Every crisis represents an opportunity for someone, and covid-19 is no different, with proponents of digital tech enjoying ever-greater success in opening up the NHS to commercial interests keen to extract maximum value from patient data. Naomi Klein’s take on the disaster capitalism blueprint has surely never been more relevant.
So as the second wave of the pandemic hits the UK, it’s perhaps no surprise that last week’s online Tory conference included a virtual presentation of a ‘white paper’ on technology in the NHS which outlined how the health service has gradually been adopting a remote access model – even before the virus emerged – and with just a little help from the private sector.
The paper features case studies highlighting the positive impact the private sector has had in digital health, and discusses how NHS assets might be monetised, noting for example that the data sets (ie patient records) held by the health service could generate £5bn a year.
US multinationals like Google have already sewn themselves into the fabric of the NHS just to get their hands on exactly this sort of information. And exploitation of data, remember, is very much at the forefront of current government health policy, largely thanks to the influence of prime ministerial aide Dominic Cummings.
Online news site openDemocracy recently revealed details of an “unprecedented” transfer of personal health information of millions of patients to private tech firms as part of the NHS’ datastore project. NHS Digital and the Private Healthcare Information Network, meanwhile, are involved in a joint programme to align private healthcare data with NHS recorded activity.
But in spite of its data mining background, is take up of the digital tech promoted at the Tory conference actually increasing? Well, yes it is.
During March – the month leading up the national lockdown – NHS Digital commissioned a survey which showed almost 40 per cent of respondents had upped their use of NHS websites and apps following the outbreak. A month later more than a million people had registered with the NHS login system, and 520,000 people had registered to use the NHS App.
Research by the King’s Fund found that within weeks of the pandemic taking hold, more than 75 per cent of GP surgeries were conducting some patients consultations by video, nearly half of all consultations in May were conducted over the phone, and remote hospital appointments surged.
It also discovered that more than 60 per cent of patients were happy to take part in video consultations, although the Royal College of GPs suggested surgeries offering mostly remote appointments would not be meeting those patients’ needs adequately.
In sectors such as mental health, where you might expect the inability to assess body language and eye contact during face-to-face consultations to negatively impact on assessments of patients’ wellbeing, the picture isn’t totally clear.
A BMJ feature in June noted that, while some patients found video consultations intrusive, one consultant said mental health “aligns itself very well with telehealth”. But that opinion may just reflect the already poor provision of face-to-face psychiatric care in the UK, compared to other European countries.
Regardless of the wisdom or effectiveness of remote access to healthcare, health secretary Matt Hancock told a meeting of the Royal College of Physicians in late July, “From now on, all consultations should be tele-consultations unless there’s a compelling reason not to.”
That statement picks up on the NHS England’s (NHSE) Long Term Plan, published in early 2019, which envisioned that the NHS will eventually offer a ‘digital first’ option for most services. It also promised that patients would have the “right” to online consultations by early 2020 – and to video consultations too, by April next year.
In the context of primary care, the phrase ‘digital first’ suggests a near future when GPs are no longer employed by, or work out of, local surgeries, and patient demand can be managed ‘at scale’. NHSE says there will be “opportunities to manage online consultations at a larger scale, for example across primary care networks or via a hub model”.
These mooted “opportunities” reflect the current government’s push to centralise seen elsewhere in the health service – check out the last issue of The Lowdown for an update on the pressures faced by Clinical Commissioning Groups (which are themselves essentially merged GP practices) to further coalesce as Integrated Care Systems.
The ‘eHub’ model is fleshed out in NHSE’s ‘Using Online Consultations In Primary Care’ implementation toolkit, published in January this year. This document refers to ‘standalone online consultation services’ which “offer additional clinical capacity to practices, primarily through online consulting by clinicians who operate separately from the established GP team, though they may be working in a business partnership with them”.
But facilitating remote consultations is just one application of digital technology in the NHS. ‘Wearable’ tech is another, and again presents data opportunities to suppliers, as well as health benefits to patients.
In June this year NHS England published a press release promoting the roll-out of At Home, a programme of trials involving patients recovering from various conditions, who are given devices to enable medical staff to monitor those patients’ progress remotely after hospital discharge.
A wonderful step forward, undoubtedly, permitting earlier discharge, the freeing up of hospital beds and the opportunity to cut down on follow-up outpatient visits.
But anecdotal evidence from one patient, who was briefly admitted via A&E to a major hospital in East Sussex two months ago to have a pacemaker fitted, confirms that data mining is very much a part of this digital deal.
Shortly before discharge, Beryl (not her real name) was offered a Merlin@home transmitter so the hospital’s cardiac team could keep a discreet eye on how she was getting on, without the need for face-to-face follow-ups. Signing away her rights to any information transmitted to a third party – in this instance an arm of Abbott Laboratories in California – was part of the deal though. No signature, no transmitter.
The world of digital tech clearly isn’t completely altruistic – or inclusive. The conference paper mentioned earlier suggests digital access is still unavailable to many – because 12 per cent of people lack access to a decent broadband service, a similar number lack the skills or resources to access such a service, and others are excluded because of a mental or physical disability.
NHS Digital backs this up, saying take up of its various digital health initiatives is constrained because 11,300,000 people lack the basic digital skills to use the internet effectively, and 4,800,000 never go online at all.
And don’t forget the tech isn’t always that efficient or successful either. Just think of the much-delayed covid-19 app that cost £11m, the thousands of contacts lost last month by the tech-led NHS Test and Trace project, and the £10bn wasted on the NHS’ failed 2002-2011 National Programme for IT.
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