The NHS is healthier than you think

The NHS toolkit needs just one extra blade

“It is not the most intellectual of the species that survives; it is not the strongest that survives; but the species that survives is the one that is able best to adapt and adjust to the changing environment in which it finds itself.”

Charles Darwin

On Thursday I attended a remarkable event. It was organised by Answer Digital as a celebration of achievement by various components of the NHS. Pitching it this way was a stroke of genius; it’s too easy to focus on the challenges our health service faces, and to complain about those times when it fails us.

The NHS is the fifth-largest employer in the world, employing over 1.5 million people. That’s a staggering figure for a small island whose total workforce is only 34 million. Managing and coordinating such a behemoth is a gigantic task, which the NHS attempts to solve by operating through a complex network of semi-autonomous operational units. I suspect I wasn’t alone in thinking before the event that this was its greatest weakness. By the end of the day I had begun to see things differently.

The day was begun and ended by Sonia Patel, CTO of NHS England. She referred to the above statement by Charles Darwin, and it became ever more relevant as the day progressed.

What I saw was genuinely a celebration, of persistence, enthusiasm and, above all, creativity. As I listened to the solutions that these people had implemented, I suddenly realised that what I’d regarded as the NHS’s greatest weakness was also its greatest strength. It’s adaptable. It’s a behemoth, but it can change direction like an antelope. Through budgetary crises and a global pandemic, it’s been able to navigate the storms and continue to deliver. This structure might not be perfect, but it performs remarkably well. That could be why so little was said about a unified system. Yes, communication problems were a frequent mention, but the key focus was on delivering great service within each component of this giant machine.

So what about the Single Payment Record?

Considerable work is being devoted to creating a single identifier that could unlock every aspect of a patient’s healthcare. There’s no denying that this would greatly simplify administration and improve cross-reference and ease referrals or address changes. But how can it be implemented across the entire enterprise? Not only do technologies differ but, at least as importantly, so do procedures and requirements. Each component of the machine has evolved its systems to suit the job that it’s there to do. Any notional unified IT system is doomed to founder on the rocks of consultation. Compromise is inevitable, and with that comes loss of functionality. And how long would such a system take to implement, and at what cost? We could easily be looking at a ten-year project that costs billions, that isn’t quite what anyone wanted and, when finally put in place, addresses needs that were current a decade ago.

This doesn’t look like a Good Thing. Fortunately, I think there’s an easier, quicker and vastly cheaper way.

I’d registered for the event in the hope of identifying whether our identity system could have an application in healthcare. I’m pretty certain it does. You can see a few of my thoughts here.

I see identity as more than a way of recognising one person. We identify things every minute of every day. We’re sitting on this chair, we use this mobile phone and pay this bill using this banking app. In cross-border payments, we apply our eKeyiD to identify every component in the same way. Then we nest and inter-relate all of these identities through our federated ledger, each node of which can be hosted on any cloud platform and securely accessed through any technology.

What this means for the NHS is that it can leave its existing systems almost untouched. Each operational unit can continue to work with familiar platforms, under its accustomed methodology, but every component can securely access every activity, medication or any other interaction with any patient.

It was an exciting and greatly motivating day. I chatted with many clever, creative and motivated people with buckets of innovation. If they represent the direction of our NHS, then it’s in very safe hands.