For the most part, the National Health Service (NHS) remains obstinately un-joined up. One example: a friend recently phoned the hospital to get some more medicine, but the nurse didn't have access to the relevant paper notes, which had already been sent back to the GP.
'Why don't you know what dose you were on?' the nurse asked, rather accusingly, struggling to work out the likely prescription. 'Well, why don't you?' the frustrated patient shot back.
The sort of seamless click-and-collect experience that shoppers expect when dealing with a retailer are a long way from the daily reality of the NHS, where patients find themselves repeating the same information over and over again, dealing with lost files and failures to communicate.
Beyond being just irritating, the lack of joined-up systems across the NHS is holding back progress and can be positively dangerous.
In a recent speech, the newly appointed Health Secretary Matt Hancock painted a grim picture of the current state of technology within the NHS. How hospitals each operate dozens of systems that don't talk to each other, while GPs, social care, pharmacies and community care use another entirely different set of systems. System crashes are a regular occurrence, he admitted, as the health service clings to technologies long abandoned by everyone else.
"The NHS is one of the biggest buyers of fax machines on the planet. And it's clunky, clunky, clunky," he said. "And the net result is not just scarce resources wasted but countless hours of clinical staff spent trying to work broken systems, patients being given sub-optimal care because the systems didn't communicate, and ultimately lives lost."
The NHS has tried to fix this before, with the giant National Programme for IT, which attempted, at massive cost, to build gigantic systems that could work across the entire health service. It failed.
Since then there has been something of a backlash against centralised systems, but this in turn has made it hard for the NHS bodies to communicate across boundaries -- something which brings new risks, as Hancock bluntly pointed out: "A world in which we ask an ill patient many times over for their name and address is a problem. A world in which a hospital can't pull up a patient's GP record is downright dangerous. So our systems need to be able to talk to each other."
The bigger problem is that, while NHS spending continues to rise, it's still being outpaced by increased demand for services. The population continues to grow, and while we're living longer we're also more likely to have multiple, expensive, long-term conditions for doctors to treat.
The government hopes that greater efficiency can be achieved by making the different parts of the healthcare system work better together, driven by better use of technology. This could be the key to bridging the gap between the money it's willing to spend on the NHS and the service we are increasingly expecting.
Some of this is wishful thinking: when there's no more money to be had, politicians will often promise that technology will, somehow, magically make up the shortfall. But there is also plenty that the health service could do with technology to become more efficient and improve patient care. Research by the IPPR think tank suggests that the NHS could free up frontline time worth up to £12.5 billion a year -- almost 10 percent of its annual running cost -- by investing in a far-reaching programme of automation. Another £6 billion in productivity gain could be realised by automation within social care, the think tank says.
But more money will be needed to realise these changes. According to another think tank, The Health Foundation, funding increases of four percent a year are required to generate modest improvements in NHS services over the medium term, with five percent annual increases needed in the short run. Recently the government offered the NHS a 70th 'birthday present' of 3.4 percent.
Hancock's speech was an attempt to set a new path: to force NHS systems to be interoperable by setting out clear standards, combined with strong identity security to protect confidentiality. All of this is welcome and sensible, as are plans to improve the way NHS organisations buy technology and to encourage innovative companies to engage with the NHS.
Updating the ageing technology in use across the NHS will remain a challenge. It's entirely understandable that, with health budgets not keeping pace with demand for services, spending money on updating PCs and other infrastructure is hard to come by.
But the real cost of saving money that way can be great: when the WannaCry ransomware attack tore through the NHS because software patches hadn't been installed, doctors were reduced to using WhatsApp to communicate as operations and appointments were cancelled.
Every half an hour a doctor wastes trying to get logged onto an ageing PC, which hasn't been replaced in order to save money, a couple of consultations he or she could have carried out are lost. Every time paper records are mislaid, an appointment is cancelled and treatment delayed.
Getting the basics fixed is not only likely to improve services now; it could also create a springboard for future innovation.
- NHS and technology: Making the case for innovation
- IoT and the NHS: Why the Internet of Things will create a healthcare revolution
- AI and the NHS: How artificial intelligence will change everything for patients and doctors
- VR, AR and the NHS: How virtual and augmented reality will change healthcare
This special report will look at how technologies like AI and robotics, virtual and augmented reality, the Internet of Things and wearable technology could all boost healthcare and productivity across the NHS if the money can be found to invest. The public is certainly interested: a recent survey found that more than half of people were willing to share data with the NHS via a lifestyle app or fitness tracker, and two thirds thought that the benefits of machine learning in healthcare outweigh the risks.
But right now, the NHS is not in a position to take full advantage: chasing after robotics or AI or virtual reality (which all offer great promise) without fixing the fundamentals will be as pointless as adding another floor to your house while the foundations rot away.
The gap between the existing technology of the NHS and the brilliant potential of the future is painful and acute.
For example, one huge opportunity for the NHS is to make better use of the vast amounts of data it generates and collects. Creating massive data sets that could be mined -- using big data analytics or AI and machine learning -- to find the connections between illnesses or to improve treatments could be a huge benefit to patients. But this is currently impossible: much of that information is still held on paper, or in databases that are unable to share data with other systems.
- Robots and the NHS: How automation will change surgery and patient care
- Why the NHS is killing paper records to save lives
But technology alone is never enough -- in fact, technology alone is rarely anything but a disaster. What's needed is a broader rethink of both the way healthcare is delivered and how it is provided. Technology is creating pressure for change, but also providing the means to deal with that change.
Doctors must understand that they can no longer control all the information about their patients. Giving patients access to their own records will make them better informed and more engaged in their own treatment, and much more likely to spot errors before they become dangers. Patients also need to be better informed and willing to take responsibility for their own health, rather than simply being passive consumers of healthcare services.
In a health service where talking to the doctor over the phone is considered novel, video consultations and AI-powered chatbots are just a couple of ways that services will have to evolve.
The demands of patients are changing. Wearable tech like the Apple Watch will make real-time health data a reality -- one that the NHS is not geared up to absorb. Doctors have long complained about patients turning up with terrifying diagnoses that they've created for themselves by Googling their symptoms. But as technology improves, patients will increasingly be equipped with far more data about themselves. The latest Apple Watch will be able to generate an electrocardiogram for wearers and future devices will no doubt add further capabilities.
- Smart watches, fitness trackers and the NHS: Are wearables just what the doctor ordered?
- Building the Tricorder: The race to create a real-life Star Trek medical scanner
Such an increase in patient-generated data will put increasing pressure on doctors, but may in the longer term be a benefit to all. Increasingly healthcare could become an 'always-on' process, rather than something that you only encounter when you are sick. In other words, something that we all monitor and tweak as we go along.
This will make us healthier in the long term, but will also continue to add to the pressure on the NHS unless its systems and working practices can be re-engineered.
Few in the NHS will want yet another reorganisation, especially one that's promoted as a digital transformation project. A gradual approach is likely to be more effective, so long as benefits are shared rapidly. But there is little time to waste, and it's unlikely that the money the government has offered so far will be enough to do the job. Technology cannot alone cure the NHS's problems -- but more funding, more technology and new ways of working together may at least show a path forward.
Hancock is fond of mentioning how his first job was in tech, working on fixing the millennium bug for a small company. Using technology to prepare the NHS for an even more demanding future is likely to be just as big a battle as solving the Y2K bug, and the deadline may be just as challenging.
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