Joe’s View: Christmas in space and the app that fell to Earth

Alongside the inevitable Christmas bloat, the NHS App is in danger of becoming bloated with modules of additional functionality, writes Professor Joe McDonald

As you make your way home in the cold night air with the last of your Christmas shopping cutting off the circulation in your fingertips, before you go in your front door to put the last present under the tree, look up into the night sky for a moment.

Cloudy, but there are some gaps through which you may glimpse the stars and something else, brighter than the stars and moving fast across the blackness.

Santa? The International Space Station (ISS)?

Spare a thought for the 10 brave souls spending Christmas in the ISS this year and for all the brave souls who have spent Christmas there over the last 25 years.

Spare a thought too for all those in its sometimes-terrifying predecessor Mir, the first modular space station, where long-term residence in space was pioneered by the cosmonauts of the former Soviet Union, making the ISS possible.

Mir was the victim of too great a weight of expectation, politics, money, and egos

Mir represented the high point of Soviet achievement in space and was the pride of the nation before the nation fell apart – followed shortly by Mir.

Following the collapse of the Soviet Union, money to support Mir ran short and corners were cut. There was a serious fire on board and an attempt to dock a rubbish disposal module nearly ended in disaster.

This incident gave rise to the urban myth that they added too many modules and eventually the station was just too big and pulled by gravity out of the sky in March 2001.

In fact, Mir was the victim of too great a weight of expectation, politics, money, and egos and was deliberately brought to earth in a fiery death that left behind only broken dreams. The tale is wonderfully told in the television series of the year, the BBC’s ‘Once Upon a Time in Space’.

The NHS App’s gravitational pull

Watching the tale unfold, my mind was drawn to another project which seems to have developed a massive, political, gravitational pull of its own – the NHS App.

I know from my experience of the success of the Great North Care Record that success has many fathers and that failure is an orphan, but the obvious national success of the NHS App has made it beloved by the politicians who are desperate to be associated with success.

Being this close to the political heat is a dangerous place for an IT project to live (remember the National Programme for IT?) and the NHS App now seems to be gathering modules of additional functionality, like an unsustainable space station, which look hard to manage technically, politically, and financially.

I’m sorry, but an app is just an app –  it can’t be the saviour of the NHS. We need an App Store full of beautiful interchangeable apps to save the NHS.

Having been involved in more national EPR usability studies than anyone else in the world, I’ve learned that it is niche products that are beloved by their users and products with a wider scope are less liked. Scope and usability are inversely proportional.

I’m sorry, but an app is just an app –  it can’t be the saviour of the NHS

For example, remember how thrilled you were when you first got Uber? It got you a taxi, handled the payment, and guided your driver who hasn’t done ‘The Knowledge’, safely to your destination anywhere in the world. Amazing.

Now it wants to get you a meal, a flight, a flu jab, recommend a hotel and it’s, frankly, gone to hell.

‘App bloat’ has ruined it and I fear the weight of expectation and proximity to politics puts the NHS App in as precarious a position as Mir and there is a real possibility of it ‘doing an Uber’.

The NHS App should not be allowed to bloat, so that it can do one thing really well – provide the login for the citizens to enter the ‘NHS App Store’ and get what they need.

Awkward discussions with politicians are urgently required, maybe a job for Sir Jim Mackey who now seems to be trying to get a personal grip on NHS tech scope creep. Very wise.

Meanwhile up on the ISS things are also a little awkward for the part-American, part-Russian crew this Christmas, as every night they can see pinpoints of red, flashing in the Ukraine and Russia that represent the loss of peace (Mir) in Europe. Three christmases now with deeply unfestive lights.

I hope the astronauts in the ISS can come together to celebrate Christmas. I hope you have a merry Christmas and a peaceful new year during which the NHS App and I try not to gain too much weight.

Peace on earth and goodwill to all men.

Professor Joe McDonald is medical director at Sleepstation and The Access Group, former NHS trust medical director, national clinical lead for IT, founder of the Great North Care Record and consultant psychiatrist. He is the author of  FHIR and Loathing in Las Vegas, featuring a compilation of columns published by Digital Health News.