On July 05th, 1994, Jeff Bezos established Amazon. Within a few years his company and the Amazon website was tracking our buying habits, making personalised recommendations to each of us based on our purchase history. So why hasn't the NHS been able to introduce technology that has helped patients as much as Jeff Bezos has helped consumers?
It is one of the great ironies of our time that the NHS, an enterprise dealing in life and death, has lagged behind a bloke who set off selling books online in its implementation of technology. If ever there was a venture, a calling, a cause, that cries out for the efficiencies, economies, accuracy, and consistency technology provides, it must be the world of health and care. What could possibly be more worthy? Patients would receive better care, adverse incidents, and the subsequent investigative and legal costs would reduce dramatically, the expertise of clinical and patient-facing staff would be better used, capacity would be increased, and costs would be saved. It's a no-brainer, right?
So why is the NHS so far behind the pace when it comes to the use of technology?
#1 - There is no pressure to innovate...
In the private sector, there is constant pressure to innovate and get better at meeting the needs of the people you serve, because if you don't, you can be pretty sure your competitors will and you will lose your customers to their services and products. In the private sector it is ultimately the marketplace, that nebulous term used to describe the collective purchasing and consumption behavior of a group of consumers, that dictates success. The customers in a competitive market are the ultimate arbiters of success or failure because they define the value, real or perceived, that they get from the product. In the public sector, it is not that the views from the marketplace don't matter, the truth is that there is no marketplace. The only people public services need to please are the regulators that oversee and monitor their work. Customers be damned, in fact, they are often seen as nothing more than an inconvenience to be tolerated and kept at arm's length, as long as the regulator is kept happy then that's all that really matters.
#2 - There is nothing similar to compare it with...
I used to sit on something called a Patient Participation Group that my local GP Practice ran. I was one of about eight or nine semi-regular attendees who were listed as patients at the local Practice. It was a bi-monthly meeting at which we shared any experiences of using the local Doctors and aired anything of concern. The GP Practice Manager was often there accompanied by one of the Practice Doctors. At every meeting, there was a collective outpouring of praise and recognition for the work the Doctors did and for how brilliant the practice was. But when I asked the group on what basis they thought the service was good, nobody really had an answer because nobody had anything similar to compare it with. The Practice Manager would say something general like, we have made some improvements to the website this month, and everyone would look at the new improved website as if they knew what they were looking at and go, oh yes, isn't that great. The reality was that the website was horrendous, if it had been a living entity it wouldn't have been allowed out without its mother. The GP Practice had set the website up because they had been told to so that they could tick a box for the funding body and the regulator, not because they saw it as a way of delivering value to the people they were there to serve.
#3 - Nobody is really in charge...
In the private sector, someone is designated as the person in charge. This person is usually seriously overpaid, and they are the person, rather like a football manager, who gets the praise when the company is doing well, and takes the flak and gets the sack when things don't go according to plan. They are also the person who is responsible for leading in the chosen direction of travel for the entire organisation, they are the person who stands up and says, "this is where we are going and this is how we are going to get there". Leaders in the private sector have to be more than just dealers in hope, they have to be dealers in results because the marketplace is watching and the shareholders are expecting. But have you ever wondered who is actually in charge of the NHS and the wider health and care system in the UK? Sure, you can locate someone with the title of Chief Executive, there are a lot of those about, but there isn't somebody actually in charge of the entire thing. The Health Secretary of the moment might think they are in charge, but they are transient and in reality, have very little power. The Chief Executive of NHS England is also similarly impotent when it comes to setting the direction of travel and ensuring delivery of any promises made. It therefore stands to reason that if nobody is really in charge, then in the absence of the meaningful leadership needed to drive innovation and improvement, little of it will occur.
So what can be done?
Firstly, I'm not a privateer, yes as a former business adviser I can see the benefits of competitive marketplaces when it comes to driving user-focused innovations, but like most people in the UK, I don't want a privatized health and care system. What I do want, is a greater voice and more power as a patient and shareholder of the system. I want my views to count for more than the arbitrary findings of highly paid bureaucrats and out-of-touch regulators. Secondly, I want to know how the services I have access to compare with the best of the best, from health, care, and any other sector that relies on meeting the needs of its service-users to ensure its own survival and continued prosperity. I want the public services that we as citizens fund, to take their lead and learn from those who are successful in any field of endeavor. And lastly, I want someone in charge who answers not to a political overlord or a group of faceless invisible bureaucrats, but who is visible and accountable to their service users and their ultimate funders, the taxpayer. What do you think? You can share your thoughts and feedback with me at tom@cormetis.co.uk