Why nurses are now obsessed with software interoperability - a silver lining in the COVID cloud according to UK Health Secretary

Stuart Lauchlan Profile picture for user slauchlan October 1, 2020
We've all become medtech junkies, according to Matt Hancock's worldview. Thanks COVID!

(Screen grab from Parliament )

It's the fastest downloaded app in British history, so we're pretty proud of that.

The app in question is the NHS Track and Trace app launched in the UK last week and the proud speaker is Matt Hancock, Secretary of State for Health in the British government and the man in charge of leading the response to the COVID-19 pandemic.

While Hancock’s reaction to the download figures is entirely in keeping with his status of never knowingly missing out on a chance for some self-congratulation, there are those who understandably might take a slightly more critical position. 

Back in April, as the COVID-19 pandemic’s first wave was making its presence felt, Hancock’s department decided to eschew the services of the likes of Apple and Google and in characteristic pursuit of British exceptionalism, build its own ‘better’ app. The app, he told an electorate cowering in lockdown, would be “crucial” in the battle against the virus and would be up and running in “a matter of weeks”, a schedule later narrowed down to “the middle of May”. 

In early May, a pilot is run on the Isle of Wight with citizens there able to download it to their smartphones…unless those phones came from Huawei or were older models of Apple or Samsung devices. Later in May, Apple and Google’s contact tracing system starts to be used in other countries in earnest, but there’s no sign of the British ‘better’ alternative escaping to the mainland. 

By June, Hancock was walking back from the his earlier “crucial” claims for the app and talking up the idea of people needing advice from human beings to gain confidence. Meanwhile reports circulate that the app is only picking up around 4% of contacts when used on an iPhone, compared to around 99% accuracy levels for the ‘inferior’ Apple/Google alternative. 

By the end of June, the home-grown app was abandoned, at a cost of nearly £12 million, as Hancock confirms he has no idea of when a workable version might be released. When a viable version does finally appear in September, it’s launched with a great fanfare, followed by the admission that thousands of users are unable to enter their data into it if they received an NHS COVID test rather than a private one. 

Hancock's history

But still, it’s the fastest downloaded app in British history, so let’s look on the bright side as is Hancock’s go-to position. In fact, he’s the living embodiment of the ‘glass half full’ politician. He was promoted to Health Secretary after a few undistinguished years as Secretary of State for Digital, Culture, Media and (for some reason) Sport - © BBC/W1A - where he spent much of his time seemingly operating as an extension of the BT press office, parroting its stats and claims and promising, over and over and over and over and over again, superfast broadband for all, that needless to say never materialised. 

Hancock also ran for leadership of the Conservative Party, aka getting to be Prime Minister. His self-belief that he could somehow actually be Head Boy saw him go head-to-head with eventual winner Boris Johnson, declaring the future PM to not be in line with his own values. That circle was swiftly squared with all the unprincipled flexibility that comes with not being encumbered by the petty restrictions of a spine as Hancock threw himself behind Johnson in the race and has followed obediently in his wake ever since, echoing whatever the policy of the day happens to be to any passing TV camera crew unable to move fast enough to get away. 

Such is his Tigger-ish enthusiasm, Hancock is even able to see past the death toll and the infection rates and indulge his technophilic tendencies - he has an app named after himself! No really… - by finding a potential silver lining in the COVID cloud: 

I think the biggest thing that's changed during the pandemic with respect to this agenda of medtech is that the both the public and the clinicians are now demanding and drawing through technology, rather than essentially having or deemed to have a scepticism factor about it. So  [through] people like me who are big tech fans, there has been a growing band of early adopters in the NHS and in the UK health system and thankfully the early adopters were just enough and that the underpinning technology was just strong enough, so that at the moment the pandemic hit and the mass market moved from being essentially neutral on health tech to essentially embracing it, we had the funding structures ready. 

Now there's just a classic S-curve of adoption. We now have the vast majority who are enthusiastic users of telemedicine and of technology. Just a couple of examples.  I'm really struck when we have our international calls with [other health ministers],  we all have seen a very similar, radical increase in the use of telemedicine in primary care, and in outpatients. In the UK, 99% of GP practices offer video consultations. That is up from under 10% before the pandemic. It's a radical shift. We're also changing the financial underpinnings of the NHS to ensure that in primary care that...essentially those consultations need to be properly considered and accounted for. We've seen the extensive use of 111 Online to access care, whether that's a secondary care, urgent but secondary care that doesn't require a 999 call but is urgent. That itself allows the NHS to triage patients to where they best can get the treatment. A huge amount of that is done now, online….So there's a huge amount of opportunity in this space and there's a huge amount of exciting options.

The critical thing that's changed, he argues, is that medtech is now being demanded by the system itself, rather than the previous scenario of tech evangelists trying to drive it in :

People who were sceptics tried it and found that technology helps them improve the way they can deliver care and helps patients to access care more easily. That's why COVID has changed the culture from techno-scepticism to techno-enthusiasm within the NHS, and within almost all health systems across the world. There is a broader change that will happen too, which is that the more that you can put somebody's health into their hands through a smartphone, the more that people will feel ownership of what they need to do in order to stay healthy. So the prevention of ill health agenda will be enormously enhanced by people having the tools in their hand to be able better to manage their own health. 

I've been struck by…the enormous focus that we've had rightly to put into diagnostics over the last nine months. ..[Germany] started with a brilliant diagnostics industry; we started with a very small one. And we've both built them at record levels for our citizens and we've learned an awful lot from how Germany does it. But the striking thing is that the focus of the debate on that has almost entirely been about COVID tests, understandably. But  actually switching the whole system to be all diagnostic and therefore more about preventing ill health is a long term change that we need to go on  and we need to accelerate that path. I've absolutely no doubt that will be one of the long term consequences of COVID, and it makes the system more resilient.

That at least will be crumb of comfort to anyone with a relative hooked up to a ventilator in an intensive care unit, no doubt. But it seems that we are a nation of tech converts thanks to COVID, even on the very frontline of the crisis where concerns about pay levels, funding and working conditions have been replaced by a new burning topic. As Hancock tells it: 

I never thought when I became Health Secretary [that when] walking into a group of nurses in a hospital the most exciting thing you could say is that we're going to solve [tech] interoperability. But that's true. It's a huge journey, but at least it's one on which at least everybody is agreed that we must travel. 

My take

He’s hopeless. 

We’re helpless. 

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