NHS Long Term Plan

Lord Holmes of Richmond Excerpts

Thursday 31st January 2019 Lords Chamber

[Lord Holmes of Richmond (Con)]

My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate. I also declare my interests as listed in the register.

In the time available, I will limit my comments to the potential of elements of the fourth industrial revolution which could be deployed to assist the National Health Service and all healthcare. In fact, I will limit myself to two elements: artificial intelligence and distributed ledgers. Artificial intelligence has incredible potential to augment, not replace, our clinicians and so transform diagnosis and care. Let us consider the work that has been done at Moorfields, where artificial intelligence is being deployed to analyse hundreds of thousands of retina scans—something that it would be impossible for one person to do in a lifetime, never mind a career. Here artificial intelligence is not replacing but augmenting the consultants who are working in that area.

This goes beyond the business of healthcare into the business of the NHS itself. Let us consider the number of missed appointments, costing over £1 billion to the National Health Service. Artificial intelligence certainly has a role to play there. As we set out in the report of the Select Committee on Artificial Intelligence, published last April, were the United Kingdom to deploy ethical artificial intelligence effectively, we could be not just a world leader but a world beater. There can be no better place to do this, and no better illustration of it if we get it right in the NHS—and indeed across all healthcare.

I turn to distributed ledgers, which are often called blockchain but, in relation to how they are deployed, it is better to describe them as distributed ledgers. These are effectively immutable, anonymised, decentralised records with huge potential in healthcare for drug safety and security, care assurance and many other examples. But again, let us go beyond elements that impact directly on care. Currently, the NHS spends 25,000 doctor days on assuring the identity of people coming into the service. Assured ID is of course incredibly important, but there are many different ways of doing it. Imagine those 25,000 doctor days being deployed on patient care.

There is much disagreement around the potential of 4IR in health and many other areas but there is broad agreement on the critical and central importance of data. Data underpins all this; with NHS data comprising some 65 million patient records, it has extraordinary potential, although massive risks and issues remain to be understood, not least the almost singular lack of interoperability within the service. Practical problems also have to be considered against legal, cultural and ethical considerations.

Can my noble friend the Minister outline the Government’s plan to address probably the greatest epidemic in the NHS—that of data fragmentation? Data has always underpinned health innovation. Dr John Snow used it to isolate the cause of cholera and Florence Nightingale to revolutionise hospital hygiene. The NHS currently produces a proliferation of data but is all too often stymied in its ability to use and deploy it because of the aforementioned fragmentation.

I am in no sense naive about the issues, risks and challenges of deploying these new technologies. To put it simply, we need to ensure that trust is fully and firmly at the centre of all our trusts.

Consider the immutability of all patient records—being able to have a single source of truth, your patient record, in your hand, alongside the trusted, immutable tracking of your timestamped record, including everyone who has accessed it and why. None of this is straight- forward. There is so much that the organisation must do to get to a position even to consider many of these technological possibilities, but they are possibilities. If the NHS is an oil tanker, it is an oil tanker that has to climb a mountain. That is not easy.

If we get this right, even partially, we will not just have a National Health Service that is a world leader in patient care. We will have a National Health Service that is a leader in the adoption and deployment of artificial intelligence and distributed ledgers for public good: a service fit for the future enabled by the 4IR. That is a possibility, not an inevitability.