Tech Needs People

I had a health episode recently. I won't say what, but it was something that could have turned nasty and landed me in lots of trouble. Conceivably, my last trouble, at least as a person with all four limbs. Luckily, a pair of wonderful clinicians acted with calm and timely competence. They were really up against a ruined system, however.

Not so very long ago, Britain's National Health Service was an envy of the world. British health rocketed from an oddly low base among "developed" countries to high life-expectancy, increased height and heavier birth weights. I don't mean we topped the rankings — we never came close to the health of Japan, Switzerland, or Australia — but from our late 20th century baseline, the trend was sharply upwards. No longer.

I witnessed the decay in the NHS from the inside. When I started running health data, it was common for me to do something like optimize a diabetic care pathway to maximize patient engagement. Now, I rarely do anything except justify expenditure. The Conservative governments we had from 2010 decided that Britain's economic woes were a budgeting problem; thus public spending had to be cut. Among other things, that meant stripping the health service. This was done under a much propagandized policy of firing superfluous managers. Wrong — there were already too few managers, it just looked like there were too many.

Once upon a time, the health service had matrons, secretaries, and janitors. At some point, title inflation turned them into nurse managers, office managers and facilities managers. Firing them didn't cut any fat, it removed the people who kept the wards organized, made sure there was ink to print prescriptions with, and replaced the blown lightbulbs. Without them, the system crumbles. There is a very modern addition to this.

I've been professionally attached to the NHS for most of my working life. Most years, I circuit the autumn expo season and talk to all manner of health tech suppliers, procurers and hopeful startups. It is a constant refrain that the NHS needs better data infrastructure, and on the face of it, certainly. I could have become very ill because one hospital department couldn't see the schedule of another and booked me into a non-existent emergency care slot; which was refused because the triaging clinician couldn't see the original department's data and misunderstood the referral. This is beyond silly.

In fact, it's far and away beyond silly because the NHS has the best data infrastructure of any large health service. It's better than America's, it's better than Germany's, and it's better than what the French have. The problem isn't hardware, software, or connectivity — the problem is an almost total lack of competent data staff.

I'm sorry, I know great data scientists, engineers, and analysts in the NHS, but in a system serving 65 million patients, you are too few. All of you know that there is a grassroots movement in the NHS to convince data workers to learn a programming language like Python or R. That such a thing is necessary speaks to two absurdities: 1) the majority of data workers do not know how to program, and 2) the senior management of the NHS thinks this is okay. That kind of mindset is how you end up with hospitals configuring their (mind-bendingly expensive) data infrastructure in such a way that two departments can't transfer information to each other.

Sadly, the new Labour government does not seem likely to rectify this. Come to think of it, the new Labour government doesn't appear to be listening to any voices from the wider tech sector either. When Wikipedia's saintly Jimmy Wales tells you that eroding online privacy is a bad idea, you ought to listen. When a hospital can't communicate with itself over its own data infrastructure, you need people to fix that.