All this week I am trying to unpick the five major arguments being made about the overwhelming pressures that challenge the NHS. I am trying to uncover why the way in which these arguments are made is, rather than unlocking and forcing change, making that necessary radical change more difficult.
My overarching point is that it is the posing of these arguments as a set of challenges that are in fact overwhelming the NHS. What I am trying to is to demonstrate that each challenge presents opportunities for the NHS to adapt rather than being overwhelmed.
Today I want to look at the nature of technology.
In our everyday lives technology enables. Sometimes it frustrates but mostly it makes our lives a lot easier. Modern communication is rarely a burden and mainly a boon. In our world it doesn’t feel like an overwhelming challenge.
The challenge of new technology for the NHS lies in the enormous and recognised gap between what the NHS knows it is achieving through technology – and what it knows it could. Most people, whether they be a district nurse in a patients’ home, a GP trying to find out which drugs were prescribed to their patient in hospital, or a patient just trying to find out what is going on, know that their experience of the NHS is not as “technology enabled” as it could be.
Each of them, and others beside, recognise that simple and cheap elements of new technology could transform the ways in which things work – and how they are looked after.
Indeed some of this is not new technology at all, but is old technology used to its full potential. A GP friend of mine always used to say that if doctors ever recognised that the telephone was a two-way instrument – that could be used to talk to patients as well as having them call you, the consultation process could be transformed.
And within that observation lies an important truth. New technology only really works if it enables something that the NHS already wants to do. Too often the NHS has tried to use technology as a change agent in its own right. When that happens the current way of working – the current culture – maintains its old way of working and the new technology simply bounces off it.
Its lies like a heap of junk in the corner of the room.
So the battle for modernity in the NHS needs to be won by using technology as a small part of change, rather than as its main driver.
One example would be changing the nature of the GP/patient consultation. The technology supporting telephone consultations has been around for a long while. The technology for email consultation for not so long, but few people would still refer to email as new technology.
Yet it is only in the last couple of years that the GP practice with multi-channel forms of consultation has developed with any scale. ‘Getting to see’ the doctor has become less significant than ‘talking to the doctor’. This hasn’t abolished the face to face consultation, but it has placed it in a multi-channel set of contacts.
This has not been caused by the invention of the telephone and email. It is a consequence of some GPs recognising that they have to change their core practices if they are to serve the best interests of their patients and then using ‘new’ technology to facilitate the change. Once the decision to change has been made really new technology can transform this multi-channel relationship with patients.
In the future we will see this as a significant change in one of the core relationships of medicine. Given that we know that the main site of health care is the patient’s own home, interacting with the patient there during consultations will become ever more important.
If we succeed in making the home technologically enabled – so that it can provide a place of safety for high acuity cases – then the ‘burdens’ of both aging and non-communicable diseases (discussed over the last two days) will be transformed.
The potential here is transformative. It provides us with a real chance to address the disparity between the services that are provided – with their over-emphasis on hospital-based care – and those that are needed – for more care in the community and at home. The opportunity is to harness technology – from big data, through patient-owned health records, to mobile health applications – to help make that transition.
And before anyone points out that the use of modern forms of communication is differentially spread around the population, this is of course true. But the relationships formed by new forms of communications are surprising and can be developed by the NHS. Many people much older than me have benefited from using Skype as they keep in contact with their family across the world. Grannies rent or buy new TVs so they can have big pictures of their grandchildren beamed in from New Zealand.
What we know about this technology is that the public will only use it if there is a point to using it. Grandchildren provide such a point.
I would suggest that the better management of health – staying out of hospital – will provide a similar powerful motivation.
New technology will be an enabler in developing the public’s motivation for better self-care. But it will not make that happen. That will need a better understanding by the NHS of what motivates people to better self-manage their own lives.