Understandably, the announcements in the digital health
media have all sought to accentuate the positive, lauding Kelsey for his vision
and giving him further platform to pontificate about a digital revolution for
the NHS.
So firstly, a quick recap of Tim’s progress is required.
Prior to being given a custom-made shoe-in job at NHS England courtesy of his
friends in Number 10, Kelsey was a successful journalist working both as a
freelance and then for the Independent on Sunday and Sunday Times. He’s also a published author having penned a
travel book on Turkey.
The big break with journalism came with the setting up of Dr
Foster with Roger Taylor (no, not that one) and Roger Killen. Dr Foster sought to capitalise on a line of
thinking in the NHS that saw consumerism and choice as a means of getting the NHS
to up its game.
Some of the people pushing this agenda, notably Bob Gann at
Help for Health Trust, saw it through the prism of patient information: i.e.
provide patients and the public with more and better information about services
and it will help them make better informed choices and take more responsibility
for their own healthcare. Gann developed this idea firstly with the Health
Information Service (HIS) telephone helpline and then with NHS Direct and its
early web offering, NHS Direct Online.
Dr Foster took a slightly different tack, focusing on
performance and quality data that could be used to underpin patient’s choice of
services, and it was this model that gained the upper hand in the Blairite
reform years of the late 1990s. Dr
Foster had a lot of success in compiling and publishing hospital performance
data – data that the Department of Health had historically shied away from
publicising because it raised difficult questions about quality and consistency
in the service that had the potential to embarrass ministers.
Ultimately, Gann and Kelsey would join forces on NHS
Choices, the national website of patient information and data that was intended
as the keystone of a consumer-driven revolution in healthcare. At the time it
might well have seemed like a match made in heaven.
Although it’s clear that significant numbers of people have
used NHS Choices, it’s far from clear what impact the website has really had on
the public: these things are notoriously difficult to demonstrate, so the
default is to fall back on positive anecdotes.
What is clear though, is that NHS Choices cost quite lot of money,
having signed a 3 year deal with Capita with a value of more than 60M (for
comparison, the early NHS Direct website cost less than 5M for an equivalent
timespan).
To cheerleaders like Kelsey, NHS Choices was going to herald
a revolution in the relationship between patients and the public, in the same
way that the Internet itself was going to for all sorts of activities and
businesses, and he was far from alone in that view. At the same time, there was an opposing camp,
embracing moral panic with a similar level of gusto. These were the people (frequently GPs)
issuing po-faced warnings about ‘cyberchondria’ and bemoaning the armies of the
worried well turning up in surgeries armed with fists full of printouts from
dodgy websites.
With the benefit of hindsight, both positions seem slightly
comical: the cyber-utopians believing the web would fix everything, and the
cyber-dystopian prophesying doom.
So things move on and the dotcom boom and bust roll by. The internet does eventually fulfil some of
its early promise, but over a much longer time span than most believed, but
then the revolution rolls on into web2, social media and smart-phones, the logical
extensions of the internet.
It’s not surprising that those dreams left unfulfilled by
the first wave of Internet development would be transferred to the second wave,
and that’s exactly what happened.
Sometime in the 2000s, Tim Kelsey drifted from being an evangelist for
the web and NHS Choices, to being an evangelist for apps and social media as
the foundations of a patient’s revolution – something that might address the
fundamental information and power asymmetry at work in the NHS.
It’s probably churlish to dismiss Kelsey as some kind of bandwagon
hobo, always jumping aboard the latest gimmick-train. I’m sure his views are sincerely held and
have developed as a response to a changing world and the emergence of new ideas
and technologies. However, it’s possible
to see a mind lacking in scepticism and rather dazzled by novelty. Every new gadget or gizmo promises to deliver
the revolution for patients that he craves. Whereas in reality, we’re only
taking small steps, and frequently the benefits of each step are equivocal.
After a brief (blink and you missed it) term at McKinsey and
shoed-in as a government ‘transparency czar’, Kelsey has his perfect job
created for him in the role of Director of Patient Experience at the newly
created NHS Commissioning Board (soon to be renamed NHS England).
The role must have seemed like a dream come true: at last
the power and authority of a senior role in a newly created uber-quango from
which to affect the kind of change he had dreamed of. But here is where the
wheels begin to come loose and wobble disconcertingly. Affecting change in an organisation like NHS
England is intensely difficult, even with a high level of authority. Add to
that the paralysis caused by the immature and unformed nature of the
organisation and it becomes next to impossible to affect change on the scale
that Kelsey envisaged.
As a reluctant and inexperienced bureaucrat, Kelsey was
always going to be at a disadvantage.
Initial promises of a paper-free NHS by 2015, stores of accredited apps,
an investment fund for new IT projects have all been dragged under by the
interminable bureaucracy and cost-cutting required by austerity. It must have been intensely frustrating for
him to have been handed what appeared to be the keys to the drinks cabinet, and
to have found instead, a labyrinth designed by Kafka with the bottled hidden in
every nook and cranny.
The signs have been there for a while: bold announcements
and statements of purpose have given way to exhortations. The Personalised Healthcare by 2020 document
was a paper tiger; an unleaded pencil.
Its purpose appeared to be largely decorative: to pay lip-service to Kelsey’s
agenda and give NHS England a (very thin) veneer of modernity, whilst
committing to diddly squat.
It consisted of relatively modest aspirations with no real
sense of how these might be achieved. As
a product of a bureaucratic-political organisation like NHS England, its
decorative, ceremonial nature demonstrated just how little power and leverage
Kelsey really had. It might as well have
been a roll of wallpaper.After such a frustrating experience, it’s hardly surprising that Kelsey would retreat to the private sector where it may be easier to achieve things quickly, albeit on a smaller scale. It will be interesting to see whether the long-wished for revolution for patients ever will materialise, and whether this will be driven by data, apps and individual choices, or by bigger slower, more tectonic technological forces as work under the bonnet of the NHS.
What is certain is that Kelsey’s time at NHS England has been far from a resounding success, however much it’s wrapped up in nice words. In this case at least, it takes more than some big ideas and well-connected friends to start a revolution in the NHS.
