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Two Sides to the Coin: Computer Glitches or Human Disengagement in the NHS?

May 15, 2018

What do breast cancer and pension age have to do with one another? Let alone with a tech startup? The answer lies in letters or, more generally, situations where women continue to be at a disadvantage.


Letters? In two recent headline cases, letters, which were supposed to be sent by the UK government, were never received by groups of women. The contents of the letters could have been monumental. In the first case, the changing of the women's state pension age, in the latter, the invitation to a final round of breast cancer screening. The fact a letter was not received seems to continually affect around half a million women, not to mention around 200 women who the Department of Health deemed to have died early as a result of not getting to their final round of screening. Given that the first scandal gave the Government due time to re-evaluate how it sent out letters of significant personal effect, the first question would seemingly be, did the Government not learn after the pension scandal?


The gut response could be that with the breast cancer screening letters, the blame lay with a “computer glitch” rather than the post office. This glitch, deemed to be a failure in the algorithm since 2009, was left unchallenged, and seemingly unnoticed by the health service and the users who were waiting on their appointments.


The problem with labelling anything IT related as a “computer glitch” fundamentally ignores the human element of programming. If these letters had been failing to go out for almost ten years, why were the protocols for this not investigated? It shows very much a health service which sees digital automation as an entity unto itself: unintegrated and separate.


This trickles through to all areas of service delivery. While approving state-of-the-art MRI scanners or secondary or tertiary equipment is seen as a must, the scepticism or downright fear of technology hinders the NHS at its heart: service delivery. The lack of connection to its bodies of public and preventative health shown here - ie automated letters - is seen elsewhere across the NHS. Consider the fact that home diagnostic kits for lifelong conditions have only reached the pilot stage this year, despite being on the market for at least 10 years, and the cost to the NHS of managing conditions like type 2 Diabetes is increasing. The procurement of data systems has been patchy and siloed. This means that significant resources have been allocated to duplication of procurement and systems, resulting in clinicians feeling swamped and daunted by using technology in the workplace. It has meant that people continue to rely on a letter as their primary source of communication about information that could be life changing.


This is not to say that Public Health England and the NHS habitually wear tin hats. Rather that those delivering technological innovation and those delivering day to day service seem to have little interface, or mutual goals. Anecdotally NHS staff feel forced to take up technological change rather than having a say in what would be most beneficial to them or understanding why this would make their life easier. If innovation was more of an iterative process within the NHS, questions about future-proofing the service or how half a million women didn’t get the health check that could detect a potentially fatal illness, would be less of a systemic issue.




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