As he prepares to slash the number of managers running NHS England by as much as half, Rishi Sunak has proffered a potential solution to the crisis engulfing the health service: Send in the robots.
The Prime Minister has vowed to “radically innovate”, using new technology to deliver healthcare reforms that will challenge “conventional wisdom”.
His suggestion conjures images of Arnold Schwarzenegger’s Terminator carrying patients into A&E, or the sinister HAL 9000 overseeing hospital wards. However, experts say the reality is more prosaic – and ultimately more useful. Improvements can be made in digital record keeping, appointment management and analysis of X-rays that could yield huge improvements.
The overhaul proposed by Mr Sunak comes at a critical time, with the NHS battling inflation, recruitment problems and an enormous patient backlog following the Covid crisis. A record 7.1 million patients are waiting for procedures in England, up from 4.2 million before the pandemic.
This is contributing to the huge tally of 2.5 million people who are unable to work because of long-term sickness, which is acting as a drag anchor on economic growth.
Although automation cannot completely fix the NHS's problems, there are hopes it can at least lighten the load. The ultimate goal of rolling out technology across the NHS is to free up staff time to use their time more productively.
At the moment, even simple tasks can be frustrating. Everything from how much fluid a patient has drunk to whether they have been turned in bed must be diligently entered into an electronic records system, but just logging on to sluggish hospital computers can sometimes take five to 10 minutes alone. Hospital computer systems are also usually not linked up to GP surgeries and social care providers, which often forces staff to manually request information be shared by email or phone.
Worse still, it is not uncommon for patients to be transferred from one hospital to another with no electronic records at all. Instead, they arrive accompanied by a sheaf of papers that must be read through.
Many of these basic problems would be tackled if a national strategy published during the summer is adopted, which will require local NHS care systems to have joined-up patient records by March 2025.
The strategy also calls for more technology to improve patient care, particularly in diagnostics. Artificial intelligence (AI) – or machines trained to recognise patterns from huge troves of data – may in future be used to analyse X-ray images and CT scans, offering diagnostics with just as much precision as a doctor.
Google’s artificial intelligence division DeepMind has already developed software that can diagnose eye diseases that are as good and sometimes better than top doctors, according to a 2018 paper.
Robots could suggest treatments, help to triage patients, automatically deliver tests results and book people in for in-person consultations.
Tom Hardie, a senior fellow at The Health Foundation, says automation could help tackle “the mountain of admin” in the NHS, including letter-writing, paperwork and scheduling.
One trust in Suffolk has trialled the automation of appointment reminders using a text-messaging system, which can reallocate free slots when patients cancel. The system has cut missed appointments and sped up GP referrals.
In another example, Imperial College Healthcare NHS Trust has trialled the use of AI to analyse thousands of patient feedback forms in minutes – a task that would normally take several days to produce reports on how services need to improve.
Other technologies go beyond the confines of the hospital and into patients’ own homes.
A pioneering scheme called Project Breathe in Cambridgeshire involved people with cystic fibrosis, a genetic condition that weakens the lungs and affects the digestive system. Sufferers were given wearable digital devices that monitored lung function, blood oxygen levels, weight, sleep and temperature, with this information uploaded to “the cloud” via their smartphone.
A machine algorithm was then used to spot any worrying symptoms and deliver alerts to clinicians at the Royal Papworth Hospital, allowing them to intervene sooner and prevent the need for a lengthy stay in hospital.
Another promising area automation could transform is cancer diagnoses. Machines trained to spot anomalies in scans have proved highly accurate in academic studies.
Hardie believes these kinds of systems, which “augment” rather than replace human beings in the NHS, will help to make the health system more efficient and ease pressures on staff.
“That is partly because many tasks in healthcare are not wholly automatable and human agency is such an important factor,” he explains.
Despite the promise of a utopian tech-powered future, attempts to digitise the NHS have proven stubbornly difficult over the years.
Many private companies complain that a mess of red tape slows down work with the NHS and say contracts offered by the cash-strapped service are not profitable enough.
Professor Sir John Bell, Oxford University’s regius professor of medicine and an adviser to the Government, says that medical staff under huge pressure to meet targets can also be resistant to new technology because of fears it will go wrong and simply make things worse.
But he points to innovation that happened during the Covid pandemic, borne out of necessity, as proof that big changes can be made.
The health service, the Government, private sector and regulators came together to rapidly deploy mass testing systems and the vaccination rollout during the crisis, with rules that would have blocked easy information-sharing temporarily waved away by ministers.
It resulted in British authorities having a better analysis on the spread of the disease than almost any other government, Bell argues.
“People said we're in a hurry, we're going to get this stuff done quickly. I call it the burning platform mentality,” he adds.
“But now many barriers have reappeared and the speed at which stuff happens has become glacial again.”
Automation could make an enormous difference, he says, but the organisation itself lacks the in-house expertise to develop the powerful, scalable software that is needed.
“I think it requires serious collaboration with the tech companies,” he adds. “Apple or Microsoft, or Oracle – they really get this stuff, they've got terrific software capabilities and they can make stuff that works.”
More futuristic solutions were also proffered in a 2018 report by Lord Darzi and the Institute for Public Policy Research, including the introduction of physical robots that stitch wounds, bring patients meals and porter them around buildings.
Pritesh Mistry, a fellow for digital technologies at the Kings Fund, says some of the most impactful changes may end up being mundane, rather than cutting-edge.
“The real low hanging fruit is things like reliability of systems, quicker devices and things like that,” Mistry says.
“Making sure the technology actually works through better IT support, so it doesn't take up more staff time, doesn’t require them to be trained up or change their processes and workflows, that might be the easiest thing to do.”
Hardie agrees, saying that basic measures which ease pressures on staff could then free up time for them to begin thinking about further efficiencies.
“A lot of healthcare staff are exhausted and overstretched, not just because of Covid-19, but also because there's a significant number of vacancies,” he says.
“So technology, if we get it right, might be able to support them to work in a more sustainable way.”
If it comes to pass, Sunak's vision for a tech-empowered health service will be more akin to a Microsoft Office update than the arrival of Dr Terminator.
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