Question A: What is the fifth biggest employer in the world, with 1.7 million staff?
Question B: A million people access this organization every day. What is it?
These days, the answer (same for A and B) is obvious. The NHS, duh. Our NHS, the largest healthcare system in the world. Serving anyone who is ordinarily resident in the UK. For free.
The NHS is a giant. A massive people-scape of staff (medical, managerial, administrative and maintenance) and patients. It is also a massive techno-scape, because all its people rely not just on each other but also, and crucially, on technology.
And that’s where it gets reaaally complicated.
To offer the best possible care to patients, the NHS needs cutting-edge technology. It also needs technology that is safe when it comes to data and privacy.
That’s a tightrope, because innovation poses risks to security, but too much focus on security will stifle innovation.
So the NHS is torn between security and innovation, or stability and dynamic change, on a scale that is mind-blowing. How do you wrap your mind around that?
There is no easy answer. But it helps to think of the NHS as a digital healthcare ecosystem.
What’s a digital healthcare eco-system?
An ecosystem is an environment that contains different species and ecological niches. It’s like a community of interacting creatures and entities. These depend on each other for their survival and effectiveness: they need to communicate, collaborate and sometimes compete.
An ecosystem has to sustain itself but it also, crucially, has to keep evolving. It thrives on dynamic stability.
The NHS is very much like that. It contains people and ‘niches’ (GP practices, hospitals, management hubs…) that work together in interdependent, interactive clusters. All these different parts need to connect and communicate for the NHS to thrive.
Technology plays an important role in this – that’s why we call it a ‘digital eco-system’. That technology will be part of a larger regulatory framework with shared organisational structures and principles.
What are the blockers?
Given the scale and complexity of the NHS, a (stable) regulatory framework is necessary. But that’s not the same as ‘regulate and forget’, because the ecosystem needs to be able respond and adapt to change. The rapid rate of technological innovation is a key driver of change. The current pandemic is another one at the moment.
The NHS ecosystem has different layers: national, regional and local. Depending on the governing ideology, it may be more centralized or decentralized, more closed or more open.
Arguably, some of the failings in communication we’ve seen in the context of COVID-19 stem from the strongly centralized approach adopted by the UK government and Public Health England. The many problems thrown up by Test and Trace are one example of this; the current tensions between national and regional leaders another.
Historically, the NHS has been accused of being both too monolithic (like one enormous block) and too fragmented. That’s probably not surprising: its organisational and bureaucratic structures are not just huge but also weighed down by legacy technology and commercial arrangements.
The NHS has keeps investing in efforts to thrive as an ecosystem. One recent example is the National Programme for IT (NPfIT), an attempt to develop an integrated digital infrastructure. But the NPfIT has been accused of not being cost-effective, and some people have called it a disaster.
That may be discouraging, but the NHS is looking towards the future and in for the long haul. A digital healthcare system that is both dynamic and security would have huge benefits. There is a lot at stake.
And now more than ever. The Covid crisis has made abundantly clear why the NHS must be able to respond rapidly; why data must be available and secure; why different parts of the health system must talk to each other, without disconnects; and why transparent, up-to-date information must reach the right people at the right time.
The bottom line? I am rooting for the NHS. I hope it survives threats from viruses and ideologies, and thrives as a digital healthcare ecosystem. It won’t be easy, but giving up is not an option.