A Tech Giant and the NHS
Can we trust Microsoft and its rivals to help the health service innovate?
There are two widely differing views about the NHS. One camp argues that it is a bureaucratic over managed dinosaur that desperately needs to overhaul its antiquated technology and that job can only be done by a rapid transfusion of private sector ideas and talent. The other is adamant that the health service’s problems are all due to years of government underfunding and that the last thing we should do is hand it over to commercial forces, particularly those American tech giants.
The truth of course is somewhere between those two extremes and recently I got a more nuanced view - from an executive at one of those tech giants, Microsoft. I had heard Jacob West speak at a conference on healthcare technology and had been struck by his insistence that the NHS was far more open to innovation than many assumed.
When we met - via the inevitable Microsoft Teams call - he hammered home that point, with the health service’s response to the pandemic as an example “We saw a real acceleration of innovation didn’t we? I like to think that some of the maybe lazy myths about the rate at which the NHS can adopt innovation were put to bed.”
Now, it is not surprising that Microsoft’s UK MD of Healthcare and Life Sciences should want to say nice things about a major customer. But Jacob only joined the software giant 18 months ago after a career in government and health service management, including running a major NHS change programme and an independent inquiry into London’s healthcare.
I agree with him that digital transformation that had been promised for years happened almost overnight when Covid arrived, with medical staff quickly adapting to video meetings and remote working. The NHS says the adoption of Microsoft Teams saved nearly 3 million hours of working time over a period of six months - and as I found when I spoke to Moorfields Hospital the change to new ways of working is permanent.
But what about the adoption of cutting edge technology such as AI? For years I’ve been reporting on advances from tech giants including Microsoft which promise everything from remote robot surgery to automated examination of brain scans. But the progress from the lab to practical use - from code to clinic as one doctor who’s also an AI researcher puts it - still seems painfully slow.
Jacob West insists we are now seeing practical implementation of AI, pointing me towards developments in voice recognition technology. For years doctors, like lawyers have been heavy users of Dragon voice recognition software from Nuance, now owned by Microsoft. But a new system called Dragon Ambient Experience promises to transform the experience of a doctor’s appointment, so that the GP or consultant isn’t continually turning away from you to type into a computer. “It’s using technology to take away technology, turn that conversation into a structured note, written into the electronic health record, with suggested diagnoses and prescriptions built into the AI.”
He points to other uses of AI adopted in the real world - a Microsoft chatbot helping a Somerset NHS Trust handle an appointment backlog, a project using machine learning to help doctors analyse 3D medical imagery. Microsoft’s Hololens, the mixed reality headset which has made painfully slow progress amongst commercial users, is being deployed in high risk areas of some London hospitals, allowing medical teams to see a doctor treating Covid patients from a neighbouring room.
This all sounds mildly encouraging but quite minor, especially in the context of an NHS facing a rolling series of crises. But West refuses to be anything but upbeat:
“Because I spend a lot of time with the people who are committed to change at the frontline of the NHS and are achieving some impact,” he says, “I feel quite optimistic about the ability of the NHS to continue to improve even when the headwinds - funding, staffing, operational and so on - are really quite strong.”
The area where there may be most potential for innovation is in the use of the health service’s vast untapped reserves of data. Jacob talks with enthusiasm about Our Future Health, the ambitious programme to track the health data of 5 million people, where Microsoft will help provide a secure cloud platform. He describes that programme as “unparalelled globally” and an example of the NHS being at the cutting edge of innovation.
I point out that such programmes have been hamstrung for years by controversies about privacy, particularly around the access to sensitive data that might be given to powerful companies like Microsoft “I would like to hope that we might have put some of those debates to bed,” he says, “and that we've got things like Ben Goldacre’s report on trusted research environments and an emerging orthodoxy around how we properly, safely, compliantly take that data and are able to repurpose it for research purposes.”
Jacob West says better technology, which will result from collaboration with the private sector, is essential if we are to solve the NHS’s problems and that in this regard healthcare lags behind other areas in people’s experience.
That sounds right and I liked the optimism with which Jacob ended our conversation - “even whilst the weather around us may be a little grey rays of sunlight are coming through.”
But the public are also entitled to ask some searching questions about the role of such powerful American tech companies in our health service. Should we trust Microsoft to keep the millions of conversations about patients now running across its platforms secure? Can we be confident that when Google uses our health data to make advances in AI the NHS will get a fair share of any profits from the resulting innovations ? And should Palantir, founded by libertarian Trump supporter Peter Thiel, be given a lucrative contract to build a new NHS data platform?
I predict plenty of stormy weather ahead.
To a very great degree, patients are most concerned about insurers disallowing coverage on a 'preexisting condition' ruse. Life itself is a preexisting condition. Thus fathers are bound and gagged to employers if they have a child with a birth defect or leukemia. A change of employer (and his insurer) disallows the major events of family health history.
As to Peter Theil, I wouldn't trust him to run a bakery. He is the father of 'move fast and break things,' as well as a guru for personal control to maximize profit. If you approve of how Zuckerberg runs Facebook, you'll love his mentor, Peter Theil.