It started with a single email saying ‘Test’ on it just after I had begun my morning surgery earlier this week. Within a few minutes this had multiplied a hundredfold as emails from people in the NHS I had never heard of replied to it, and not long after that the whole NHS email system shut down, adding significantly more stress to an already hectic day.
The cause was simple — somewhere in Croydon an IT ‘senior delivery facilitator’ sent a test email not to one person but to the whole NHS workforce. All of it. Everyone who then replied asking not to be sent it instantly added another 800,000 or so emails into the system which promptly did the decent thing and gave up. (Now we all know that to err is human and to forgive divine and so on, but I do struggle to see how an IT expert has problems in sending an email. After all, I may not be the most eminent physician in the world but I would hope to know if a patient is dead or alive as a basic starter for ten. It’s not rocket science.)
On the other side of the coin, email correspondence from my local hospitals remains uncommon, with most important or urgent letters still being sent over to me by post or fax. Yep, fax.
This dichotomy does raise a more serious point, however, which is how the NHS adapts to new technology in a fast-moving digital world. Over the last decade both clinicians and innovators have banged their collective heads against desks when faced with the wall of obstacles to taking up new technologies, while governments pay lip service to making the best new treatments and innovations available. However, there may now be light at the end of this tunnel, and it may be that Brexit has provided new impetus to the process.
Seeing the world through fresh eyes means pushing Britain as an innovator in healthcare technologies, and Brexit is stated as one of the reasons that this Government has finally, genuinely, implemented a change which will help patients access revolutionary new technology.
This comes through a report just published by the Accelerated Access Review — a body set up in 2014 to make recommendations on how to accelerate access for NHS patients to innovative medical technology. Following this review, NHS England has announced that six strategically important medtech devices will be fast-track funded for the first time as part of a new Innovation and Technology Tariff to be deployed from April.
One of these will be of great value to men suffering from the effects of benign prostatic enlargement (BPE), a condition I see every day in my surgery and which, by the age of 70, causes symptoms in 80 per cent of men. Medication does not always work and can cause side effects, and conventional surgery can leave patients with incontinence and erectile dysfunction.
The review recommends a novel, minimally invasive technology called UroLift where implants are used to relieve prostatic obstruction without cutting, heating or removing prostate tissue. Men return home after a few hours, typically without having to have a catheter in place, and follow up is normally by telephone.
Typically carried out under local anaesthetic and with a zero risk of permanent sexual dysfunction, the procedure is now being rolled out across England, along with others including high-tech scissors to minimise obstetric injury and web-based applications for the self-management of chronic lung disease.
It will not have escaped anyone’s notice that we currently live in politically interesting times, and the populist zeitgeist that created Brexit and put Trump in power may also now help improve the NHS if people are more informed about new treatments and push for them.
The tight fiscal restraints on the NHS mean it is more important than ever to ensure patients can access the most cost-effective new innovations in a way that is affordable and sustainable. As a doctor I have been here many times before looking at technological false dawns. This time, though, it really does seem to be happening, and one day I might even have a working NHS email system and a fax machine that’s no longer required. But not just yet.