Health 2.0 and the future of the NHS

The government has embarked on another “ten year” review of the NHS, which has proved remarkably resistant to such initiatives since it was founded in 1947.

Technology journalist Jon Hoeksma wonders if Web 2.0’s information and networking technologies might not be a bigger driver for change; or even a challenge to the health service’s monopoly on information and service provision. 


In his interim report on the NHS, health minister Lord Darzi wrote that the reforms set in train in 2000 remain a work in progress. To coin a phrase, much has been done, but there is much more still to do.

He also noted that the health service has no appetite for further, radical change; but then, with barely a flicker of irony, went on to call for a once in a generation review and a new “vision” for the future.

Stop me if you’ve heard this before

Aficionados of health service policy will recognise a familiar pattern here. The government wants to radically improve healthcare, without dismantling the health service or alienating its staff. But the experience of the past 50 years is that while it has huge capacity to innovate and adopt new treatments, some of the fundamentals of the NHS are remarkably resistant to change.

Despite the efforts of successive governments, numerous policy initiatives and – recently - vast increases in expenditure, the NHS remains broadly familiar. It is a centrally organised and directed system that delivers pretty equitable access to health services of variable quality and effectiveness at a reasonable cost.

In other words, the truth is that the NHS is not too bad; but it isn’t - as politicians often claim, or promise - the best healthcare system in the world. A survey published in September ranked it 17th out of 29 systems in Europe.

Provider capture

The truth is that the NHS is not too bad; but it isn’t – as politicians often claim, or promise – the best healthcare system in the world.

In particular, today’s NHS is not really patient-centred, or even particularly flexible or responsive. Although politicians talk of patient-centred healthcare, without a truly radical re-think it will continue to be largely determined by entrenched provider interests.

Recent initiatives such as Patient Choice and Payment by Results are struggling to gain traction as organisations continue to see their “must-dos” as those handed down from the centre. NHS foundation trusts have some new freedoms, but are still on a three line whip to meet the national 18-week waiting time target.

As another recent report, this time by the King’s Fund think-tank, argued, the government needs to clarify what role it wants central direction, inspection, choice and its other initiatives to play, and then try to line up its targets, funding regime and other levers behind them.

But this raises some fundamental questions about what it is that the NHS should do. So very radical when it was created in 1947, the NHS has locked fixed our notions on what healthcare should be. We recognise its failings, but it often holds us too in thrall to contemplate alternative approaches.

In 2007, should the NHS still be principally the “sickness service” to which we turn when ill, which provides treatment at moments of crisis while battling to cope with a growing number of long term-conditions?

Or should it be a genuine “health service”, placing the individual, their families and carers at the centre of everything it does? Should all health services be designed top to bottom to deliver services flexibly and conveniently to individuals?

In sickness, but not really in health

The ideal, of course, would be a bit of both. Many pregnant women, for instance, want the both the choice of having a home birth and the option of an expert gynae and obs surgical team close by if they need it. Once the child is born, they also want good health visitor services.

But despite numerous initiatives over the decades, it has proved difficult to dislodge the sickness model of healthcare and to create more community, preventative and – today – personalised services. Almost since the NHS was launched, the Department of Health has been trying to make it more primary care-led and progress has been strictly limited.

One reason is simple and understandable: taking money away from hospitals is deeply unpopular with the communities they serve and the professionals that work in them, especially if it’s not immediately obvious what is going to take their place.

Meanwhile, out in the World Wide Web

The challenge is to become both the information and service brand that people trust most.

If we want to change the way we each think about healthcare, we may need to look beyond politicians and health professionals for answers. One place we might look is in the dramatic changes that Web 2.0 technology is having on how sections of society interact with each-other, form bonds, exchange information and ideas.

If Web 2.0 has one unifying concept, it is that the technologies involved are radically disruptive, economically, socially and technologically. Web 2.0 networks are grown from the ground up – gaining strength from their membership. They are the antithesis of top-down, centralist initiatives that set fixed objectives and boundaries.

The NHS is unlikely to find salvation in the bewildering highways and byways of Facebook, Flikr, Youtube, or the cacophony of blogs. However, it has already, perhaps unwittingly, sown its own Web 2.0 seeds that could yet yield some truly unexpected fruits.

eHealth 2.0

The NHS has, perhaps unwittingly, sown its own Web 2.0 seeds that could yet yield some truly unexpected fruits.

Chief among these is the HealthSpace initiative, the patient-controlled component of England’s NHS Care Records Service. Originally an NHS Direct project, HealthSpace has been grafted onto the hugely centralist NHS CRS project but could yet emerge as the populist success story.

Early versions of the system give patients access to a web-based summary of their medical record, with future plans to add in full details of test results, medication history and information and knowledge resources.

Link this to transactional services such as the ability to book appointments and order prescription refills and you have a powerful disruptive set of tools.

Who, for instance, will be in control of a patient’s medical record when they spot errors and want them corrected? Who will be in control of their treatment if they can see they have strayed off their expected pathway or their medications don’t align with the latest guidance?

Giving the patient full control of their record could also cut through the tangled mess of consent and confidentiality arrangements. If the individual controls who can access their record, and even view audit trails, they own it.

And if individuals don’t have confidence in the government holding their medical records, then there are a growing number of commercial personal health record (PHR) companies competing to do this for them. In the Czech Republic, IZIP already has over a million people using its web-based PHR. In the US, Microsoft is also participating in ambitious PHR developments.

Information is power

The NHS has also begun to develop new information resources such as NHS Choices, which are intended to provide patients with information on the quality and responsiveness of particular NHS services and even individual clinicians.

Again, it’s not just the NHS making the running here. The UK website birthchoices.co.uk already gives pregnant women comparative information about caesarean rates and other aspects of maternity services.

Patient Opinion gives patients the ability to share experiences of their treatment with others (sometimes providing valuable feedback for managers in the process).

And if healthcare providers other than the NHS provide more and better information of the type that individuals need to make healthcare decisions, they are likely to attract more patients.

Whatever Lord Darzi’s review of the NHS comes up with when it is completed next year, it is already clear that the NHS is set to become one among many providers of healthcare information and new healthcare services.

This worries many. But the challenge is to become both the information and service brand that people trust most. The Health 2.0 genie is out of the bottle; the NHS needs to begin to respond or risk being bypassed.

About the author:
Jon Hoeksma is technology journalist of the year, and the co-founder and editor of the E-Health Insider industry portal: www.e-health-insider.com