It hasn’t been all that long since Matt Hancock was best known for his app, which he called Matt Hancock, in a very Ronseal approach to technology. Not long after being promoted from a digital minister to culture secretary, Hancock rolled out the app in a bid to keep his constituents up to date with local goings-on, and to create a space for feedback. Naturally, Hancock got the piss taken out of him on social media. But aside from legitimate data concerns with the app accessing users’ photos – seemingly even when permission was not given; but that, unfortunately, isn’t a niche breach – the derisive response was, for the most part, unjustified.
People can’t have it both ways: dissing politicians for not being innovative or digitally astute, and then mocking the few who seem genuinely interested in technology and how it can change politics for the better.
Hancock has since replaced Jeremy Hunt as health secretary, and one of his priorities is digitising the NHS and improving its extremely poor relationship with technology. To be fair, this was an area Hunt was also interested in, except he turned his focus to making the lives of junior doctors miserable. In a piece last week for the Telegraph, Hancock described the current NHS computer systems as “downright dangerous”, which isn’t an exaggeration, as anyone who followed the WannaCry ransomware attack will know. When the malware hit the NHS in 2017, systems went down and staff were reduced to making notes with pen and paper. It turned out some computers were running old, unpatched Windows operating systems. This reliance on archaic tech is something that Hancock is very keen to eradicate: “Don’t get me started on the fact the NHS remains one of the largest buyers of fax machines on the planet,” he wrote.
As well as it being difficult for patients to access their own records and data, the lack of communication between professionals, practices and hospitals can be infuriating and detrimental to patient care.
Recently, I moved house. Instead of registering with a new local GP – when I initially rang up to do so, the receptionist begged me not to, because the surgery was already so oversubscribed that it was on the verge of closing its list, and she warned me there would be five-week waits for appointments – I joined GP at Hand. GP at Hand is run by a private company, Babylon. It is an app that works as follows: patients can arrange video or phone conversations with consultants, at a time convenient to them.
Usually, I pick the nearest time, rather than a later scheduled one, and so far I have always managed an appointment within 20 minutes. All video and phone consultations are recorded, so patients can watch or listen back. Doctors also provide the patient with written notes. Prescriptions can be arranged on the phone, and are sent electronically to a pharmacy of the patients’ choice within the hour. If an in-person appointment is required, the patient calls a number and arranges one at a health centre (there are currently five hubs). I get an in-person appointment within 24 hours. So far, the app is only being piloted in London, but figures suggest 30,000 people have signed up.
It sounds hyperbolic, but GP at Hand has changed my life. It’s now very easy to access the medication I need, and speak to a doctor when I have to. Hancock himself uses the app – in a speech this week he called it “revolutionary”, saying he wants it to be available for everyone.
But not everybody is as enamoured. It is controversial among many GPs, because surgeries are run as private businesses: the NHS pays the surgeries a fee for each patient on their books. Bricks-and-mortar GPs are therefore concerned about GP at Hand taking their patients, and thus money, away – in particular patients who are younger and fitter, and who are therefore more likely to use the app. They fear this will leave them with older patients or those with chronic illnesses, who are more expensive and difficult to treat. The BMA has accused Babylon of “cherrypicking”. But I have a serious long-term condition, bipolar disorder, and at present there is no better option for me.
Sarah Wollaston has raised concerns that an app would miss certain conditions – but nobody is suggesting replacing face-to-face care entirely. When I couldn’t hear in one ear, I had a video consultation, before I was sent to a health centre, where I was diagnosed with a retracted eardrum. Sorted within a week. I’d wager that those with heart conditions would prefer to be seen by video within minutes, then face to face to be on the safe side, than wait weeks to get a GP slot. And unlike NHS 111, the people giving the advice are doctors. At a time when A&E waiting times are missing targets by hours and staff are under-resourced and overstressed, GP at Hand could reduce these pressures.
The chair of the Royal College of General Practitioners, Helen Stokes-Lampard, has admitted the model is “phenomenal”, while acknowledging it could be improved upon (I would love to see an option to request the same clinician). It seems ludicrous that there is opposition to it on the basis that it wouldn’t be right for everyone when thousands of patients would, like me, benefit from an efficient app. While there are some who wouldn’t be suited to such a service, there is the option to develop a public equivalent of the app and educate patients, so more can use it.
It’s also about time the funding model of GP surgeries was reviewed and issues such as ghost patients addressed. But an expansion of GP at Hand was recently blocked by the decision-making clinical commissioning group in question.
Hancock has announced a £200m boost for a trial of a new NHS app, which will include things such as organ donation preferences. NHS England’s chief executive, Simon Stevens, has spoken highly of tech innovations, highlighting DeepMind’s successful collaboration with Moorfields eye hospital. The move to EPS (electronic prescriptions) has saved the NHS £130m in the past three years.
Working with technology experts is crucial; previous NHS digitising efforts haven’t exactly gone to plan. In 2016, an £8m programme was scrapped, a revelation quietly released on the day of the Chilcot report. And the need to keep data safe is paramount (but remember that the NHS lost 900,000 letters in five years, so it’s not just tech at fault here). The Royal Free hospital was found to have breached the Data Protection Act in a collaboration with DeepMind (owned by Google). But transparency has since been introduced, and the technology itself – used to monitor chronic kidney conditions – has proved successful.
The future of health is alongside tech, and that must not just mean private companies– such as Apple’s Health app, or the excellent Clue period tracker– or some people getting access to schemes as a result of a “postcode lottery”, as Hancock put it. The public sector should be leading the charge in these areas, to sustain the NHS. So I won’t be mocking Hancock for his enthusiasm for all things tech. He is actually thinking about a way to improve the NHS when, quite frankly, his government colleagues have so far left it teetering on the brink of collapse.
