Labour is committed to digital and pinning hopes of NHS renewal on AI. But the shadow Health Secretary should understand there are no easy wins in digital transformation. By Digital Health editor-in-chief Jon Hoeksma
It’s a sign of the changing political tide that Wes Streeting, shadow Secretary of State for Health, was a keynote speaker at last week’s NHS ConfedExpo. Even more so that people were paying such close attention to what he said.
And what he had to say was interesting as he firmly committed to digital, AI and data as key enablers of NHS modernisation and renewal under a future Labour government.
There was plenty in his speech about training many more doctors and nurses, and investing in buildings, but these are recognised as longer-term objectives, requiring both time and investment.
What is striking about the focus on digital and data is that they seem to have been identified as offering potential for significant improvements in health in the short-term. AI, in particular, appears to have been identified as offering much more immediate results without requiring up-front investment.
The logic seems to be ‘there are a host of start-ups and mega tech companies working on AI in health, let’s just let them do their thing’ – rather forgetting that they are all counting on the NHS and other healthcare systems paying for their services.
There is no question of the huge potential of AI across many areas of health and care, as well as the widespread concerns about its potential risks and harms. The more digitised the NHS is, with ever richer data, the greater the power to harness patient data for care, planning and research.
Wes Streeting, shadow Secretary of State for Health
Get the basics right
But AI is not an island. It is just one part of a complex digital eco-system that remains rooted in much less glamorous worlds of hardware, infrastructure, and networks, and of course lots of IT, digital and data professionals. Getting the IT basics right year-in-year-out is every bit as important as the latest shiny and exciting AI app.
Can trusts provide staff with laptops that run windows operating systems that are not about to cease being supported? Do staff using patient electronic medicines management software have access to reliable wi-fi throughout the buildings they work in? Can care home staff access basic information on a patient through shared care records? Are networks and medical devices secure from cyber-attacks, and can organisations recover services when they are inevitably hit by attacks? Are trusts running data centres that literally meltdown when summer temperatures soar (as happened at Guy’s and St Thomas’ last July)?.
The reality of course is that boring basics and cutting-edge innovation need each other. Too often though some hard-pressed health service organisations decide they need to take a holiday from investing in the basic IT foundations they rely on. With digital and data now so vital to the running of modern health services, it’s almost analogous to deciding to take a break from paying for utilities, medical gasses or swabs and sutures.
Chronic lack of investment
The problem identified all the way back in 2002 by Derek Wanless, in his eponymous review of health and care, is that at the macro level the NHS simply does not invest nearly enough year-on-year in IT to see the full benefits of digital transformation; and as a result, the pace of change and modernisation has been persistently slower and benefits more elusive than they might otherwise be.
Interestingly, the last ‘New’ Labour Government drew much the same conclusion as Streeting, that better IT and digital tools were vital to enable NHS reform and modernisation. Back then it was called computerisation.
This led to Tony Blair championing the £12.7 billion NHS National Programme for IT, which while providing a bonanza for some tech suppliers and management consultants, largely failed to achieve its grandiose aims, as laid bare by subsequent National Audit Office investigations. Perhaps unsurprisingly, Streeting didn’t mention NPfIT in his speech. Maybe its selective amnesia or maybe there is nobody left in the youthful Labour health team that even remembers it.
Which is a shame, because a prospective future Labour government that wants to harness digital technology to improve NHS productivity and patient outcomes, could learn some valuable lessons from the NAO reports on what went wrong when New Labour decided to computerise the NHS almost 20 years ago.
Too much focus on tech
In particular, the NAO concluded that far too much focus was put on procuring technology and far too little on implementing it successfully and organisational change. As the old saw goes ‘culture eats technology for breakfast’.
Another big failing was that it was a bureaucratic, obsessively secretive, top-down highly centralised programme that often failed to secure local clinical buy-in and leadership. Over time it became increasingly detached from reality as it failed to deliver on its central vision of integrated electronic patient records.
Lessons from the Blair era
The thing that Wanless, Blair and his Chancellor Gordon Brown fundamentally got right in the early 2000s was that if you want to make a significant difference to NHS productivity and bring down waiting lists (which had reached then record levels under the preceding Conservative government) you have to invest serious resources.
It’s worth remembering that the £12 billion ten-year NHS IT programme was just one part of a whole series of big, linked investments in hospitals, staff, equipment and waiting list initiatives. New Labour basically threw everything at the NHS they could lay their hands on to turn the tide. And, ultimately, it proved highly effective, waiting lists and wait times plummeted, though ironically because it was so late the IT didn’t really make the impact expected.
Fast forward 20 years and the parallels are all too obvious. A decade of Conservative ‘austerity’ and cuts left the NHS singularly ill-equipped and lacking capacity to deal with the pandemic when it hit in 2020. Waiting lists, which had been on the rise pre-Covid, soared and have continued to rise since the official end of the pandemic, passing 7 million and counting.
Reverse the damage
Any new government that seriously intends to reverse the damage done to the NHS over the past 13 years and equip it to deal with the challenges of 21st century healthcare will again have to prioritise making sustained strategic investments in growing NHS capacity and workforce, accompanied by investments in IT infrastructure, digital and data capabilities. All are required in concert.
In another parallel of 1997, it looks like an incoming Labour government would commit to tight Conservative spending limits to show its financial discipline. But with an NHS facing meltdown of the kind feared during the pandemic, there is a case for arguing that emergency investment is required. Remember, the current government found £30 billion for Test and Trace alone. The total cost of Covid measures on the UK is estimated at £310 – 410 billion.
It’s entirely understandable why politicians like Wes Streeting, and his advisors, find AI so attractive: it seems to offer a panacea to the complex and seemingly impossible problems facing the English NHS. AI unquestionably has a part to play, but not in isolation and not without sustained strategic investments in expanding the wider capacity and capabilities of the health system as a whole.