Thoughts on the NHS 10 year plan
The UK government has published the 10 year plan for the National Health Service in England. It is based around ‘three big shifts’: analogue to digital, hospital to community, and sickness to prevention.
Some people have said it’s less of a plan and more of a vision, which is probably fair, but also probably necessary to rewire such a complex set of organisations. I’d add that the three big shifts feel like incomplete sentences: “analogue to digital means …”. Maybe that’s the bit where the plans need to live. Here’s my (digitally skewed) take:
Analogue to digital means applying digital principles to the design of everything the NHS does, not just the digital bits
Of the three big shifts, this one carries with it the biggest risk of misinterpretation and, ultimately, failure. If it is interpreted as a series of technology projects driven by near term costs it will go the way of previous efforts that look good on project plans but don’t survive contact with reality. That’s because the things that are expensive and complex for the public and clinicians are not necessarily the things that are complex and expensive for the bureaucracy.
The plan should be to create dozens more delivery teams that are organised around outcomes, not technology. These should be truly multidisciplinary - staffed by designers, technologists, clinicians, public health etc.1 They should be funded to deliver incrementally, starting small and with ruthless focus on identifying and removing health admin. Digital is not just about technology, it’s an iterative way of delivering value for service users.
Hospital to community means designing tools that help neighborhood health teams quickly create services that work for the people they serve
Typically, policymakers have had to choose which layer of the bureaucracy is responsible for the delivery of a service. Digital changes that. Common platforms, such as the NHS app or GOV.UK Notify, can enable the delivery of local services. A failure to understand that central vs local is a false dichotomy, coupled with a desire to devolve more power leads to the sort of world where every hospital trust buys the same thing from a limited pool of suppliers.
However, just creating central tools mandating them is also a risky strategy because they might not meet local needs, slowing down delivery. The lesson from GOV.UK’s common platforms and around the world is that effective public sector platforms meet the needs of teams delivering frontline services.
The plan should be to understand the needs of local health teams through user research and then create common platforms and open-source tools that support their work. Anything else is a guess from the center and the obvious guesses (authentication, notifications etc) are already spoken for. Separate teams should be tasked with identifying and platforming the common needs that emerge from those local health teams. Again, some of those platforms, such as fulfillment for home testing delivery, might only be partly digital.
Sickness to prevention means organising to test assumptions and scale what works
There are lots of assertions about how technology might prevent sickness, such as the use of AI based triage, but the fact is that we don’t know what a digital first, prevention first health service look like because it doesn’t exist yet. Can you use technology to recommend someone a stop smoking or weight-loss service? Almost certainly. Can you use technology to get people to stop smoking or loose weight? That’s a different question.2
The plan has to start to use the NHS app to design feedback loops where more data about a person can be presented back to them in meaningful ways and effective next steps suggested. Those are not primarily technology or data problems, they are clinical and interaction design questions. You need to understand what works, what can be automated and what cannot before you attempt to scale.
Organising to test assumptions probably means a lot of hand cranking in the short term, just as when Universal Credit launched it had a digital interface, but much of the behind the scenes processes were still manual. ‘What works’ has to be in part (mostly?) about patient reported outcomes and the NHS app provides a way to collect those systematically. Starting to create those feedback loops does not have to be expensive, but it does require a certain mindset.
The work of the Laboratorio de Innovación Pública UC in Chile is a nice example of this I saw recently. They have a team that includes nurses and designers working to reduce waiting lists through iterative improvement of services.↩︎
My strong hunch is that the answer lies not in fully automated, stand alone digital tools, but in blended AI and human interactions. Some types of coaching and learning seem to rely on epistemic trust and theory of mind that, AI, logically must have some limits in respect of, not being conscious. There is also a risk that we get a trench of AI tools that create a separate ‘channel’. Jay Springett has written about how “This brand-new technology is becoming invisible, baked into workflows so seamlessly we stop noticing them. This shift feels inevitable.” I read that via Matt Jones, who has written on designing for AI as an addition to human capacbilities.↩︎