How does people-driven digital square up to NHS-led digital? #PdDigital15

How does people-driven digital square up to NHS-led digital? #PdDigital15


How does people-driven digital square up to NHS-led digital? This was a question considered by Paul Hodgkin in his final Power to the People column for E-Health Insider. You can find the full article here and below are a few snippets that illuminate some of the themes we are likely to be considering at #PdDigital15.


Citizen outspend the NHS on digital

We spend a lot less in the NHS on digital technology that we do as citizens:

So what have I learned? One signature theme is that NHS IT years are the reverse of dog years – if each human year is equal to seven dog’s years then the stuff that happens in the world of NHS IT is about 1/7th of that achieved by the citizenry.

Just look at how much the NHS spends on IT kit compared with the citizenry. During the Connecting for Health campaign, the NHS spent around £1 billion per year on IT.  

Meanwhile, the people – that’s you and me and pretty much everyone else – was spending a minimum of £400 per household per year on phones, broadband, tablets and PCs. With 25 million households that works out at a cool £100 billion over the same decade. NHS £1: Citizens £10.


Citizens doing it for ourselves

Whilst the NHS is wrestling with huge barriers and challenges to digital technologies, citizens are doing it all anyway:

Information governance, systems that don’t talk to each other, cultures that clash, organisations that compete when they should collaborate – all these are the very stuff of high transaction costs; which is just a fancy way of saying they are a complete pain to work with.

Meanwhile, citizens just boogey on down to Google or Facebook to find people with the same interests. They start chatting and Tweeting and in a twink they have integrated themselves with their neighbours over the global fence. Then they start coming in your front door armed with information, support and their very own data.


Hacking health from the bottom up

To what extent does the increasing use of digital by citizens have profound implications for our relationships with healthcare professionals and provider organisations?

For centuries, the relationship between patients and their health care providers has been a one-way street in which doctors and organisations held all the cards: it was patients who were information poor, who lacked resources, and who were much more vulnerable.

These imbalances of information, power and vulnerability have shaped medicine since Hippocrates. But our networked world is beginning, slowly, to change this. This goes way beyond the fact that patients and carers now come highly informed.

Today’s patients have access to significant new resources. Not those controlled by the system, but those created by patients themselves: the forum, the voice in the night from the other side of the world saying ‘have you tried this?’ and, increasingly, the ability to share your bio-data and your life experiences with your community of fellow sufferers.

These new resources are created by the lower transaction costs of the loosely coupled, but intelligently communicating, crowd of ‘people like me’. This is not ‘co-production’ – which is what those people called patients are still supposed to do to help the system. It’s much more like hacking healthcare from the bottom up, from the outside.


NHS informatics is essential – but perhaps not forever

But we shouldn’t underestimate the very real challenges faced by the NHS:

NHS IT is a hard slog because it handles life-critical, highly personal information in a system that is understandably highly risk averse; and I salute the dedication and professionalism of all those who strive to overcome all the barriers to progress and to improve care for patients.

While ever we still have big systems providing highly invasive care to relatively passive patients we will need all the skills of NHS IT professionals. But at some stage in the next 15 years the distributed power of the loosely-coupled network will begin to alter the dynamics of healthcare in completely new ways.


A big hank you to Paul for allowing me to reproduce some of his article on my blog to promote conversation in advance of #PdDigital15.



Paul is founder and until recently was chair of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield. Until 2011, Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.

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