in healthcare.
I have been taking my own blood pressure for a few years now. The results stay with me and on my phone. After a recent operation, my blood pressure went through the roof and stayed there for 12 hours. On discharge the nurse told me that I needed to take my own blood pressure for a week and send the results to my GP. Before I could do so my GP had to send me a text which allowed me to send my results back embedded in a text response. (I’m fine if you’re interested!)
This meant that my GP and their staff have not seen me. And crucially, in terms of the nature of clinician care, have not touched me (I’ll return to that). They have received my results from my own monitoring. They are reassured, and so am I.
I am pretty sure this has come about in 2024 for three reasons.
First the GP practice (and me) trust the technology and my ability to use it. It includes the process of my taking my blood pressure and then communicating the results to the surgery. This hasn’t happened before, so I suspect that this trust is a new to them.
Part of that trust has come about because – let’s face it – none of this is really NEW. For 5 years I have been taking my own blood pressure and the technology has been around for a long time. And I have been able to put numbers into texts for much longer than that.
So, in 2024 none of this is really NEW technology.
Second, in 2024 GPs are so busy that they don’t suggest that I come in for them to take my blood pressure. (It’s a large practice with a number of non-clinicians working alongside the clinicians). This is an important driver for change. For me it meant (and this is crucial) that if my blood pressure was going to be taken at all it would have to be taken this way.
This is the future – learning that our own activities with machines will relieve the NHS of some of its work.
Third, (and this is a negative reason that Covid has impacted). An important emotional part of the clinician-patient relationship involves the “laying on of hands”. I use that somewhat mystical phrase because clinicians do have a strong belief in being in the same room as a patient and if necessary being able to touch and feel the patient. Remote technology prevents this. For many clinicians and their patients this is a loss.
But Covid demonstrated that we could do a lot of very important health care without being in the same room. During Covid it felt like life and death depended upon all of us being able to carry out testing for the disease. In fact, the whole country depended upon our ability to self-test. We did it and we all depended upon our capacity to do it successfully.
And that experience has had an impact on a great many people.
An important Patients Association survey was published on 13 February which showed that 77% of patients were now prepared to test themselves at home.
If in 2024 three quarters of patients are prepared to self-monitor at home, then I would suggest the nation is ready for the revolution in new technology that is already happening.
My next post will explore how we make a public-facing case for making this new technology an everyday part of the NHS – as it has just become for me.