Saturday, November 11, 2017

Keeping Up?

We are certainly in interesting times, aren't we? Technology is coming at us at the rate of knots in the NHS- and the NHS is trying to give it a go of fitting in with it- how successfully -is a debate of a different nature altogether I suppose. The problem is though a traditional "method" has been to block technology based on evidence, governance etc….it appears something has shifted- and thats the attitude of the folks using it- whether it be HCPs or patients.

Take WhatsApp- the puritans will say- don't you dare use it, cos data will be leaked, confidential information will run amok - and Orcs will inherit the earth..or something along those lines. It may be a good line for governance meetings, information commissioners…unfortunately not so for those pesky modern doctors or indeed, patients. In the underground, it rages - rampant. So the suggestion is "But we could create something which will be safe- why not use it?".

Problem? The reaction is.."Naah bruv, am good. I like WhatsApp- thats how we roll- so why don't you see how you can make THAT secure, rather than make me download ANOTHER platform". To most folks outside the NHS bubble of governance, its quite unfathomable that we would want to spend money on more platforms when we have free devices like Skype or WhatsApp. I mean, I can speak to my parents each weekend on Skype- who live in India- for free- but NHS? Shiver me timbers…have you done the Governance Dance yet? And this in spite of the NHS actually using it…oh no Sir, EACH area has to have its OWN governance sign off…cos the N in NHS stands for…well..I don't know…doesn't sound National to me. I paraphrase -but you get my drift.

Lets take now the latest furore of GPatHand…many pros and cons to it- especially valid points made about funding. If you strip away patients, then you need to ensure how you balance the funding…do you increase the "fee" for more complex patients? How does a GP surgery survive etc…and they absolutely must be looked at. But the reaction is -as ever- fascinating. Is it because its done by Babylon- cos all private organisations are the devils spawn? Would we have said hallelujah and about time- if it was done by lets say, the BMA (By the way, why not?)? I don't know the answer to that- but look at twitter- many a folks are saying this works for them too in their busy lives. So what now? This is what is called disruption…or is it modernisation? Do we rail against the concept? Or do we rail against the provider? Or is this the right thing to do because that fits around peoples busy lives in 2017- but without stripping assets?

This is where technology is caught. In the world outside, technology adapts to consumers. In health, we ask consumers to adapt to the system- and we then throw around words like "compliance", "non-attenders" etc. Diabetes is no different- look at education programmes, look at technology- its all about "No- YOU fit in with me"- not.."Ok, lets see what I can do to fit in with the modern world". Education programmes- resistant to change-as thats the way its always been done, thats what got the evidence- so it doesn't matter whether Jo Bloggs can attend or not- its about sticking to what worked in the 80s or 90s. So folks vote with their feet, find their own way- or not- and then we wonder why outcomes are not quite improving. Or indeed the attendance rates.

I have got one super solid tip to many a policy-maker. Try it. Not put it on a powerpoint slide. Not run a hashtag campaign. Its called "Listening to patients". Or as the technology world says "Listening to consumers"- thats how they develop the latest thing we all go "Oh I like THAT" about. Not have a token patient to tick a box on your committee. But actually do it.Technology is no different. If you find time? Look up something in the world of diabetes -something called "We are not waiting". The response from some quarters? Predictably- Governance and evidence. People are not waiting for the future to come to them, they are going and shaping it themselves. The billion dollar qs? Can we keep up? 

Interesting times as I say- but it feels like a moment in time- the NHS -is being prodded into doing things differently. And this one won't come from politicians- but from within the system-as well as the users. Don't block it…much better to enable it. The unfolding of all of this will be fascinating to behold.

11 comments:

  1. As one of the clinicians contributing to the furore about GP at hand I agree with a lot of what you have said about technology and the NHS, but I think you have missed the point about GPaH. Babylon have been very quick and quite successful in portraying the reaction to GPaH as a reaction against technology. GPs as dinosaurs unable and unwilling to adapt to innovation. You are, I think, contributing to this narrative. Private companies are working to portray themselves as the only way for the NHS to move with the times, but this is only true if we cede this ground to them. We need to encourage innovation within the NHS, and support its development and adaptation. Where we do need to work with the private sector, we should not be repeat the mistakes of the past; giving them sweetheart deals to cherrypick patients, worsen inequalities and force other services to pick up the slack they leave. GPaH is disastrous precedent that needs to be challenged aggressively, not because it is digital, but because of the nature of the model they propose, a two tier system that will bring real harm for patients.

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  2. I actually completely agree wit you- as mentioned in the blog- the funding model and stripping assets from existing resources is silly. Its the concept i like- not quite how its being rolled out. The challenge for GPs is to counter with a similar service- of course with funding involved. Or at least thats my view of it.

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  3. Haha love the blog as always sir. NHS is very risk averse, maybe quite rightly so. But it needs to be much more agile - ie try something - if it doesnt work fair enough, but if it does - scale it up throughout. This is something that we are just very poor at.

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  5. Does what is used as evidence also need addressing? Is the only acceptable evidence that generated from a controlled trial (which is likely to the safest and most clinical but not necessarily aligned with what happens in real life) or is the reality of every day outcomes coming from 100s or 1000s of users/participants equally valid? That’s a difficult conundrum for the powers that be to come to terms with!

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