There has been a fair amount of press coverage of the NHS and its problems recently. The national treasure, so precious to us all is in trouble. Horror stories of long waits in corridors abound, overstretched GPs leave the service, unable to take the pressure, data leaks and hospitals report being near breaking point, while surgeons, even when they have the time and the operating theatres, end up being frustrated by the fact that operations are cancelled because there are no beds to send patients to afterwards.
I do not want to get into the need for more funding. But over and above that issue, there are other problems, with inefficient data use and resourcing in the wrong place. One thing is for certain: money alone won’t transform the NHS. Because money alone is not what is driving the machine. The Goliath organisation as a whole sometimes seems not to be operating in a 21st century.
I’m not an expert on running health services, but I am an expert in technology. And I know that often, issues with technology are symptomatic of wider organisational issues. And that if the technology in a large organisation is “solved” to the satisfaction of employees and customers then, in the process, other issues are resolved. Technology should never be for technology’s sake, but for those that use it. It is an integral part of how an organisation works. And in the process of taking stock of what technology is doing, the user experience and what it is doing, wider issues can be addressed.
How an organisation approaches technology is often symptomatic of functionality as a whole. If the NHS solves its technology issues, it is likely that it would solve the NHS as a whole. Technology runs into every artery of how it operates and creates efficiency and satisfaction or not as the case may be.
My research with those working within the organisation reveals an organisation that was created at and for a different time, which is buckling under the pressures and demands that it now faces. The NHS administration (and I don’t mean that in a bad sense) is simply not geared towards the needs of the 21st century.
The NHS technology landscape encourages a culture of, metaphorically, operating dials and knobs as you would in an inefficiently-heated house. Not in terms of patient care - those at the sharp end are heroically dedicated to providing the best possible care for the end user, but in terms of organisational approach.
The people who work in the healthcare system are real people with real lives. They have Amazon Prime and Netflix and iPhones and they are tech savvy. They don’t spend their entire existence within the confines of the NHS. They are normal people, with normal lives and exposure to the “outside world”. They come into the office, surgery or hospital where they work and what do they see?
Old operating systems. Upgrades and random systems unification projects going on for no apparent reason. User unfriendly interfaces. They resent the technology provided and they feel betrayed. While in their home lives they are pioneers and in their actual jobs (if they are in research hospitals for example) they are pioneers, but as far as their work technology is concerned, they are not encouraged to be the ones that challenge, that get involved in improving the flow of information. Doctors and nurses will resort to writing little notes on scraps of paper rather than wade through reams of ugly pages with poorly laid out data to add a couple of lines.
Technophobes are not born, they’re created. And organisations such as the NHS create them, because who feels enthusiasm for technology like this?
Staff from senior consultants all the way down to junior admin clerks turn their backs and say “No thanks to all that”. They don’t trust the system.
Some counties’ records are available for only a small part of the system. If it is necessary to want to see more of the records – they have to be printed out and then sent in the post. Systems get upgraded but on a piecemeal basis. They aren’t so good at speaking to each other. New systems are built, but also only in part of the organisation – it’s all just patching up. Systems are being built just for function, disregarding user experience.
The NHS, a British beacon, in order to create optimum confidence not just in its people but in its overarching organisation, needs to convey to everyone in the UK that it is a modern outfit, in line not just medically, with the best of the best globally, but also organisationally.
In the 50s and 60s the NHS had state of the art technology. But that was built on and built on rather like a wall that has had the cracks repaired so many times not much of the original wall survives and it is unrecognisable.
Much was made of a recent report commissioned for the NHS examining AI for healthcare. AI? Prioritising that would be like putting a state of the art all-modern, kitchen kitted out with robot chefs and IoT enabled frying pans into a room with a badly leaking roof. The roof needs to be fixed before a fancy addition of high tech.
Data security issues in the NHS are important, but they have been over-emphasised. Data security is not rocket science and would be highly improved with an overarching new approach.
What is needed here is not artificial intelligence but real intelligence. And the confidence and heart to rethink. The people on the ground need to be fully surveyed and engaged so that their real day-to-day working experience is collated and brought into a picture that provides real answers to the wider issues. When is the system working? When isn’t it? What are the frustrations? The time wasters? The necessary and the unnecessary bureaucracy (some bureaucratic elements are essential – I’m not knocking them at all).
Is it quicker to enter data and use a screen, or is it actually quicker to use paper? How popular are both with staff? What could make life quicker, easier, more enjoyable and accessible for both workers and customers? All organisations need to do this to stay healthy. If paper printing is what works for thousands of people working in the NHS, so be it. Go back to paper for that part.
But whatever happens, the on the ground staff are the ones who have the answers.
In my opinion, if the NHS solves its technology, it will in the process have gained enough information to be a whole new modern organisation and can look forward to another 70 years of brilliant success and delivery to the patients that rely on it.