Monday Morning Moan - how the UK plans to digitally transform its health service (a.k.a. this time it’ll work, honest, it will!)

I had a bad feeling going in to Matt Hancock’s latest speech on the future of the NHS when I saw it was being billed by the UK Department of Health and Social Care’s PR wonks as “his first digital transformation speech since the pandemic began”.

That descriptor carries an unrealistic burden of anticipation that was always going to prove too heavy. Kate Bush does her first live shows in decades! Wow! ABBA announces first new music since the band split up!! Are you for real?!?! Matt Hancock talks tech for the first time in over a year!!! Er…nah, I’m good, thanks. 

I don’t know about you, but frankly, given the events of the last year, I can honestly say that one thing I haven’t been hanging on desperately to hear from the British Government's Health Secretary are the words:

I’m a tech geek.

But that’s what I got, as Hancock used a keynote speech last week to outline his plan for the UK’s National Health Service (NHS) to “fix historic IT problems” so that every part of the service is ready “to benefit from digital transformation”.

Bad memories of modernity

At this stage, I should probably state that the very thought of high-profile NHS IT overhauls brings me out in a cold sweat. The mention of transformation schemes on such a scale brings back horrible memories of the NHS National Programme for IT (NPfIT), the bastard offspring of ill-informed techno-lust on the part of then-Prime Minister Tony Blair and spawned in frightful copulation with some of the most arrogantly-inept project leadership ever seen in the UK public sector.

Setting out to provide electronic patient records for all NHS users, NPfIT - commissioned on the back of a one hour (!) pitch to a credulous Blair, even then in search of a political legacy that didn't involve obediently trotting behind George Bush into a war - ended up costing billions of pounds of taxpayers money, embroiled the UK Government in costly court actions with major US systems suppliers and delivered…well, two-thirds of faff-all frankly. To this day, despite some stiff competition from the Verify ID initiative, NPfIT remains the totem for how not to do government IT projects.

But time is a great healer and it seems that enough time has passed for the pain of NPfIT to have faded sufficiently for the UK powers-that-be to contemplate having another go. In fact, Hancock, never knowingly under-sold or under-selling, makes the bold claim that the whole world is now ready for what’s on offer, although those of us who recall being told that we owed it to “modernity” to pursue Blair’s folie de grandeur may be less-than-convinced when he claims:

I think we have won a big argument. Those of us who can see and believe in the power of technology to improve people’s lives and improve healthcare have long held that belief, but now it’s commonplace – everyone can see it.

Sing it brother, hallelujah!!!

Internet protocols over pay rises any day!

Hancock goes on to repeat the hugely dubious claim that everyone in the NHS is now a tech-enthusiast, an assertion no less risible now than the last time he took it out for an airing:

When I talk about interoperability now, I get a very positive response. And when I talk about trying to make the NHS into a digital platform at which everyone can work seamlessly, that gets a positive response, not just from people who are themselves techies and personally interested in technology, but now everyone can see it is important.

Important it may be, but I’d imagine most NHS staff would still rank being offered a pay rise greater than a contemptuous one percent as somewhat higher in terms of importance, especially after the burdens placed on them over the past year. Systems interoperability or being able to pay the gas bill - hmmm, which topic do you think dominates the conversation at the nurses’ station on most hospital wards?

Still, back to Hancock’s version of the world and its priorities and the one point where it does at least collide with reality is in his observation that digital transformation has accelerated during the COVID crisis. As noted multiple times on diginomica, there are plenty of exemplars of this coming from the private sector. For his part, Hancock wants to talk up some health sector use cases:

GP surgeries could keep operating remotely because of the huge strides that have been made in telemedicine and then were made in the pandemic. Getting iPads into care homes to make sure people could stay in contact with their loved ones. And we built on that digital infrastructure to make sure the testing and then vaccination programs have been able to operate in a seamless way. 

In the face of such child-like enthusiasm, it seems almost churlish to utter the words ‘track-and-trace’, but there’s nothing wrong with churlish when we’re talking about a digital tech program, with a budget of £37 billion of public money over two years, which basically didn’t work, a conclusion reached variously by the UK legislature’s House of Common’s Public Accounts Committee and National Audit Office as well as supported by wide-spread anecdotal evidence.

How such a flagship digital project could go wrong when Hancock chose, as the best person to put in charge of it, a Conservative Party life peer best-known for her mishandling of one of the biggest cyber-attacks in UK business history and who hadn’t, by her own words on TV, been let in on the secret that viruses can mutate, something known to every schoolchild in a biology class, but not to Baroness Dido Harding. Ah, it all comes down to leadership in the end…as we saw in NPfIT last time around…

Blame the new guy

Talking of leadership, Hancock is at least setting out his ideas up front, laying down some key principles for his recycled new vision for a digital NHS. For example, everything needs to be connected, he urges:

We have to make it easy for everyone within the NHS to use data to help improve the care that they give That means if you’re a surgeon, a GP or a district nurse you need to be able to draw information from, or put information into, the same care record in a safe and straightforward way.

And for patients, that means people need to be able access the data that, after all, in principle, belongs to them. People need to be able to access their own care data. It is a principle on which we need to build. To make this happen, we’re putting in place Shared Care Records. This will mean patients only need to give their details once, and they’ll be captured in a local record that can be safely seen by those who are caring for them.

That noise you can hear is Tony Blair frantically nodding towards modernity once again as he recognises the basic case for NPfIT being dusted down and given another outing. One more time with feeling!

Don’t get me wrong - I think there’s nothing wrong with the basic theory being proposed here. But it’s only going to work if the right people are in charge of executing it and that's where I get sceptical. The last thing we need is another government crony to be drafted in to take charge of something this vital. This can’t just be handed to someone Hancock met down the pub to deal with. This needs understanding not only of tech, but of how the NHS works - and where it doesn't.

As Hancock himself notes, the key to effective digital transformation is transforming the underlying business and operational models, not just layering expensive technology and even more expensive Deloitte consultants - other management consultancies are available! - on top of the status quo. Digital needs to be, says Hancock, “a transforming force” that will be “re-shaping health and care as we know it”. On that note, memo to Matt - re-shaping what we know isn’t a green card for privatization or having Google on speed-dial!

What it does mean is being ready to do things differently. Among the impacts of the pandemic has been a cutting through of red tape in many areas. One of the arguments offered to explain the lack of progress made on vaccination programs in the European Union has been to point to bureaucratic processes that have held things back. That may or may not be the case, but there are certainly examples in the NHS of COVID-related efforts to simplify practices and procedures. On information guidance, for example, Hancock argues:

What we did was we wrote the guidance for a frontline clinician on a single page, so that everybody could understand it, rather than writing it through information governance experts, to make sure it was super simple on the frontline…we’ll keep working to simplify our guidance, and create rules that help, not hinder, the incredible benefits that the safe sharing of data can bring.

That’s a bold ambition and one that I can get behind. But it’s also one where, post-pandemic as the crisis wanes and the old order reasserts, I can envisage once again an all-too-familiar public sector clash coming into play, as the political will meets the administrative won’t. Hancock talks up a good disruption game and there’s nothing in what he outlines as objectives that I fundamentally disagree with, any more than I did the last time they were pitched.

But the key lies in the follow-through and the delivery, otherwise it’s all PR, platitudes and puff. Can we count on that to be different this time around? Well...

One of Hancock’s big points in his speech was a recognition that while he’s claiming “big numbers [in the NHS] welcome this digital transformation”, these enthusiasts are being held back by poor internet speed and lack of decent network infrastructure, the digital transformation “basics” as he calls them. We need to get that infrastructure in place, he urges.

That will be the job of Oliver Dowden and his team at the Department of Digital, Culture, Media and Sport (DCMS), but of course Dowden will be building on the work done - or not done - by his predecessors in his role as the politician responsible for the UK’s digital infrastructure. On that front, he’s been dealt a pretty poor hand, as Hancock now appears ready to acknowledge.

If only he’d acknowledged this sorry state of affairs and done something about it during the years when in fact he was in charge of broadband and tech policy and later the entire DCMS, instead of just parroting empty spin about investing the same small pot of money into broadband rollouts that never materialised and acting as an unpaid Apologist-in-Exile for monopolistic indifference on the part of network providers.

Better late than never, I suppose, but using your new role to bemoan the digital shortcomings you didn’t bother to fix in your old role hardly inspires confidence that this “first digital transformation speech since the pandemic began” really kicks off the conversation that we need at this point. Or the one that our poor underpaid NHS heroes deserve.