A Health Tech Manifesto

The Royal College of General Practitioners (RCGP) has just published a ‘Tech manifesto’:

RCGP-tech-manifesto-april-2019

“So what?” you might ask… Well, GPs are the hub of the NHS and are responsible for a huge number of patient consultations per year (about 340 million, compare that with 23.9 million at A&E). Any NHS IT infrastructure therefore has to get it right in general practice to stand a chance of survival. Hence my interest in a manifesto on this topic from the college that represents GPs.

Although I’m pleased to see this manifesto, I’m worried about how the NHS may try to achieve these aims. I don’t think anyone would argue that fax machines are a good tool to use these days or that sluggish network speeds are anything but a hindrance. There is frustration that the basics aren’t right but the NHS has a poor track record of pushing through change.

Historically the NHS tends to use a ‘waterfall’ approach to change, including with technology. That means that somebody or some organisation decides what is to be done and then instructs all those beneath them in the hierarchy to implement that change. It’s easy to see the logic and temptation to take this approach. The NHS is a huge organisation and outcomes need to be equitable throughout, not to mention that various bits of the system need to be able to share information and function synergistically.

This approach has resulted in rigid standards being defined. Closely followed by a cumbersome compliance assessment framework that stifles modern, iterative development. One example is the NHS app store. But it’s a problem across other parts of the healthcare world too, outside the NHS. The private companies that supply the software used in GP practices function in the same way. The Medicines Healthcare and Regulation Agency (MHRA) which regulates medical devices, including apps and software, uses a similar process.

The intention of these systems is reasonable – to standardise, to promote interoperability and ultimately to provide safety for patients. However, they result in poor quality products and software as they are unable to respond in a timely fashion to feedback from real world use or technical advancements. The products of these systems therefore often fail to meet the needs of users or are sometimes even obsolete by the time they are implemented. These flops often hit the headlines.

So, what’s the solution? I agree that we need to get the basics right, that patient safety should be paramount, that systems should allow information sharing and so on. But why specify anything further? What if the NHS set aims rather than objectives and standards? Allow organisations that are more nimble than the NHS (i.e. just about every other organisation on the planet) to compete to find the best way to meet these aims. And judge success by achievement of these aims rather than meeting arbitrary, rigid standards. So, leave us with the manifesto thanks, but please don’t feel the need to dictate standards or process.