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Hospitals are different at night.
They are quieter.
Without the crash-bang and hubbub of the day. They become thoughtful places.
John Deacon stood in ITU, thinking. Just the low hum of the machines, snaking lines across screens.
Numbers, counting down the life chances of the half dozen patients connected, hooked-up, plugged in to technologies that only a few years ago would have been unimaginable.
Sarada, a fragile Bengali woman was hanging on to life. She was very ill. Complex. A tangle of symptoms.
John heard a ‘ping’ in his pocket and took out iPhone...
.. it glowed in the darkness. The answers to his questions about Sarada cascaded down the screen.
Her test results and real-time indicators had been bluetoothed from the hospital’s electronic patient record and passed to Florence...
... Florence, the NHS’ CIP… Clinical Intelligence Partner.
Florence already had access to Sarada’s medical records, history and notes.
Answers came in seconds. Treatment suggestions, all clinically validated. The NHS’ AI decision engine was certified for triage, diagnosis support, medication safety and risk prediction.
The year is 2035…
… the NHS had long since been using machine-learned administration support for everything routine. Once a patient had been given a bar code, the rest was easy.
Catering, estates, car parking, theatre management, budgeting, energy management, procurement, staff roster… you name it, Florence's partner software Bevan iBOS... Integrated Back-Office Support, took care of it.
Medical and clinical support came later, following trials in three regions. The results were astonishing...
Is my story of the future astonishing? It's easy to write fiction.
Could Florence and Bevan really run the NHS? Would we want them to?
For sure, they'd create the headroom for money to be spent on patients and not paper. For medics and health professionals to spend their time being medics and health professionals.
Training revolutionised, the whole of the clinical and medical workforce reshaped.
Is it possible?
Probably more possible than we might imagine… but not without its problems.
Principally, three;
- Patchy data and the mess of legacy electronic records and machines.
- Clinician trust and worries about deskilling.
- AI augmenting rather than replacing judgement…
… all of which, with careful incrementalism, mitigation and accreditation could be overcome.
I’ve painted a picture of what the endgame looks like but practically, how do we get there?
Realistically?
Each Trust or Region (ICBs will be long gone) will host its own AI-enabled environment, working on local-data in secure, accredited environments using NHSE’s Federated Data Platform...
(... if it survives criticisms of it creators Palantir, and its co-founder billionaire and Trump donor Peter Thiel's tin-eared criticism of the NHS... the NHS “makes people sick”.)
Let’s call them zones and assume some platform becomes universally available.
When a question needs broader context, it could query outside that environment and link to other zones.
You don’t move the data. It’s too complex, too costly. Simpler to move the question to where the data lives.
Genomics England already do this and data platforms can support AI integration tools.
The East of England Secure Data Environment is up and running and can support health and care research and analytical tools, using de-identified data.
Why does all this matter on a Monday morning, with your inbox full of asks, demands, must-do’s and me?
I think the answer is…
... we all know, deep down, the NHS can’t carry on lurching from one set of ludicrous health policies to the next, dancing around the issues.
Planning to move the NHS from analogue to digital is impossible all the time moving from Monday to Tuesday is a struggle.
The Eight and a Half Year Plan blusters about decision support, ambient AI for documentation, predictive data and enhancing the NHS App…
... but realistically?
The Health Foundation estimate, over five years, the shift to a digitised NHS will cost £21bn. It’s a stonking amount of money but the return on investment would be outstanding.
So the question for this Monday morning… who will pull their digit out, to get us on the road to a digital NHS?
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Politicians have no idea how to make it happen.
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Bobble Hats know how but have no money.
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Treasury has no money but would quite like someone to make it happen.
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The NHS is too busy to make it happen.
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NHSE is bewildered by whole thing and makes fairytale plans to look busy, in case it happens.
We pride ourselves we can do anything, but we can’t do everything.
We have to prioritise. All governments break promises, have unfunded fantasies and think everything is a priority.
There is only one answer to the NHS productivity crisis and it's not the 8.5 Year Plan's wish-list with no money.
If we want Florence and the Machine, we have to be Hungry for it. Really want it. Make it happen.
Stop staring at our phones and wishing.
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