The massive £695m PFI-funded Queen Elizabeth Hospital in Birmingham is struggling with a rising tide of emergency attendances (up almost 8% since last year) and emergency admissions (also up by 8%); its 1200 beds are not enough to cope with local needs, the once prestige hospital is slipping down the performance league table – and its chief executive Dr David Rosser is getting desperate.

The scale of the emergency caseload is so great, with its pressure on acute hospital beds, that there is insufficient capacity to meet targets for treating elective patients, leaving numbers treated from Birmingham & Solihull CCG 11% below last year.

According to a paper presented by Dr Rosser to the Board on May 22 (but not yet available on the Trust’s website):

“Patients who entered hospital on a non-elective pathway now account for over 90% of bed days across the trust so we have less than 10% of bed days to run our admitted, elective programmes.”

“[…] to deliver our strategic aims and support future sustainability we must find ways to reduce unnecessary footfall at hospital, both outpatients and ambulatory care through ED, repurpose parts of the hospital estate to focus even more on acute and tertiary care, and better manage frailty and chronic disease in the community to reduce avoidable hospitalisation.”

So desperate is the situation that the trust is looking to the unproven technological solutions offered by Babylon, the company behind GP at Hand, the online GP service controversially endorsed by health secretary Matt Hancock.

Babylon is led by Ali Parsa, the mercurial salesman best known for creating Circle Health, which runs small, unsuccessful private hospitals and which failed so spectacularly on a 10-year contract to manage Hinchingbrooke Hospital.

Parsa left Circle before it hit the buffers at Hinchingbrooke, and is now busily talking up what he claims is an “artificial intelligence” chatbot, and using this and a huge expansion of the workforce as the basis to attract up to $400m of investment income. The company lost money in 2016 and 2017, and appears to be spending contract income as soon as it comes in.

The UHB board has now agreed to explore using Babylon’s services, including video appointments and digital triage, in the hope it might help divert pressure from its severely strained hospitals.

“We would like to explore whether an AI symptom checking tool, such as Babylon’s AI symptom checker, currently designed for and aimed at primary care, could be developed for use in relation to urgent and emergency care. …  Used in this way, it would provide the AI symptom checker through a chatbot, backed up by UHB’s clinicians.”

Just two days after the UHB board rubber stamped Rosser’s plan, Hammersmith & Fulham published a  worrying review by Ipsos Mori of Babylon’s ‘GP at Hand’ system.

It pointed out that while GP at Hand appears to satisfy the mostly youthful and affluent punters who have signed up (94% of GP at Hand patients are aged 45 or under), the app offers little or nothing to many of the older age groups, who are likely have most need of health care.

But these are also the type of patient most likely to be among the rising numbers of A&E attenders Dr Rosser is trying to deter from coming to QEH. So it’s hard to see how Babylon can help, even if it works as well as the company claims.

The report also fails to answer key question of the cost-effectiveness or sustainability of the GP at Hand model. This is both because of “the absence of data on patient outcomes” (effectiveness) – but also because Babylon itself invoked “commercial sensitivity reasons” for refusing to divulge data on the costs of involved.

UHB is potentially thinking of signing up with a private company that will not share key information.

Dr Rosser is also burning any possible bridges by embarking on a policy that he knows will enrage Birmingham GPs. They were already angry at plans by Babylon to extend GP at Hand to Birmingham, which is likely to siphon off many of their younger, fitter patients who are cheaper to look after, and leaving them the older ones with greater health needs who will drive up costs.

The GPs have said they regard the potential deal with Babylon as the trust seeking ways to cut them out of deciding which patients should be referred to outpatient appointments with specialists.

They reject what the Local Medical Committee secretary describes as “an ill-thought through and destructive takeover”.

So while most proposals for longer term integration of services recognise that primary care must be a key player, Dr Rosser has decided to put two fingers up to them, and trust in Ali Parsa’s questionable company with its unproven app and its dodgy diagnoses.

It could end in tears.

John Lister
Author

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