Cowper’s Cut 337: On the subject of money
It’s another week when we don’t yet know whether the Labour Government knows its Chablis from its chardonnay when it comes to health policy.
And several more such weeks stretch out before us until the publication of ‘Darzi Review II: This Time, There’s No Money’.
This led to the comic spectacle this week of both NHS England and the representative organisations telling Health Service Journal that the rather obvious impending NHS financial crisis is going to be bad.
Henry Anderson
One must have a heart of stone not to laugh.
NHSE’s pro tem chief executive Amanda Pritchard’s regular defences of the adequacy of the previous Government’s NHS spending plans make this ‘warning shot’ look silly.
The representative organisations look no wiser, nor better-informed. The NHS Confederation’s chief executive Matthew Taylor nodded along with Labour’s health policy advisor Professor Paul Corrigan’s NHS Confed podcast assertion that “one way to change the impression that we’re always asking for more money is to stop asking for more money ... in five years’ time, will there need to be more money? Probably almost certainly yes. But hopefully by that time, there might be some more money to use”.
Former education policy advisor to Michael Gove and policy commentator Sam Freedman’s latest blog on Labour’s financial gap effectively shows the scale and nature of the challenge.
Labour always faces a higher bar than the Conservative And Unionist Party to be deemed fiscally credible in the UK national media landscape. That’s a longstanding fact of political life.
It is possible to see that Labour felt that it had no choice but to box itself in by promising not to raise any of the three main taxes, while also recognising that the consequent economic hair-shirtism is about to make percussive contact with reality in a way that could see the situation develop not necessarily to the Labour Government’s advantage.
AI, says TBI
No sooner did I write last week that the Tony Blair Institute had failed to produce their mandatory fortnightly healthcare AI-hyping report than - whoops! - out comes another TBI AI-hyping report.
Its call for an AI-enabling “single source of truth” Digital Health Record which will have most impact in primary care would be quite sweet, if it weren’t so divorced from the reality of NHS operational delivery in autumn 2024.
Let’s recap quickly. Primary care was the first bit of the NHS to have truly effective IT systems, because it was mainly a set of small private businesses who could see exactly how investing in working IT would improve their professional lives.
And depressingly, the best integration potential with other organisations is that offered by racist misogynist Frank Hester’s TPP products.
Secondary care IT is often a mess of poor data quality and mixed usability, as the slow and challenged implementation of the Federated Data Platform is proving.
Yes, there have been a few notable bright spots in NHS IT implementation (such as the Picture Archiving and Communications Systems: remember those radiologists who claimed that PACS image quality would ‘never beat film’?), but NHS trusts have now been implementing US-derived secondary care Electronic Patient Records - which are in reality lightly-adapted billing systems - for over two decades.
In those two decades, the English NHS has failed to develop a standard EPR purchasing contract (there is only guidance and recommendations); has failed to make EPR providers furnish us with greater system interoperability; and has failed to standardise and share ‘lessons learned’ from the many, many EPR implementation problems. If ever there were a blatant case for the English NHS to have acted as a national system (conditional on having the right IT-savvy and procurement-aware national staff), it’s in IT acquisition and spread.
And the unsurprising consequence is that two decades on from the first EPR installations, a new EPR installation remains associated with a massive crash in English NHS hospitals’ performance.
And Cerner and EPIC keep getting to charge each new NHS customer for the adaptations and workarounds for which they’ve charged previous NHS customers
And lots and lots of NHS computers are still running vintage versions of Windows operating systems.
And the Federated Data Platform does not link up with primary care, which renders the aim of doing population-level health prevention pretty damn difficult.
But sure: the NHS’s problem is the lack of AI-readiness.
And if you believe that, then I’ve got some real estate in Florida I can sell you real cheap.
William Turvill
There is a school of thought that criticising this Tony Blair Institute report is a bit like getting all Brian Sewell on your children’s drawings.
That school of thought is in OFSTED Special Measures, though. The TBI’s conflict of financial interest is so very blatant: Larry Ellison of Oracle‘s Foundation in no way obscures the fact that Oracle bought Cerner, and if you read the Oracle think-piece about that acquisition, you may find that the read-across to what the TBI’s AI-healthcare-hyping reports type is striking.
This is not a document that should be tossed aside lightly, but one that should be hurled with great force. The Tony Blair Institute is to realistic health policymaking what Leonard Cohen was to cagefighting.
If you want to read something about using AI in healthcare written by not only a member of the Reality-Based Community but also an actual expert in the subject, then I once again recommend to you the work of Dr Jess Morley.
Recommended and required reading
Will return soon.