My kids scoff when I remind them about the early days of the internet at home, about their older sibling only being allowed half an hour a day on a dodgy dial up connection. It wasn’t that long ago.
I’m reasonably computer literate. I’m no stranger to the challenges of new software, a new CRM, or building a website. Though I must admit, sometimes my kids impatiently take my phone from my hands when ordering a takeaway just takes too long.
However, my heart did sink with the latest pronouncements on the new NHS “digital first” strategy, with the ubiquitous “doctor in your pocket”. It is not that I don’t believe technology can’t shortcut no end of tedious routine tasks, but more that we are so blinded by the shiny new tech, that we fail to see when it is not designed with human beings in mind, even less tested by real life people with real life problems. Systems are designed to solve a problem by looking through the wrong end of the telescope – the system’s end. And at the other end – the patients, and the staff who have to jump through hoops to try and make these things work. Ultimately there are the refuseniks(both patient and staff) who ultimately insist on speaking to a human being when, inevitably, the system doesn’t work. The final step on this journey is an irate patient (or simply one that has given up), a frustrated practitioner who doesn’t understand how things work either, and finally the admission that “we’ll be getting a new system in a few months”. All repeated how many hundreds of times across an ostensibly “national” system. At what cost?
Let me give you an example. Our usually excellent GP practice has recently established an automated triage system, to replace the human call handlers (“care navigators”) who generally picked up the phone. The new system (assuming you have a smart phone and an internet connection) is separate from the NHS App, and guides the patient through a series of prompts, depending on what is required. First, it excludes the big serious emergency stuff. Then there are 14 options to choose from – although why it can’t use words that people actually use, I am not sure. What do people think they are choosing when they tick the box to request “social prescribing” for example? Or if you receive a text instructing you to have a blood test (for what?) because your “primary eyecare provider” (who?) has mandated it. (Testing for what, why, requested by whom?). Shouldn’t the patient have some agency about what and whether he or she is the subject of these unsolicited tests? It wouldn’t take much to co-design such a system with some people who actually use services.
Every option seems to lead to a menu which is aimed at gatekeeping services rather than offering them. Typically, “there are no appointments available”, or “the appointment we were going to offer has now been given to another patient”. The only remaining option is to ring the practice, the response to which is “you have to use the App”, and “you don’t know how to use the App” or “you are probably using it at the wrong time of day”. Kafkaesque.
Systems are set up to prevent dialogue. They give an overall sense that the driving force is to fend off patients, rather than help and serve them. It is a great shame because once you get to speak to a human, they are usually great. And here’s the kicker. Having gone through this rigmarole unsuccessfully, the only option is to start again. Previous responses can’t be saved. The patient’s time is treated as valueless, their needs not met, and pressure on the NHS not relieved. Healthcare is a human endeavour to which human solutions are needed.
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