The rise of tech will finally expose the NHS’s fundamental flaws

The NHS has an infamous track record of upgrading. Its outdated computer system is legendary. The uncontrollable tech quango NHSX - which triggered the disastrous test-and-trace app - isn't even audited. The latest attempt to end reliance on 9,000 fax machines has ended in surreal defeat. The "worst fiasco of all time," Tony Blair's Top-Down National Program for IT, rightly casts a long shadow. It failed spectacularly after encountering a number of problems peculiar to the healthcare sector, not the least of which was that trust managers refused to give up control of their personal fiefs.

The reforming environment is even more hostile to the current Tory government. With powerful unions backed and supported by those who continue to insist that "our precious NHS" is "the envy of the world", even minor reforms have faced street protests. Forty percent of primary care management could probably be automated tomorrow, but can you imagine the outcry?

The great tragedy of the NHS 'declining failure to adopt new technology is that such advances offer the only hope of building a health system that can meet the challenges of the 21st century. Aside from the immediate tasks of getting through the winter without collapsing and clearing a waiting list that spans out of sight after an 18-month lockdown, the NHS - and health services across the West - are faced with pressing fundamental questions.

When the NHS was formed in the 1940s, its spending should come down as people's health improved. The opposite has happened and demographics suggest this will get worse. An aging population poses major challenges, not least because it also leads to higher demand from the relatively fewer taxpayers who fund the system.

Squaring the circle - delivering better care more people need it - must be done through technology around the world. The NHS must adapt to the future, however painful the process, or it will be passively overwhelmed by change. In the age of techno health care, not even British admiration for health care will survive if it slowly falls by the wayside.

Expect the money Rishi Sunak has reportedly earmarked for faster broadband and digitization of patient records, like previous reforms of technology efficiency, will prove to be a waste of money. But we can already see more bottom-up technology digging into parts of the healthcare system and taking root there. Make the switch to online appointments. General practitioners who use online counseling platforms as an excuse to “hide” from their patients are dancing with the devil. The increased use of apps and other technologies could prove to be an important step on the way to a reform of the basic care as a whole, which sends patients directly to specialists. There's no reason we shouldn't extend home testing to non-Covid conditions like UTIs.

The technology's extraordinary potential is tangible in a paper published by the Tony Blair Institute - a prime minister much keener on health care reform than today's Tories. In addition to rapid successes like rapid diagnostic centers and more robotic surgery, this requires a greater focus on putting patients in control of their own health through wearable technology, as well as bringing smart hospitals to a "level".

We're already behind the curve when it comes to harnessing the pandemic to catalyze massive change. In China, Internet hospitals are being introduced with 5G ambulances and online counseling up to the prescription. Germany has passed a law that allows doctors to prescribe health apps, with the costs being borne by insurers.

It doesn't have to be like that. In a way, the centralization of the NHS is an asset. For example, we have the best data in the world for research. Investors are drawn to its clear priorities, from early detection to remote patient monitoring.

However, the government could do more to help innovators get a foot in the door. Reformers should be more adept at leveraging the NHS’s extensive leadership pool to master bottom-up technology adoption processes. From consulting with doctors early in development to adapting the technology to different clinical environments, a little time and patience, and management smuggling around will pay off.

What is clear is that at some point in the future, whether they like it or not, those bureaucrats who greedily protect their legacy Windows Vista systems will have to become outliers in - rather than the epitome - NHS culture.

Imagine the distant future of healthcare. Your great-grandson uses his genome sequencer to check his spinach and eggs for signs of E. coli (a routine precaution in an era of antibiotic-resistant bacteria). He's chatting over tea with his wife, who has made a full recovery since her smartwatch detected early-stage breast cancer and was cured with a treatment invented by artificial intelligence. He works as a medical technician (they used to be called doctors) and oversees nanobots in the local caravan park in the intensive care unit (which is never “overwhelmed”).

At some point along the way to such a reality, the resistance of NHS self-interest to reform is exposed. When that all-powerful sticking point comes, the creaky, tax-guzzling public sector leviathan will be shown for what it is: a system that has trapped the country in an insane hell of cyclical problems. A health service that for the foreseeable future will have our freedom to buy out every Covid / Flu season, botch up booster vaccinations and then fight to treat the resulting cases in understaffed intensive care units.

The front line will continue to be short of cash as the task of managing their backlog draws resources to the managers. Meanwhile, politicians will never dare reform the sacred NHS.

But at some point the technological change will be so advanced that it can no longer be stopped. If our politicians wanted to do something really useful, they could start by promoting a “tech culture”, ignoring the left's privatization paranoia, and taking the first steps to embrace, not demonize, change.

You will of course be too scared. But it's nice to hope.

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