Interview: The digital challenges of the NHS and investment in solutions

Ian Bolland and Reece Armstrong spoke to Dr Ian Jackson, medical director and clinical safety officer at Refero. They discussed Matthew Gould’s appointment at NHSX, the role of the organisation, digital technologies and investments in solutions in the NHS, and the recently announced plans for an NHS AI laboratory.

Speaking to the MedTalk Podcast, Jackson welcomed the appointment of Gould and has been impressed he’s been meeting frontline staff to get an idea of what’s happening within the service, and highlighted the difficult timing of Gould’s arrival into the role.

In his first blog as NHSX CEO, Gould said he didn’t want to make the app ‘all singing and all dancing,’ and that no more features should be added to it.

Dr Jackson suggested that looking at integrating partially app-related and web portal-related technology into the NHS App would have been problematic, but described Gould’s starting point as ‘very sound’.

“I think he came at a difficult point when things like the NHS App needed some sort of positive decision making.

“My local practice is an EMIS practice and I’ve been able to book appointments, order my prescriptions and do all the things that the app was ostensibly going to do for a couple of years now.

“As a patient I had no inclination to move across to it because there was a hugely complex procedure to try and get registered with the app and I had already got all of the procedures that were needed.”

Jackson praised Gould for touring the country and feels the NHSX CEO will have got some valuable insight about the struggles that certain Trusts have had introducing more digital services.

He suggested Gould’s presence is an important link to health secretary Matt Hancock, helps manage expectations and what the secretary of state says about digital services in the NHS.

“I think it does him credit that he’s being careful with the aims for the organisation and bringing it forward.

“It’s just that over the years several politicians have said about being paperless by 2020, 2022, 2024 and things like that. The reality is that it’s a huge challenge getting there.

“I think having Matthew (Gould) there is an important link into Matt Hancock to perhaps provide feedback and bring more realism to what is feasible. I think that’s an important aspect of his role.”

Dr Jackson suggested that the variation in IT uptake, particularly in secondary care, is a huge challenge for the NHS, even more of a challenge than interoperability.

“There is a far greater variability in uptake in the electronic patient record and the overall management of patients through secondary care compared to primary care.

“All GP practices, I believe, now have some form of electronic patient records but in secondary care it is hugely complex.

“Yes, interoperability is an issue. But my gut feeling is I think we’re moving away from true interoperability – more to an ability to share information that you hold on your patient.”

He’s also concerned about solutions being purchased that aren’t tailored to NHS Trusts, which can lead to staff changing how they practice because of the way a system has been designed.

“When you get something that is quite rigid like that then that causes problems with resistance and lack of ownership in the local clinicians.”

Using the example of electronic patient records, Dr Jackson explained the lack of integration can lead to staff doing the same job twice in order to ensure safe prescribing, and that the record is in the system. He also cited a blog where a junior doctor had to load eight different programmes before operating a clinic within a hospital.

“Those sorts of things are a big issue because they increase the workload for staff. Anything that increases workload has an effect on the way they work and their preferred way of working, has a knock-on effect on acceptability – and at the end of the day patient safety.”

Dr Jackson was speaking shortly after the announcement of a new NHS artificial intelligence laboratory. He feels the terminology is unfortunate and thinks that machine learning is prevalent rather than artificial intelligence.

“Whether the investment is worthwhile is whether it’s invested in appropriate machine learning that might assist us in the NHS – then I think the investment is fine. I’ve seen good results on some of the things that are termed as AI but actually, I think that’s a misnomer.

“My feeling is that artificial intelligence per se doesn’t exist. I think we can do machine learning. I think there are huge things we can do.

“For example looking at radiology, looking at scans, we can train a machine with lots of information. I think there’s evidence there of it being really important but I would say that’s machine learning.”

You can listen to our full interview with Dr Ian Jackson on the MedTalk Podcast.

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