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Keir Starmer's techno-fix for the NHS: Déjà vu disaster or brave new blunder?

Beware over promising benefits and underestimating complexity

Opinion Around 20 years after the largest public sector technology disaster in UK history began a £12 billion contracting escapade, they're at it again.

"They" being the Labour Party, and "it" a promise to fix the NHS with the magic of "technology."

In an opinion piece in The Guardian, the leader of the opposition bemoaned the state of the NHS following the ravages of the pandemic and years of arguable underfunding.

But Labour is in a tight spot. Though hotly tipped to win the next general election, likely to be in 2024, it will have politically limited options in raising taxes to pay for one of the world's largest healthcare providers, which already soaks up an annual budget of £160.4 billion in England and suffers a chronic shortage of doctors and nurses.

"There is another change that could totally reframe the NHS and how it operates, and save money," the opposition leader opined, as if staring dreamily into the distance, consumed by a vision of a better future he alone could see.

That change, you ask? "Moving from an analogue system to a fully digital NHS. The NHS is in pole position to take advantage of advances in science and technology, if only ministers realised it," Sir Keir said.

Yes, yes. If only some minister had – in the 25 years since the dotcom boom brought the elixir of IT bubbling to the top of the business and political agenda – thought that the NHS could be made more efficient using tech investment.

The problem is they have. Several times. And it has not ended well.

The National Programme for IT (NPfIT), which began contracting under the Labour government in 2003 with a budget estimated at £12.7 billion, fell dramatically short of its ambition to offer electronic health records throughout the NHS.

In 2011, the National Audit Office (NAO) found that £2.7 billion spent up to that date did not represent value for money. "Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different," it said.

In the wake of the NPfIT failures – there were many among a few successes – the coalition and Conservative governments were more modest in their ambition for NHS IT yet still managed to come up short.

In 2020, the NAO warned that the lack of systematic learning from past failures means there remain "significant risks to successful implementation… in all areas" of the government's "Digital Transformation Portfolio" launched in 2014.

Since then, there have been more efforts. In early 2022, the UK health secretary looked to "the latest technology" to clear a 6-million-strong waiting list in England caused by the COVID-19 pandemic. Then in June that year, the NHS committed to implementing electronic health records for all hospitals and community practices by 2025, backed by £2 billion in funding.

Despite more than 20 years of initiatives, the shortcomings are manifest. In December last year, a study by the British Medical Association revealed that more than 13.5 million working hours are lost yearly in England's health service alone due to inadequate IT systems and equipment.

To home in on just one dramatic example, a catastrophic failure of electronic health systems at Guy's and St Thomas' hospitals during the summer heatwave of 2022 took two months to completely rectify because of the complexity associated with 371 legacy IT systems.

As if none of this is apparent, Starmer ploughed on promising "more choices for patients and the ability for us to better manage our own health."

The pledge has a history dating back to before even the National Programme for IT. First planned in 2000, Choose and Book was funded in 2003 via a five-year, £64.5 million contract to the commercial supplier Atos. It promised patients choice in booking hospital appointments in consultation with family doctors using an electronic booking system. In 2014, it was scrapped.

The problem was, in practice, there was no choice. A study from 2014 showed that in GP consultations, the "choice of hospital was either not offered at all or was presented to the patient as an external requirement (something the GP 'had' to do), with GPs often highlighting the perceived absurdity of the situation by expressing humour or exasperation."

The study did not encounter a single example of any patient choosing to go anywhere except their local hospital, and only one example of a member of staff who recalled (on a single occasion) such a choice being made.

None of this means technology cannot help the NHS. The technology can be improved, and it might even produce efficiencies if correctly specified. But hoping you can use technology to magic away deep-seated and complex organizational problems is a fool's errand. And you could make it worse. ®

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