Analogue because of digital
In his speech on the NHS at the King’s Fund in September, the Prime Minister Keir Starmer explained three fundamental reforms, one of which was “moving from an analogue to a digital NHS.”
I find the language of “analogue to digital” a little jarring when we’re talking about a health system that is already full of technology.
My concern is that the default solution to this type of reform will be more technology. However, we still have a greater need for more joined up systems that make better use of existing technology. This includes recognising that not all legacy technology is bad. Dare I say, even some of the pagers and the fax machines.
Every health experience is a service safari
Last week I got my Winter Flu Vaccine at Boots (a large UK based pharmacy). I booked online and everything worked fairly seamlessly with a helpful local pharmacist.
What intrigued me was that Boots had no way of informing my GP or updating my NHS record to indicate that I had been vaccinated. I specifically asked about updating my health record, and the pharmacist provided a paper form for me to drop off at my GP surgery so they could amend my record manually. The reasoning: “Boots computer systems don’t talk to each other, never mind NHS systems […] also GDPR.”
I shared this story on bluesky and it seems that some pharmacies do have ways of updating your GP or NHS health record, including some Boots stores. I was at a small branch in my local town, so maybe this is the difference between more modern, digital stores you might find elsewhere. Boots does strike me as an institution with a lot of legacy tech around the edges.
Looking purely at efficiency or the costs of admin, there is now a need for data re-entry by my GP surgery. There must also be some clinical risk of people forgetting if or when they have had a vaccination if systems are not updated.
This also reminded me of Richard Pope’s point in his book Platformland, about the need to remove administrative burden.
Analogue experiences
I had a similar analogue experience the previous week in Audiology at my local hospital. I was there for a hearing test because ENT (a separate department) were missing my previous hearing test(s) from their systems. These departments are maybe 150 metres apart in the hospital, but operate with separate systems.
Having completed my hearing test (all done with technology), the audiology department printed my results so I had a paper copy to keep “just in case.” They acknowledged that sometimes things don’t get shared between systems or go missing.
In fact, for years, I’ve always asked for a print out of hearing test results in Audiology. Like many people, I have my own NHS folder of letters and print outs. This is one of the most reliable records of my own health situation in managing a long term condition. The NHS App has parts of this record, both primary and secondary care, but only parts.
Both of these experiences were an important reminder:
Analogue isn’t always a lack of digital. It’s often the result of how technology is integrated into our systems. This is both inside the NHS, and in how we recognise the role of organisations in providing health and care outside of the NHS, including the private sector.
The opportunity is to think more about service design, and to improve and fix how we integrate and use technology across the whole of these systems. There are also lots of opportunities to start small, like with the types of interactions I’ve described here.
Data problems
A big issue is data, and there is lots of focus here at the moment, including strong arguments to just get on and fix data sharing.
I found this recent response to NHS data challenges from Hadley Beeman very insightful. We need to think more like the internet here – working with open interoperable standards – rather than pinning our hopes on big solutions.
With the right interoperability, I’m equally interested in how Boots can share my vaccination record with the NHS as I am in sharing my hearing tests with my Apple Health App so that it can do useful things. In the short term, maybe there are creative digital solutions to achieve both of these goals, even if that involves scanning and image recognition to process paper records?
Analogue isn’t always bad
A final thought.
Sometimes analogue should be the result of digital, rather than something to always move away from.
Some of the best uses of digital are how human connections are made, how direct referrals happen, and how we establish meaningful relationships through community and third sector support. I worry that we will simply become too focused on the ‘computerisation’ or ‘codification’ of care otherwise.
If anything, the strategy for reform needs to be better digital.
This is my blog where I’ve been writing for 20 years. You can follow all of my posts by subscribing to this RSS feed. You can also find me on Bluesky and LinkedIn.