What really counts – keeping humanity at the heart of digital innovation

What really counts – keeping humanity at the heart of digital innovation

Digital innovation is going to save the NHS. We use digital in every other aspect of our lives so why not the NHS? So the hyperbole and the mantra goes. But what if, in our fetishisation of digital, we get too focused on shiny products and forget what really counts? This moving blog post by health economist Dr Chris Gibbons about his family’s interactions with health services, when his dad was very ill, made me pause and reflect on how we keep values of humanity at the heart of efforts to innovate and improve health services. Here is a section of the blog post which emphasises that it was person-centred  and goal-orientated care that made the biggest difference to Chris’ dad: “Innovation has many guises. Innovative ways of thinking about the hospital system. From the point of admission to the successful discharge and rehabilitation of people in a place of their preference then linking up that system seamlessly with health and social care system. We need to emphasise the importance that people doing Neil’s [care worker] job have in linking that all together as a person centred, goal oriented approach to recovery and rehabilitation. That’s where the real value in innovation sits. It doesn’t fit neatly into a Markov model, or have fancy branding and the backing of a pharma company that’ll send you to Honolulu for a conference. But it is the kind of innovation that we should be judging against all the other “innovations” that do” How do we assess what really counts and what is going to make the biggest difference to patients when we have...
Frameworks, lyrics and non-adoption of technology

Frameworks, lyrics and non-adoption of technology

You know that feeling when a piece of music (or a book or film) resonates so strongly that it helps you understand something about your life? In my late teens it was The Smiths who did just that. I suspect that teenage hormones may have been a factor, but every lyric from Morrissey’s pen seemed to speak to me directly. Fast forward to 2018, and minus the heady mix of adolescent intensity and the tunes, I had a not altogether dissimilar sensation reading Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies by Trisha Greenhalgh et al (2017). This paper felt like reliving the first four years of my journey into the digital health technology sphere – every challenge, mistake, obstacle we have encountered is captured in this compelling paper on why technology doesn’t get adopted in the NHS. It felt a bit like the life story of mHabitat but minus the highs… NASSS is an evidence based and theory informed framework that endeavours to set out the interrelated factors that influence the non-adoption abandonment, scale-up, spread or sustainability of technology. It aims to be a tool that can easily be used in practice. The rich blend of research methods comprising case studies with qualitative interviews and ethnography, along with a review of the literature, elicited the seven framework themes (see the diagram above). Our tacit experience of non-adoption could have easily have been one of these case studies – everything from poor clarity of the problem the technology is meant to solve; poor...
Convenient access to your GP – what’s not to like?

Convenient access to your GP – what’s not to like?

General Practice is in crisis. A record number of GP practices closed last year as a result of growing patient demand without the requisite funding and workforce to respond. So a new app-based service for Londoners, which offers information services and video based consultations must be a good thing – right? The launch of GP at hand, which promises that you can see a GP in minutes for free, has been widely covered in the press. Whilst it has its fair share of promoters, they are some notable detractors. The purpose of this post is to curate those concerns and to consider implications for the future of digital in the NHS. What is GP at hand? GP at hand is a new NHS service offered by a GP Practice in partnership with the commercial company Babylon. The practice offers registered patients the ability to book an appointment via the app, have a video consultation via the app 24/7 and within two hours, pick up a prescription from their chosen pharmacist, visit one of six clinics in London Monday to Saturday. The app, which is powered by Babylon, also offers a symptom checker, health monitoring, and the option to replay your appointment so you can remind yourself of what was discussed. The app offers convenience, quick access and the ability to speak to a GP anytime and anywhere. A quick reminder about how General Practice works General Practices offer primary care services to a local community. On their website, NHS England say they are ‘at the heart of our communities, the foundation of the NHS.’ Most GPs are independent contractors...
Carebnb and the law of unintended consequences

Carebnb and the law of unintended consequences

Along with the title: “NHS may rent spare rooms to ease bed crisis” The Guardian ran a story this week, on what it describes as an Airbnb style scheme designed to help alleviate pressure in the NHS, by enabling patients ready to be discharged from hospital to recuperate in a private home. The story, which was first featured in the Health Service Journal, was also covered by Roy Lilley in his regular blog where he raises a host of concerns about CareRooms including safeguarding, exploitation, safety, training and regulation. However, beyond the obvious concerns, he asks the more fundamental and interesting question: “The real issue is not if CareRooms can be made to work safely.  The real issue is why are we even contemplating this? … Austerity is the mother of innovation and here is an innovative solution driven by the mother of all austerity.” On its website, CareRooms offers hosts £50 per room per night, and the promise of up to £1000 a month, for providing a bedroom and three supplied microwave meals for a discharged patient. The website incorporates pictures of hotel style immaculate bedrooms along with a reassuring narrative: “We are working with the local health and care community to provide a safe, comfortable place for people to recuperate from hospital.” Co-founded by a doctor, CareRooms was conceived out of real struggles with shortages in social care, and makes a compelling case to solve what is a well-reported strain on the NHS. It has the support of the NHS clinical entrepreneur programme and I have no doubt it is positively intended. So if the concerns raised...
Towards a manifesto for digital health #socialjustice

Towards a manifesto for digital health #socialjustice

What would a manifesto for digital technologies grounded in social justice look like? In other words, the development of digital technologies in health and care that enable an equitable distribution of wealth, opportunities, and privileges within society and which balance the interests of individuals, communities and institutions. After all the NHS is a collective endeavour – each of us contributing so that we all have access to health and care free at the point of demand. A few weeks ago I co-facilitated the first of mHabitat’s three Digital Humanities in Health and Care seminars along with Dr Helen Thornham from the School of Media and Communications at the University of Leeds. Along with a group of practitioners, technologists and academics, we considered the role of ethics and justice in respect of the inexorable rise of digital technologies in health and care. Mark Brown, one of our speakers, talked about the contested notion of social good in sphere of digital health: “Delivering public services is a political act. The shape of public services and how they feel are defined by political and historical realities. The decision of who pays tax, what taxes they pay, upon whom those taxes are spent and who it is that does the work is political. The ‘social good’ is not an uncontested idea. The culture of Silicon Valley is increasing looking, in the American phraseology, like a dumpster fire. Libertarian ideas run riot, with the very ideas that our public services in the UK are founded upon are seen as a deadly infringement of the rights of the individual to choice. Low tax, low regulation...