Progress | Centre-left Labour politics

A properly funded NHS is not available on the app store

Matt Hancock’s fascination with tech is papering over the cracks in our health service, writes Nathan Hodson

As secretary of state for digital, culture, media and sport, Matt Hancock became the first member of parliament to launch his own app, utilising the knowledge developed growing up in a family of software entrepreneurs. However, since becoming secretary of state for health and social care he has remained fixated on digital, much to the dismay of doctors across the country.

This is not a Luddite tendency or technophobia among healthcare professionals. A key difference between this brief and his last is that the cut-and-thrust of entrepreneurship – and its intrinsic trial and error – is inappropriate where patients depend upon services.

All good doctors demand evidence, and at present there is insufficient research showing that these apps improve healthcare outcomes. The comments of east London GP Dr Naureen Bhatti, quoted in the British Medical Journal, characterise the overwhelming view of the profession: ‘I welcome technology in healthcare, but I want evidence that it will improve patient care.’ Meanwhile, even mobile health advocates David Peiris, Jaime Miranda, and David Mohr acknowledge that the evidence base is ‘immature’.

His Labour counterpart, Jonathan Ashworth, points out that the major challenges facing the national health service are waiting times, staffing, social care, cuts to children’s mental health, and the stalled hospital build in the west midlands. Solving this will take more than an app: our health secretary is busy fiddling with his phone while Rome burns.

Recently, Hancock has lauded the rollout of the NHS app which will change the way GP appointments are booked. Speaking to Forbes, Halima Khan of Nesta’s Health Lab warned the app could reduce efficiency and increase inequality: ‘It is unclear how it will incorporate triage and avoid appointments being booked unnecessarily … There are also those who do not have access to digital technology who may be disadvantaged when trying to book an appointment.’

Arguably this flashy intervention threatens to exacerbate the NHS’s core challenges.

Hancock’s approach to children’s mental health is to introduce guidelines for screen time, mirroring famously ineffective guidelines on alcohol intake. All this offers is more guilt for parents left struggling to negotiate with distressed children, rather than improving child and adolescent services or taking on companies which fail to consistently impose purported age limits.

Significantly, Hancock has endorsed GP at Hand, a controversial app for electronic GP consultations. GP at Hand deregisters patients from their current GP practice and claims the NHS funding following that patient. The Advertising Standards Authority recently banned its adverts which failed to make this deregistration clear. Naturally, the app appeals to young healthy people, although older patients are not explicitly excluded. However, patients with chronic diseases and mental illness are advised to stick with a physical GP.

Critics claim that this amounts to ‘creaming off’ straightforward patients who may spend all year without ever needing treatment. This leaves traditional practices with fewer resources to care for more complex patients. Doctors have complained that GP at Hand is destabilising GP practices in central London where it operates.

Online triage of an otherwise healthy population would be promising if the present payment system did not mean that the most vulnerable people lose out while profits accrue to the company making the app, Babylon Health. Overall this is bad for the NHS: failure to manage chronic diseases in the community leads to complicated (and expensive) hospital admissions. Having discovered that the current payment system is ‘gameable’, Hancock should be focussed on ensuring equality of access and quality treatment for complex patients. Instead he promotes the app in newspapers, claiming to be registered with GP at Hand and finding it ‘brilliant’.

The last Labour government changed the funding of the GP services to protect those most in need. The Quality Outcome Framework ensured that people with mental illnesses and long-term conditions got best-practice care through financial bonuses for GPs. This incentive promoted equality, unlike the perverse incentives benefiting GP at Hand. Hancock should be incentivising care that protects people who are disabled and chronically ill, but GPs are sceptical given that he has almost always voted to cut the welfare budget and against increasing benefits for people who are out of work for long periods due to disabilities or long-term illness.

The Labour party recognises that technology can have a transformative effect on public services. When Labour invested in IT in schools, many teachers did not know how to use computers and were stretched to increase their digital literacy. This was possible because Labour improved the whole education system, not just its digital dimensions. Had Hancock inherited from his predecessor a thriving NHS and a nurtured workforce, then adding apps might benefit patients. Instead his health service is underfunded, understaffed, and mismanaged; his priorities do not match the needs of people in England. You cannot stretch a system that is already at breaking point.

Putting apps front and centre might be good for the tech companies he name-checks, but it is not a national health policy. It is starting to look like Hancock wants to use the NHS to meet the needs of tech.

We need a Labour government that will use evidence-based tech to meet the needs of NHS patients.

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Nathan Hodson is an FY2 doctor researching medical ethics at University of Leicester

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