Technology is everywhere reshaping our lives. Former Health Secretary Stephen Dorrell, however, believes that healthcare is lagging behind this trend. Writing in the foreword to a new report on the benefits of Technology-Enabled Care Services published by PPP (Public Policy Projects, a think-tank), Dorrell says that the reasons healthcare trails other sectors are “complex and intertwined”. They include, he argues, fragmented health and care structures, limited resources, and reluctance to change. “Yet”, he says, digital health has the potential to transform our lives and could make a significant contribution towards the ultimate goal of preventative healthcare.”
The PPP report sets out many ways in which Technology-Enabled Care Services (or ‘TECS’) are already benefiting patients. It is helpful in defining and categorising the sometimes bewildering range of measures in this field. ‘Telecare’ is described as the process of monitoring activity to identify when changes occur (e.g. someone has fallen over at home). ‘Telehealth’ includes the monitoring of vital signs such as blood pressure and oxygen levels, while ‘Telemedicine’ involves using video and other technologies to conduct remote consultations. Technologies such as smart doorbells or voice-activated software fall into another category – ‘assistive technologies’.
It is when the report comes to the barriers to the adoption of TECS however, that it is most interesting. Perhaps the most persuasive reason given for healthcare’s slow uptake of technology are the cultural challenges. The report refers to the health and care sectors being traditionally risk averse, which makes them slow to adopt new approaches. “As a result”, the report says, “adoption and spread of new technologies can take a long time, with each locality insisting on its own pilot or proof of concept”.
Linked to this is what the report refers to as “sector fragmentation”. The 2019 ‘Topol review’ into preparing the healthcare workforce to deliver the digital future is quoted. That report referred to the “challenge of getting the buy-in required from a multiplicity of NHS stakeholders in order to embed telehealth within complex local health economies in such a way as to exploit its cost-reducing potential”.
It is, perhaps, slightly perplexing, that issues of risk aversion and fragmentation are so prevalent in the UK. The NHS is, after all, famous for being one of the largest and most centralised organisations in the world. Nevertheless, this problem does ring true. Healthcare is, by its nature a conservative profession, and in an organisation as large as the NHS there is a tendency for a premium to be put on not standing out too far from the crowd.
A related concern that the report identifies is the lack of an evidence base for TECS. It says that “whilst many commissioners and purchasers recognise that TECS has the potential either to save costs – or at very least prevent expenditure – there is a limited evidence base to build a use in a business case for change”.
It is striking how circular these issues are. This suggests that, if we are not to lag behind in taking the opportunities that technology offers, a mechanism needs to be found for giving new approaches a try. The recommendations in the report are slightly unconvincing, however. They refer, rather vaguely, to “government support”, “innovative funding models” and including technological awareness in CPD training.
Perhaps a better approach might be to learn from the experience that the NHS has gone through during Covid. New approaches were adopted because they had to be – a culture of carrying on doing the same thing, the same way as it had always been done, was simply not acceptable.
In the field of conducting investigations, I know that many organisations use a Word template that they keep track of on an Excel spreadsheet. For a typical NHS trust, which has dozens of investigations going on at a time, this falls so short of the best that can be achieved with a system like Eva (https://www.evaapplications.com) that it can only be a matter of time before things change. Let’s hope that reports like this help to speed up the process of ensuring that healthcare reaps all the benefits that it can from the rapidly developing technology sector.