Computer Says No - Telemedicine

NHS 24. National Programme for IT. Gpass. Now telemedicine. Is technology the answer to all our problems in the NHS and are those of us campaigning to retain A&Es just old stick-in-the-muds? Three words I would reply with; resources,resources,resources.

My dad and I were having a conversation one day about robots (as you do.) There had been a programme on the telly about the latest AI and how you would maybe get robots to visit people living on their own.
'That's a good idea,' I said. 'Each elderly person could have a robot of their own; they could cook and clean, and help them if they fall.'
'That's not what you would get if it was a council robot,' said my dad.' They would buy the cheapest robots on the market, and there would be one very slow robot to five houses. You would only get it if it was means tested, and if you asked it to do anything useful it would say, 'Computer says no.'

I'm afraid that's how I feel about telemedicine. It is very good in its own context; for use in the Highlands and Islands or on oil rigs. It's very good in road traffic accidents where you can send on pictures of injuries to the hospital you are going to. It's good for people with long term stable conditions such as diabetes if they want to send in a blood test or if you want to do an ECG. But if we shut Monklands A&E for example, do I believe that NHS Lanarkshire would immediately set up a state of the art telemetry system to everyone in Lanarkshire who had diabetes, COPD and cardiac problems? Do I believe that they would provide the necessary trained staff to interpet angiograms and scans coming in? Do I believe that they would do anything, apart from use it as an excuse to fling people into the black hole of 'Care in the Community' whose biscuit tin budget would barely cover the price of a community alarm in every elderly person's house, let alone broadband? Terribly sorry to be cynical, but the answer is no.

We have had IT systems before, promising to be cheaper,faster and sexier than old boring doctors. One of these was the National System for IT down in England and Wales for medical records. The initial cost was estimated at £3.2 billion. The final official cost was £20 billion. The unofficial estimate is £50 billion. You see, it isn't just the computer you need. You need the staff. You need staff training and you need an engineer to fix it when it breaks down. This all costs money.

NHS 24 is going much along the same lines. It was going to be cheaper than doctors out of hours service, it was going act as a triage system and reduce the number of time wasters and A&E admissions, and reduce pressure on GPs. Well, so far it has cost £126 million. Each phone call to NHS 24 costs £36. The number of A&E admissions has gone up over the past two years and according to Audit Scotland, last years admissions reached a ten year peak, with an extra 50 0000 admissions. How many of those went up to A&E, because they couldn't see a doctor to reassure them? Oh, and half the calls were referred to local GPs.Under the old system, when someone phoned their local health centre, the chances were that the person on the other end knew them.They would have their medical records to hand, and they would know whether the person was a simply a pest, or if they had a condition that merited an out of hours visit. Now that middle filter has been taken out and we have been left with what is little more than a helpline for the worried well.

Can I make an old fashioned boring suggestion? Instead of introducing more IT into the NHS, how about introducing - human staff? Some extra consultants? Reintroduce out of hours run by GPs with proper funding this time? You might find A&E admissions going down, and GPs don't break down as much as computers do. If the vast amounts spent on IT were spent on doctors and nurses, you would have a first class service. And that's not computer science.