Changing the NHS – New Technology – 6

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).

Consider the Unintended Consequences of Change

When making any big changes one issue we need to think about is any unintended consequences. Of course, because they are UNintended, sometimes we can’t foresee them, and this is especially true for technological change.

One part of this that I am only just getting my head around – but will become normal in the next few years – is the use of AI, not just in the workplace, but even more significantly in any new model of NHS care in the patient’s home. It even sounds odd to write this since I, like a few others, still tend to see technology as being machines – like MRI scanners.

But algorithms are not physical things, they, like so much of this new world, are in the air (or more precisely in the ‘cloud’). And they can easily move from the cloud to your home via your laptop or phone.

At one level that’s pretty old hat – techies know this. But what it means for patients is that they can use some of the new knowledge that their clinicians are using in their homes. How, at my age, with my medical history, do I understand a high temperature and sweats? At the moment if it lasts very long and I‘m worried I phone 111.

And what would 111 do? Over the phone they would apply an algorithm to my symptoms and my description. Right now they won’t have my medical record, but I could – on my phone. 111 will advise a number of possible actions. Sometimes to go to your GP, sometimes to visit your pharmacist to request medication.

My point is why do you need 111? The algorithm they’re using could just as easily be on your phone. As a referral mechanism you could do all that they do.

It’s very true that the operators of 111, have over the years gained a lot of knowledge and experience which makes their judgements better than my just doing a one-off.

BUT crucially the algorithm has access to all of that knowledge and experience (and more). It gives me so much more knowledge to base any decision on. All in the palm of my hand.

Of course , for some patients, clinicians with experience of diagnosis being guided by the same algorithm would have more confidence in their judgement, but to make the current model work with the level of sickness we have, and will have in the future, we will need to use the acquired wisdom of technology to help us make the decisions that we can ourselves.

But others – me for example (and possibly you dear reader) – would love to have all of that knowledge at our fingertips.

If you also had your own clinical records, you could add that information to the app together with any data that you may have – such as blood pressure, temperature etc Because having that information puts you in the position of being able to provide it to the app and receive better guidance than 111 can offer.

And before I hear a cry from the back of the room of “that won’t diagnose cancer” – no-one is suggesting that it will. We will need a clinician plus an algorithm for that. And just to be sure a scan, plus another clinician, plus another algorithm. (We will be using them there too).

How does all of this relate to thinking through consequences?

If, as looks likely, over the next five years most patients could a) have all of their records on their own devices, b) carry out other medical monitoring (not just the temperature and the testing that was key during Covid, c) have an algorithm-driven app to make sense of this on their phone or tablet,  d) know today’s waiting times for primary care, urgent care and the opening hours of local pharmacies – they will have a pretty good initial health service in your hands.

Just as most people now have their bank.

But won’t this mean more demand for clinicians who will be overwhelmed by the even more “worried well”? There will certainly still be patients who will feel that their needs require a visit to a clinician. That’s already the case. But there will be others who will be happy to have health care in their own hands and be able to look after themselves just as they now look after their own banking.

To make a personal point. For most of my life – partly because of my upbringing – whenever I went into a bank to withdraw some of my money, I felt incredibly grateful to them for letting me have it. I don’t feel that now that my bank and my money is in my hand. I sort of think it’s mine.

The analogy with health care is pretty important here. For most of my life – partly because of my upbringing – whenever I went into an NHS clinic of any kind to get home health care, I felt incredibly grateful for the clinicians for letting me have it.

I won’t feel that in the future because, like my bank and my money, my health care is partly at least in my hand. I sort of think it’s mine.

This is what I mean by ‘changing the NHS model of care’.

What are the unintended consequences here? If the public have much more health care in their own hands, it will have an impact upon those who at the moment have health care in their minds – NHS staff.

There will be significant changes to the work that NHS and social care staff actually do.

And this is where I return to my previous post in this series.

“There will still be enough sickness to go around”

Health and social care will still need the numbers of staff that we have at the moment, but the nature of the work they will be doing will change.

Given that most of the staff that will make up the NHS and social care labour force in 2035 are already there, they will (probably all) experience changes to what they do and the skills they need to do it.

That completely changes the way in which HR retraining (and retraining and retraining) will be needed.

If you currently look at an entire clinician career about 90% of the money spent on their training goes into their initial training. Over the next decade, given the necessary changes in roles those proportions will need to radically change.

A good proportion of the resources that will be saved by using technology (remember productivity increases when the proportion of labour to machinery in the work changes) must be reinvested in retraining staff so that it becomes a normal part of their experience.

And to finish on the process of retraining.

In the present and the future that too is a process that will no longer need buildings called lecture theatres and classrooms.

You can hold your retraining in your hand and be in control of where and when it happens.

It’s true that technology causes problems, but it also provides solutions to those problems.