{"id":8075,"date":"2024-03-05T10:35:00","date_gmt":"2024-03-05T09:35:00","guid":{"rendered":"https:\/\/www.gpsj.co.uk\/?p=8075"},"modified":"2024-03-05T10:35:59","modified_gmt":"2024-03-05T09:35:59","slug":"stabilising-the-nhs-its-going-to-take-a-lot-more-than-ai","status":"publish","type":"post","link":"https:\/\/www.gpsj.co.uk\/?p=8075","title":{"rendered":"Stabilising the NHS \u2013 it\u2019s going to take a lot more than AI\u00a0\u00a0"},"content":{"rendered":"\n

A general election is coming, and Labour is likely to win. At its January meeting, the Highland Marketing advisory board discussed what should be on shadow health and social care secretary Wes Streeting\u2019s agenda for health, care and technology.  <\/strong> <\/p>\n\n\n\n

A general election must be held before the end of January next year, and most commentators are expecting prime minister Rishi Sunak to go to the polls after the spring Budget or autumn spending statement. <\/p>\n\n\n\n

Unless the polls are wrong, or there is a dramatic change in UK political fortunes, Labour will come to power whenever the election takes place. That has triggered interest in what shadow health and social care secretary Wes Streeting has been saying about health, care, and technology.  <\/p>\n\n\n\n

Streeting has been deliberately ruffling feathers by arguing that \u201cLabour is too nostalgic about the NHS\u201d and the health service needs \u201creform\u201d more than it needs money (The Sun<\/a>).  <\/p>\n\n\n\n

While it\u2019s not yet clear what \u201creform\u201d would look like, Labour\u2019s \u201cmission\u201d for government<\/a> talks about a shift towards prevention, to reduce demand on health and social care, and a shift towards community and social care, to ease pressure on the acute sector and improve access for patients.  <\/p>\n\n\n\n

Willing to face up to the task ahead? <\/strong> <\/p>\n\n\n\n

The Highland Marketing advisory board thought this was disappointing and inadequate to the challenge ahead (a week after their debate, a coalition of experts assembled by the BMJ<\/a> urged the next government to declare the state of the NHS a national emergency).  <\/p>\n\n\n\n

\u201cSaying \u2018there is no more money\u2019 is not an acceptable message,\u201d entrepreneur Ravi Kumar argued. \u201cThere are 1.3 million people working in the NHS, and they all vote, so they need to say they are going to find the money.\u201d   <\/p>\n\n\n\n

Back in 1997, New Labour went to the polls warning there were \u201c24 hours to save the NHS.\u201d Even so, it tried to hold the line on Conservative Party funding commitments and installed the very Old Labour Frank Dobson as health secretary to keep the lid on industrial unrest.  <\/p>\n\n\n\n

It was forced to change track in 2000, following a winter crisis that unlocked a decade of unprecedented funding increases and The NHS Plan<\/a> \u2013 billed, Wes Streeting might like to note, as \u2018a plan for investment: a plan for reform.\u2019   <\/p>\n\n\n

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The money paid for new regulators, hospitals, scanners and IT, and the capacity to drive down waiting lists and times. Admittedly, less progress was made on community and primary care reforms and on public health.  <\/p>\n\n\n\n

Today, both need urgent attention and there will be consequences if they don\u2019t get it, ranging from worsening health inequalities, to further council bankruptcies, to even more pressure on the NHS. However, the NHS is not responsible for their organisation or delivery, which falls to councils and the private sector, so there is only so much that NHS policy can achieve.  <\/p>\n\n\n\n

\u201cIn policy terms, we saw another boost for these ideas in the Five Year Forward View<\/a> in 2014 and the NHS Long Term Plan<\/a> in 2019, but not much has come of them,\u201d industry expert David Hancock pointed out. \u201cSo, if Labour is going to stick with them, the question has to be: what is different this time?\u201d  <\/p>\n\n\n\n

Natasha Phillips, the former national CNIO who has just joined the advisory board (Hospital Hub<\/a>), hoped that Labour isn\u2019t thinking that another round of reorganisation will do the trick.  <\/p>\n\n\n\n

\u201cI think the first ask of any new government is: please do not re-invent the wheel or re-organise,\u201d she said. \u201cThere are no perfect structures, and we all know from repeated re-organisations that changing them takes time and distracts from delivery. What we need to do is make the structures that we have work. That means workforce \u2013 boots on the ground and the money to pay for them.\u201d  <\/p>\n\n\n\n

AI to the rescue! <\/strong> <\/p>\n\n\n\n

Labour\u2019s \u201cmission\u201d also puts a great deal of faith in technology. For example, it flags, the potential of AI and generative AI to read scans and deal with routine administration. Andy Kinnear, a former NHS CIO and consultant, said there is no doubt that both will be used widely in healthcare.  <\/p>\n\n\n\n

\u201cGenerative AI has gone from \u2018that\u2019s an interesting idea\u2019 to reality in less than a year, and it\u2019s going to rip across every area of our lives,\u201d he said. \u201cSo, it\u2019s not surprising Labour is talking about this, but there\u2019s a lot we don\u2019t know. Does radiology cease to exist as a profession, because AI can read the scans for us?  <\/p>\n\n\n\n

\u201cDo 50,000 nurse vacancies no longer matter, because generative AI can make the workforce so efficient we don\u2019t need those people?\u201d Framed this way, it\u2019s pretty obvious the answer is \u2018no.\u2019 So, if AI is going to support, rather than replace, workers and pathways, it\u2019s not going to be a free good.  <\/p>\n\n\n\n

As radiology expert Rizwan Malik asked: \u201cIf Labour is saying there is no money, where is the money going to come from to do this? Because the NHS is recognised internationally as a leader on AI, but most of the things that have been deployed to date have been funded by the centre. Very little washes its face.  <\/p>\n\n\n\n

\u201cIf this is going to be rolled out more widely, local organisations are going to need to get business cases together, and it won\u2019t be easy, when you take into account all the costs, including the server-end costs, and the implementation costs, and the change management\u2026\u201d  <\/p>\n\n\n\n

To which Natasha Phillips added training and education. \u201cIt\u2019s easy for a party to say how much technology they will buy, but it\u2019s not about just buying technology,\u201d she said. \u201cThere will need to be investment in the workforce to get the most out of it.\u201d  <\/p>\n\n\n\n

Jeremy Nettle, chair of the advisory board, agreed with this. \u201cAI is a tool for clinicians and administrators to use, it is not a replacement for them,\u201d he said. \u201cAnd for it to be a tool, it needs to be funded. If you are going to use technology, and you want to use it to support a first-class service, there has to be the investment required to make it work.\u201d  <\/p>\n\n\n\n

What about the rest of NHS IT? <\/strong> <\/p>\n\n\n\n

It might be easier to make this kind of investment in AI if the rest of NHS IT was prepped and ready. In reality, too many organisations are working with overloaded infrastructure, patchy wi-fi, aging devices, and software systems that don\u2019t integrate with each other \u2013 if they exist (fuller discussion, Health Tech World<\/a>).  <\/p>\n\n\n\n

NHS England is running a frontline digitisation programme to try and get all trusts up to a basic level when it comes to electronic patient record capability. But successive cuts to the IT funding announced in the 2021 Budget mean it has been scaled back.  <\/p>\n\n\n\n

Trusts hoping to swap their legacy IT for \u201cnext generation\u201d systems or to extend their EPR functionality are likely to be disappointed. Even the target to get EPRs into the trusts that don\u2019t have them has been pushed back a year (digitalhealth.net<\/a>).  <\/p>\n\n\n\n

\u201cPeople are talking about AI as a silver bullet, and we have been down this road before,\u201d said Cindy Fedell, a former NHS CIO who now works in Canada. \u201cYou can\u2019t just drive down one road. We have crumbling infrastructure. Some hospitals don\u2019t have EPRs. We need to invest in cyber security. There\u2019s a lot to be done.\u201d  <\/p>\n\n\n\n

And why do so many tech plans fail? <\/strong> <\/p>\n\n\n\n

The latest end date for frontline digitisation is March 2026, which is well into the lifespan of the next government. So far, though, Labour has said nothing about the programme. Nor has it said what it will do about other, more recent, national projects, such as the significant investment that has been made in shared care records.  <\/p>\n\n\n\n

Yet, David Hancock pointed out, it will either need interoperable systems or something like SCRs if it is serious about integrated care and public health. And, for the moment, it\u2019s SCRs that are the best bet for sharing longitudinal health data with care teams and population health management experts.  <\/p>\n\n\n\n

Labour is keen on the NHS App. Its mission says it will become a \u201cone stop shop\u201d for health information, fed by providers but \u201cowned by the patient\u201d to drive more \u201cpersonalised\u201d care across the system.  <\/p>\n\n\n\n

This sounds great, but very similar claims were made for putting patient data and information on \u201cthe information superhighway\u201d back in 2000, in private personal health records like Microsoft Health Vault in the Cameron era, and portals today.  <\/p>\n\n\n\n

Indeed, some of Labour\u2019s specific promises are less ambitious than previous commitments. For instance, the \u201cmission\u201d says it will use the Digital Transformation Fund to make sure that patients can \u201csee their medical records through the app.\u201d  <\/p>\n\n\n\n

When now chancellor and then health secretary Jeremy Hunt was promising patients read-write access as part of his \u201cpaperless by 2018\u201d plans (thebmj<\/a>). The advisory board felt Labour should reflect on why previous efforts to put information into the hands of patients to drive choice, engagement, and better outcomes, have achieved so little.  <\/p>\n\n\n\n

The constant reorganisation of ministerial and NHS teams and a lack of regulator and press interest in delivery have played a part. But, James Norman, a former NHS trust CIO who now works on the supplier side, felt the biggest reason is that they have been run as projects separate to day to day working.  <\/p>\n\n\n\n

\u201cAny government that comes in this year will need to recognise that the first thing the NHS needs is to return to stability,\u201d he said. \u201cYou can\u2019t just talk about technology and expect it to deliver that. In fact, if you don\u2019t do it right, you\u2019re just going to add cost and complexity. It becomes another tick-box exercise, instead of a whole system change.\u201d  <\/p>\n\n\n\n

No avoiding the need for leadership \u2013 and money <\/strong> <\/p>\n\n\n\n

The advisory board felt that getting into fundamentals of system-change will require leadership from politicians, clinicians, and NHS managers. Which is hard to deliver when the political cycle is five-years and NHS leaders make their careers in the acute sector.  <\/p>\n\n\n\n

However, if Labour is going to get serious about the NHS, it will have to get into it. And find the money. Ravi Kumar said: \u201cIf there is a message for politicians, it is that they can shift the current dynamic, but to do it, they need to find the money. Any government can find money, if it wants. They found it during Covid. They can find it for wars. It\u2019s a choice.\u201d  <\/p>\n","protected":false},"excerpt":{"rendered":"\n

A general election is coming, and Labour is likely to win. At its January meeting, the Highland Marketing advisory board discussed what should be on shadow health and social care secretary Wes Streeting\u2019s agenda for health, care and technology.   <\/p>\n

A general election must be held before the end of January next year, and most <\/p>\n

Continue reading Stabilising the NHS \u2013 it\u2019s going to take a lot more than AI\u00a0\u00a0<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[9,1313],"tags":[25,417,26,828,1827,3581,1877,143,3852,122,542,416,422,1748,2257],"class_list":["post-8075","post","type-post","status-publish","format-standard","hentry","category-nhs-healthcare","category-politicians-political-parties","tag-government-public-sector-journal","tag-government-journal","tag-gpsj","tag-health","tag-healthcare","tag-healthtec","tag-highland-marketing","tag-it","tag-labour-party","tag-nhs","tag-politics","tag-public-sector-journal","tag-public-sector-magazine","tag-secretary-of-state-for-health","tag-social-care","odd"],"yoast_head":"\nStabilising the NHS \u2013 it\u2019s going to take a lot more than AI\u00a0\u00a0 - Government & Public Sector Journal<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.gpsj.co.uk\/?p=8075\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Stabilising the NHS \u2013 it\u2019s going to take a lot more than AI\u00a0\u00a0 - Government & Public Sector Journal\" \/>\n<meta property=\"og:description\" content=\"A general election is coming, and Labour is likely to win. 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