Technology: friend or foe?

06 July 2018

The ever-changing digital world can save businesses money and time, so why should healthcare be left behind? Or is the picture more complex than that? Award-winning health journalist Danny Buckland reports.

Technology Friend or Foe

The NHS has had a difficult relationship with technology, and its reputation was tarnished following an expensive IT system failure in 2011. Then an NHS England trust in 2015 allowed 1.6 million identifiable personal records to become available to Google DeepMind (ICO, 2017). Nonetheless, its vast enterprise makes the NHS a fertile area for innovations in online appointments, medication reminders and remote e-monitoring services. And the NHS digital arena is awash with fresh ideas and business opportunity across the UK.


Big potential

Sophie Castle-Clark, senior fellow in policy and digital programme lead at the Nuffield Trust, sees huge promise in improving quality of care and streamlining clunky systems, but cautions that savings may be elusive in the short term.

‘There is potential from lots of things that we could automate, but we have found those efficiencies are going to take a long time to realise and, in the short term, there has to be a big investment of staff time, capital and resources to change working processes to make the most of technology.

‘There is a “productivity paradox” as technology saves money in every other business so why not healthcare? That is because it is a people business and is very complex. It means doing things differently at all levels and in something as big and fragmented as the NHS that is not easy to achieve at scale.’

She believes resistance to the sharing of patient data can be overcome. ‘I don’t think the concerns are necessarily unwarranted but we need transparency and the explanation of what data sharing has to offer in terms of care and service is important,’ she says.

‘We need people to appreciate what we would be throwing away if we let concerns about data privacy outweigh the benefits. But that understanding is the big missing piece at the moment.

‘Things will change significantly in the next 70 years and technology will be a big part of that, but we are still in the foothills of that journey.’


Staying cautious

Mental health services have been identified by the Department of Health and Social Care as an area where technology can provide great benefit. ‘It has a huge part to play because it can be adaptive and flexible, but I am very wary because it is not a magic bullet,’ says George Coxon, until recently the UK chair of the Mental Health Nurses Association.

‘People can access mindfulness or cognitive behavioural therapy online but I am not convinced by its efficacy. In my experience as a counsellor and mental health practitioner, there is little substitute for a face-to-face consultation.’

He advises: ‘Telemedicine and providing consultations through Skype can be a part of treatment but people need the opportunity to be heard by another person and have that direct contact. The danger is that technology will dehumanise the fundamental nature of mental health support, care and treatment which is essentially about feelings, dealing with distress, overcoming difficulties and the need to apply personal contact.’

On the personal touch, George concludes: ‘People don’t often want advice, they want support. So I’m sceptical about it and you will find an awful lot of people are invested into it for wrong reasons, usually for commercial gain rather than to enhance service to the individual.’

But, with ever-growing caseloads, health visitors, district nurses and the wider community practice staff are aided by a string of apps that provide quick reference information, such as the Oxford dictionary of nursing and the Nurse’s drug handbook. And for instance, Northern Ireland’s Department of Health (2018) has drawn up a framework to create an always-on district nursing service over 10 years supported by technology. A district nursing framework 2018-26 envisages staff working remotely using mobile devices with access to the country’s electronic care records.

Dr Crystal Oldman, the QBI’s chief executive adds: ‘There is going to be an enormous amount of change, but it is difficult to say what will happen. Look at technology 70 years ago and who could have dreamt of laptops, iPads and mobile phones that could enable healthcare to be so much more efficiently, effectively and safely delivered? I am really hopeful about it but we have to be mindful that human contact is vital for health and wellbeing.’

Supporting evidence for digital benefits includes a report by Deloitte analysts (2015) on how technology is transforming health and social care in the UK. And there are excellent examples of NHS innovation (see Leaders on the technology path, below).


The cost of innovation

Sadly, technology does not come for free. And, as we have seen, the NHS track record with technology is patchy. A troubled patient-record IT system, instigated in 2002 and dismantled in 2011, cost the taxpayer around £10bn, and the flagship target of creating a paperless NHS by 2018 was quietly dropped by health secretary Jeremy Hunt.

The government was forced to spend £150m to shore up its cyber defences in the wake of the WannaCry ransomware attack in 2017 that hit 80 health trusts and 603 NHS organisations, ambulance services and GP practices in England.

Last year, the Treasury approved a £385m fund (part of a £1.3bn budget to accelerate a paperless NHS) for Global Digital Exemplar hospitals to forge new technology partnerships – the profit element was underscored by the Department of International Trade, which is openly promoting British expertise by touting for business (UK Government, 2016).

It’s worth noting that many of the advances swirling around the healthcare landscape are driven by private money: a government report recorded 3700 companies in the UK’s medical technology sector generating a £21bn annual turnover (UK Government, 2018).   However, one of the greatest challenges is the NHS structure, with its multiple entry points and maze-like procurement processes often stalling initiatives and delaying adoption, despite strong supporting evidence. A roundtable discussion involving leading NHS officials preceding UK e-Health Week 2017 heard that selling to the NHS must be ‘one of the most frustrating and challenging experiences on the planet’ (British Journal of Healthcare Computing, 2016).


Leaders on the technology path

Just some of the excellent examples of NHS innovation include:

  • The ChatHealth system provides a vital communication route between school-nursing teams and 11- to 19-year-olds who can request information anonymously via text messages. NICE believes the service has scope for other clinical teams, including HVs for parents with newborns bit.ly/NICE_ChatHealth
  • The Welsh health secretary agreed to fund 11 innovative projects with the Efficiency Through Technology Fund (Welsh Government, 2017). Projects include the development of an improved pressure ulcer reporting system in care homes.
  • NHS Digital is transforming technology’s influence on public health through a £4.2bn strategy to 2020 with IT central-to-patient engagement and system efficiencies via online consultations and management tools (NHS Digital, 2017).
  • NHS England (2017) is promoting 11 key projects such as RespiraSense – a wireless device that detects early signs of pneumonia, sepsis and cardiac arrest; and HaMpton that allows pregnant women at risk from pre-eclampsia to input blood pressure readings and urine test results into an app at home. 

Picture Credit | iStock



British Journal of Healthcare Computing. (2016) Selling to the NHS ‘most challenging and frustrating’ experience, says NHS CIO. See: https://www.bj-hc.co.uk/selling-nhs-most-challenging-and-frustrating-experience-says-nhs-cio (accessed 19 June 2018).

Deloitte. (2015) How digital technology is transforming health and social care. See: https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health.pdf (accessed 22 June 2018).

ICO Royal Free. (2017) Google DeepMind trial failed to comply with data protection law https://ico.org.uk/about-the-ico/news-and-events/news-and-blogs/2017/07/royal-free-google-deepmind-trial-failed-to-comply-with-data-protection-law/

NHS Digital. (2017) A summary of NHS Digital's plans for 2017-18. See:  https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/nhs-digital-s-plans-for-2017-18/a-summary-of-nhs-digital-s-plans-for-2017-18 (accessed 19 June 2018).

NHS England. (2017) App that helps pregnant women monitor hypertension among new NHS innovations that will save lives and improve treatment. See: https://www.england.nhs.uk/2017/11/app-that-helps-pregnant-women-monitor-hypertension-among-new-nhs-innovations-that-will-save-lives-and-improve-treatment/ (accessed 18 June 2018).

Northern Ireland Department of Health. (2018). A District Nursing Framework 2018-2026. See: https://www.health-ni.gov.uk/sites/default/files/publications/health/district-nursing-framework2018.pdf (accessed 28 June 2018).

UK Government. (2016) The UK: your partner for digital health solutions. See: https://www.gov.uk/government/publications/digital-health-working-in-partnership/the-uk-pioneering-digital-health-solutions (accessed 28 June 2018).

UK Government. (2018) UK medical technology: at a glance See: https://invest.great.gov.uk/industries/health-and-life-sciences/medical-technology/ (accessed 19 June 2018).

Welsh Government. (2017) 11 innovative health technology projects successful in £7.3m funding bid. See: https://gov.wales/newsroom/health-and-social-services/2017/ettf/?lang=en (accessed 27 June 2018).

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