So this is my last Power to the People column. Time to move on before I start repeating myself. Time hand the space over to someone else with a different generational perspective.
It’s been a privilege to write something each month and to have been given a free hand by the EHI editors to cover the things that I think have been important.
So what have I learned? One signature theme is that NHS IT years are the reverse of dog years – if each human year is equal to seven dog’s years then the stuff that happens in the world of NHS IT is about 1/7th of that achieved by the citizenry.
Just look at how much the NHS spends on IT kit compared with the citizenry. During the Connecting for Health campaign, the NHS spent around £1 billion per year on IT.
Meanwhile, the people – that’s you and me and pretty much everyone else – was spending a minimum of £400 per household per year on phones, broadband, tablets and PCs. With 25 million households that works out at a cool £100 billion over the same decade. NHS £1: Citizens £10.
A second theme is that the transaction costs within the citadels like the NHS are rising, while those of the citizen are falling like a stone.
So for any citadel – be it government, the NHS, the police, the BBC, the banks, schools, Network Rail, Tesco – the costs of coordination are rising. Meantime, they are falling for any connected citizen; be they Edward Snowden, Twitter trolls or petrol heads who want to show their support for Jeremy Clarkson.
To take just one example, look at the transaction costs of integration, that Holy Grail of current healthcare policy. Each move to integrate stuff in the NHS comes toting high transaction costs.
Information governance, systems that don’t talk to each other, cultures that clash, organisations that compete when they should collaborate – all these are the very stuff of high transaction costs; which is just a fancy way of saying they are a complete pain to work with.
Meanwhile, citizens just boogey on down to Google or Facebook to find people with the same interests. They start chatting and Tweeting and in a twink they have integrated themselves with their neighbours over the global fence. Then they start coming in your front door armed with information, support and their very own data.
Now, admittedly, this is happening more slowly to the NHS than it is to hotels faced with Airbnb or universities challenged by MOOCs. But the underlying economics mean that in the medium term new forms of coordination and change will come faster from patients and carers than they will from organisations and politicians.
Power to the people
For centuries, the relationship between patients and their health care providers has been a one-way street in which doctors and organisations held all the cards: it was patients who were information poor, who lacked resources, and who were much more vulnerable.
These imbalances of information, power and vulnerability have shaped medicine since Hippocrates. But our networked world is beginning, slowly, to change this. This goes way beyond the fact that patients and carers now come highly informed.
Today’s patients have access to significant new resources. Not those controlled by the system, but those created by patients themselves: the forum, the voice in the night from the other side of the world saying ‘have you tried this?’ and, increasingly, the ability to share your bio-data and your life experiences with your community of fellow sufferers.
These new resources are created by the lower transaction costs of the loosely coupled, but intelligently communicating, crowd of ‘people like me’. This is not ‘co-production’ – which is what those people called patients are still supposed to do to help the system. It’s much more like hacking healthcare from the bottom up, from the outside.
NHS informatics is essential – but perhaps not forever
Of course, the core task of NHS informatics – getting the right information to the right professional about the right patient at the right time – is deeply non-trivial and lies way beyond what patients and citizens will ever be able to do independently via app or web.
I do not think for one moment that if only NHS informatics was somehow better, or more like private industry IT, then the high costs of change would be magicked away.
NHS IT is a hard slog because it handles life-critical, highly personal information in a system that is understandably highly risk averse; and I salute the dedication and professionalism of all those who strive to overcome all the barriers to progress and to improve care for patients.
While ever we still have big systems providing highly invasive care to relatively passive patients we will need all the skills of NHS IT professionals. But at some stage in the next 15 years the distributed power of the loosely-coupled network will begin to alter the dynamics of healthcare in completely new ways.
The accrual of what we now call life style data, linked to personal biosensor data, and driven by the emotional power of acting together with those who are also struggling with the same disease and problems as you – all this will reshape how patients see themselves and it will transform medical practice.
A revolution underway
‘Power to the People’ is no longer a slogan left over from the 70s. It is a statement of where the benefits of much technology are flowing.
Marx said that we would need a revolution to free the means of production but it turned out that Bill Gates and Steve Jobs were happy to sell them to us for £500. Let’s hope the NHS survives the revolution that is just beginning to wash at healthcare’s doors.
Paul Hodgkin is founder and until recently was chair of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield.
Until 2011, Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.