Last year I looked at a new report from the House of Lords that explored the ‘future of healthcare’. As the name of the report suggests, the nature of the work lended itself to longer-term thinking, and this is a central criticism of current NHS leadership. Whilst the Five Year Forward View published by NHS England in 2014 is widely supported, it doesn’t look beyond 2019, and nothing has entered the public domain to highlight NHS policy beyond then.
Unfortunately, it’s not at all clear that the report fills that vacuum, despite a hugely impressive range of names summoned to give evidence to the committee. It makes 34 recommendations in total, and whilst it’s hard to argue with many of them, they do nonetheless create the impression of a service whose edges are being tinkered with rather than a truly long-term vision for how healthcare provision might change to meet the tremendous challenges it faces.
It’s a conclusion that came to mind again when reading a recent report from the Wellcome Trust and Future Advocacy into the way AI technologies might change healthcare in the coming years. The report examines some of the ethical, social and political impacts AI could have on healthcare.
Changing health and research?
The report outlines five ways in which the authors believe AI will change both healthcare and medical research:
- Making the basic processes that form the basis of healthcare more efficient.
- Using AI to make drug discovery and genomic science more effective.
- Using AI to perform clinical work such as diagnosis, prognosis and screening.
- Using AI to better interact with patients and other service users.
- Using AI to identify and monitor the spread of disease.
Suffice to say, most of these potential use cases are at a very early stage and are largely potential rather than realized gains at the moment. Even with such projections however, I can’t help but wonder if they aren’t proposing the use of AI to make a ‘faster horse’.
That was the infamously derogatory term used by Henry Ford to describe what people would ask for if he consulted them about his groundbreaking Model T. It’s a line that clearly portrays people as being beholden to what they know rather than what might be.
Can change come from within?
That’s not to say that the questions raised in the report about the social and ethical application of AI aren’t valid ones, because they are, just as most of the issues raised in the House of Lords report into the future of healthcare were.
They both fall into the trap of tinkering at the edges of change however rather than fundamentally re-examining how healthcare be delivered with the new technologies that are increasingly available to us.
As with the Lords report, the list of the great and good who contributed their thoughts to the report is a lengthy one, but most work firmly within the healthcare system in the UK, and so I wonder if they succumb to the innovator’s dilemma and are so familiar with healthcare as it is today, that they fail to see how it might become in future.
Indeed, the Director of Strategy at NHS England has previously admitted that “if we had to recreate the system, none of us would recreate what we currently have.”
Of course, all any of us can do is ‘start from where we are’ and so I’m not advocating unrealistic levels of change, but I do feel that the tools we are developing at the moment provide us with an opportunity to rebuild healthcare so that it’s emphasis is shifted towards keeping us well in the first place rather than mending us when we’re ill.
It’s a change that is urgently needed across the western world, as healthcare providers struggle with an ageing population complete with a growing range of chronic conditions that require management rather than cure. It’s a trend that urges the sector to change, but change is historically something that the sector does incredibly poorly.
Leading the change
Whether there is the ambition or stomach for such a change remains largely inconclusive, and these doubts originate from the very top, with real concerns about whether the leadership within the NHS is up to the task.
A recent study from researchers at Harvard, Lancaster and Bristol Universities explored the impact leadership has on performance levels in the NHS. Worryingly, the analysis finds very little evidence that the leader makes any difference to their organization at all.
“Overall, our results indicate that the CEOs of large public hospitals such as those included in the NHS do not bring about changes in hospital performance, a result that stands in stark contrast with earlier findings relating to the private sector and to smaller public sector organizations,” the authors say.
What’s more, most leaders are healthcare veterans, and any movement of talent would be from one hospital to another rather than from outside the sector. So there is a carousel of leaders from within the NHS, with little real impact being had by any of them. Indeed, any pay differentials observed by the researchers was more likely to come from the executives political acumen as their managerial nous.
With numerous studies highlighting the important role leaders play in driving change, and indeed on the mandate for change that tends to accompany external hires, it does paint a rather dismal picture of the prospects for the NHS and its ability to capitalize upon the unique opportunity the rise of AI presents it.