Changing the NHS – New Technology – 5

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).

Ensuring promised cost savings are delivered.

20 years ago, when I was working in a national job, and more recently when in a regional job, tech companies wanting to work with the NHS always said it would save an amount of money. It was usually a big number, and in truth the NHS can always make very good use of extra money. So, this was an attractive sell.

But when solutions were implemented, the money was rarely saved and promises of improving productivity rarely realised.

Over the next ten years the NHS cannot afford this to continue. Other services save money through tech. The NHS now needs to do the same.

There is much discussion about poor productivity in the NHS – and it’s a very important discussion. Productivity is judged by output per staff member. Productivity goes up when you increase the technology (machinery) that staff members use. If, on the other hand, you add more staff and machinery stays the same it’s very likely to go down.

If you work in a service such as the NHS, the main currency for success is how many new people you employ. If we are talking about hospitals – where in the four years up to 2022/3, we employed 20% more nurses and 19% more doctors – then unless you considerably increase machinery in that short period it is very difficult to increase productivity.

Put simply, if the NHS is to increase productivity over the next ten years, it will need to increase the amount of machinery per person.

But technology will only increase productivity if it is matched by staff members wanting to use it to increase their work outputs.

In other services the application of technology is used to increase the amount of product per person. Historically the application of technology to existing work processes swallows up some existing jobs. This has been one of the main motifs of the application of technology to industries since it changed weaving in the 18th and 19th centuries.

And, given anxiety about job losses, back in the second decade of the 19th century the response to the introduction of technology was the same as it has been in every decade since. This is a very bad invention because it is taking away our jobs.

Back then this struggle created a name that has been attached to technology resisters ever since – Luddism. (Ned, or King Ludd was a (probably) legendary figure who smashed the knitting frames that were swallowing the jobs of weavers)

“Luddite” is the name that has echoed down the ages for those resisting change.

The hammer wielders that smashed machines in the 1810s, and the radiologists decrying the AI tech reviewing scans were/are both protecting their livelihoods. Their resistance to change arises from the very reasonable fear, not only of losing their wage packet, but of the job that gave a lot of meaning to their lives. If we ignore those fears, it is inevitable that change will be resisted. If technological change is resisted as a nation and as an NHS, we will fail to gain the benefits we need it to provide.

That’s why if we are to use technology to increase NHS productivity over the next decade – and we really must – we must talk directly to those fears and help people through them.

I always start with a phrase that sounds flippant but is very important.

Ten years from now there will still be enough sickness to go around.

For many years now the modus operandi of the NHS (and social care) has been to have hundreds of thousands of vacancies. Every day everyone rushes around trying to see all the patients they can. The notion that in some way that we will ‘run out’ of sick people is so far removed from day-to-day experience as to be absurd.

Ten years from now there will still be enough sickness to go around.

But the way in which all these staff work with people will be very different. That may be true of nearly every staff member. Without effective cleaners’ health care could not function and AI will inform cleaners of those locations where a lack of cleanliness is the most dangerous. AI will structure the decision making of the CEO and it will guide the brain surgeon about exactly where to cut. Jobs will be different. Perhaps all of them.

But there will be jobs. And for that fact to provide any reassurance to staff Human. Resources will be the part of the NHS that may change the most. If it’s true that most people’s jobs will be changed by technology several times, and if those people whose jobs are changed will need to be employed doing the new jobs, HR will have to get used to retraining, retraining, retraining. It would be absurd to make people go through the pain and anxiety of redundancy, and then have to go through the pain and anxiety of applying for new jobs, when what actually needs to happen is the same people being retained (and repeatedly retrained) for new technology-assisted tasks.

Moving from one job to a different one will become very normal. Those NHS organisations that become good at this will thrive, those that don’t will have a very difficult decade.

To take a concrete example. At the moment I have three apps to work with the NHS. My GP app for primary care, my MYChart app for epic with my hospital care, and my NHS App (mainly for Covid passports). All need staff working with them. Alongside those staff are others that bypass the apps and phone, email, text me and write letters. Add all of that together and even though there is new tech, productivity is pretty low.

There could be one app (as there is with my bank and almost all the other institutions I rely upon). This could mean administrative staff working in very different parts of the NHS would no longer have to variously communicate with me.

They will not be doing their current jobs. But given the need for a much greater skill mix in the NHS, and the amount of care and its organisation that we need, it’s absurd to see them as ‘not needed’.

There are several million people who need care they are not getting; the increased productivity of technology will help them get that care – and more quickly. To do it we will need to retain and retrain our people so that technology can help us meet so much need.

Even with technology, there will still be enough sickness to go around.

2 Replies to “Changing the NHS – New Technology – 5”

  1. Hi Paul,

    Would be interested to hear your thoughts on why the promised cost savings never materialise?


    1. I think the main reason the cost savings never materialise is because the NHS lacks the skills and motivation to chase them down, realise them, and the capture them.

      We can see with tech,as with other expenditures, that these are treated just as additional budgets rather than investments to actually save money.

      We can do this (and will) but will need different skills and mindset

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