Sub-postmasters falsely accused of theft are closer to justice, thanks to the furore around the TV drama Mr Bates vs The Post Office. But the disastrous consequences of the flawed Fujitsu Horizon system should make digital leaders in the NHS vow to do better, says CCIO Martin Farrier
Mr Bates had no chance. At least when David faced off Goliath he had a slingshot and the five stones he casually picked up from the stream. And Goliath was one man.
Mr Bates on the other hand took on a monstrous Post Office. In this entirely unequal combat, the Post Office hardly broke sweat. Its multi-headed monolithic nature lumbered forward for more than two decades dragging Mr Bates and more than 700 sub-postmasters behind.
Incredibly, the Post Office has finally been brought to a halt. Mr Bates’ victory is even more unlikely than David’s triumph over Goliath. Perhaps the British love of the underdog is why the ITV drama Mr Bates vs The Post Office caught everyone’s attention. More likely, it’s because we see ourselves in the vulnerable sub-postmasters as we face the overwhelming power of corporations and their data.
At the core of the story is the infallible nature of data. Held beyond question. Impossible to be wrong.
Too big to fail
Few of the Post Office managers will have understood the Horizon software that Fujitsu ran for them. What they needed to know was only that it worked and that it cost a billion pounds. That made it too big to fail and beyond question. When you have eliminated the impossible whatever remains, however improbable, must be the truth. Sub-postmasters were what remained. It was impossible for the data to be wrong.
We now understand that the data was in fact very flawed. Mr Bates pulled back the curtain on Fujitsu’s Horizon and found an automagical box, inhabited by people pulling levers on a system that didn’t work.
There have been curtains pulled back in our own world of healthcare. We too have overpowering systems. And this is not just an issue for digital, it is about the organisational cultures in which digital systems operate.
In the recent NHS scandal, the nurse Lucy Letby remained free to murder babies while trust managers denied the evidence of the experts, the paediatricians. Like the sub-postmasters, the paediatricians knew something was badly wrong. There were too many deaths of babies in a small neonatal unit. They were told they were mistaken. They collected evidence of the deaths and recognised Letby as the cause of the deaths. This time they were threatened with referral to the GMC, loss of their jobs and public humiliation. As with the Post Office, there was a redistribution of blame.
It is against a background of growing distrust in institutions, and unease about the increasing power of computer technology – surely made worse by the Post Office scandal – that we are asking people to trust us with their health data. We hold the most personal data of a whole society. Worse, we keep it for people. We don’t trust them with it. We don’t even promise to give it back to them. As chief clinical information officer I will only return someone’s data to them if they write me a letter on the right form. Even then I may redact some information because it could be harmful to them.
Earn the trust of patients
If we want the trust of our patients, we need to set a different course. Healthcare needs to become a trusted ally. That requires data to be easily accessible and easily challenged. We need to provide much more than a helpline. We need patients to be able to mark up problems with their data, agree appropriate changes and updates, and suggest improvements. They are the experts. As digital leaders in the NHS, we can represent the right way of managing data. We can empower people with their own data.
The NHS app is close to becoming a portal into the data that patients wish to see and one that enables them to contribute their own data. They shouldn’t need my permission to do that. It should be the other way around. I need to be adding to their record. We already know that people value their health data; they are already building step counts and blood glucose data. They are gathering health data on apps. They are capable of being our trusted partners. If we manage the relationship right, we can be their trusted partners, sharing our expertise.
Mr Bates has a medical record. I want to believe he can access it without ringing a helpline. I want to know that he can have corrections made. I want him to feel welcome when he needs to discuss his data. We are GPs, consultants, nurses. We are not giants and the NHS must never become a corporate monster. When things go wrong with a digital system, we must remain approachable. This doesn’t need to be a battle.
Consultant paediatrician Martin Farrier is director of digital medicine and chief clinical information officer at Wrightington, Wigan and Leigh NHS Foundation Trust.