Last week, I ended my blog saying
that I was off to see my GP on the Monday for a possible shingles vaccination.
Given I’m into Day 28 of a shingles episode and still feeling pretty horrible,
I didn’t expect to be given the vaccination. I was wrong. My GP advised that I
should have it, so I did, and she gets the associated £12.06 fee. I felt I really
did get a lot out of my 7-minute consultation. I’m a fan of primary health care,
and it was a good experience.
Later in the day on that Monday, I
found myself standing on a train, bound for Nottingham and the Health
Partnership Network (HPN) Mental Health conference. I stood all the way from
Manchester to Sheffield, before the hundreds of students got off and seats became
available. It was a very hot and unpleasant journey. Arriving at my hotel, I
rewarded myself with a delicious glass of Malbec (which actually cost £1.30
more than the shingles vaccination fee). But it was worth it.
The conference was different to
any other I had been to, but more about that later. That said, the entire
conference arrangements reflected how mental health care is still a Cinderella
service, when compared to acute services. There was an acute conference running
in the hotel concurrently with ours. Theirs was held in a large,
air-conditioned room, with many white-clothed tables, loaded down with bottled
water and sponsor goodies. You could see the screen from any table in the room.
In comparison, our venue was in a cramped room, with portable air conditioners that barely troubled the hot air. We sat in tightly-packed rows of seats. There was no water, and certainly not any sponsors’ gifts. Viewing the screen depended on how large the person in front of you was. We were made to feel very much like the poor relation. I’m not sure why they didn’t combine the two groups as the conference’s foci appeared very similar – the emergence of neighbourhood health care; the use of new technologies, particularly AI; what a mess the changes to NHS England, ICBs and the Department of Health and Care were; population health and more AI.
What made the conference different
was that the sponsors had arranged 15-minute sessions with individuals, rather
like speed dating, I guess. When booking a place on the conference, you were
asked to describe the challenges facing your organisation; something I didn’t
get around to doing. So, someone did it for me, and it transpired that our challenges
were: AI, reducing talking therapies waiting lists, and how a crack team of psychiatrists
could (for a fee) come and sort out any problems we might be experiencing with
our consultant psychiatrists. Strangely, (not sure that is the right word)
only one of these ‘challenges’ was relevant.
Now don’t get me wrong, some of the
presentations and conversations were very interesting. I might even go as far
as saying ‘inspiring’. There was one company that took us through the system
they were showcasing, via a case study. Two things struck me as interesting.
The first was a telephone number that allowed for a single point of access to
services, and which in true AI style could hold a conversation with the caller.
It wasn’t a chatbot, and through audience participation (asking random
questions), it wasn’t a pre-recorded response either.
The programme could speak in 45
different languages and used everyday words to both seek further information,
or in responding. It was very clever. The second part of the system both
impressed and worried me. It used agentic AI. Agentic AI systems don’t simply
answer a prompt (how can I stay cool in this hot weather?) but take many ‘actions’
to reach a conclusion or answer: reading records, conversing with other systems,
accessing data sets and information repositories.
What we weren’t told was the cost
of such services. They are not run using familiar licences (Microsoft, ChatGPT
and so on) which can be used as much as you like for the set licence fee. Apparently,
agentic AI utilises a costing model that charges for every action undertaken. So,
some AI tasks might actually cost more to an organisation than the salaries of staff
such programmes were meant to replace. The assumption, that a digital worker is
cheaper than a human one, will really need challenging! Whilst AI will have a place in future health
care, in mental health care, as with other health and care services, people
will always be important, and even Cinderella got to go to the ball.
Ai is the future. Catch up or be left behind.
ReplyDeleteBeing wrong, curious and slightly optimistic: perhaps Cinderella has already arrived
ReplyDeleteI enjoyed reading your latest blog, particularly the opening account of the shingles vaccination. Like you, I’ve had experiences of brief NHS appointments that delivered rather more value than their duration might suggest. Seven minutes well spent is sometimes better than thirty that are not.
Your reflections on the conference also resonated. Mental health has spent decades as the Cinderella service and, judging by the descriptions of the conference rooms, perhaps she is still waiting for a better invitation to the ball. Some things appear stubbornly resistant to change.
Where I found myself departing from your conclusions was on the subject of artificial intelligence.
Like you, I am naturally sceptical whenever a technology is presented as the solution to every organisational problem. The NHS has seen enough management fashions come and go to justify a healthy degree of caution. Every few years there seems to be another initiative promising to transform healthcare, only for reality to prove somewhat more complicated.
However, I wonder whether AI is slightly different.
You quite rightly questioned the assumption that digital workers are automatically cheaper than human ones. That strikes me as an important challenge. Costing AI by the action rather than by the licence introduces an entirely different economic model, and organisations that fail to understand that may find themselves with rather expensive “efficiencies.”
Yet cost is only one side of the equation.
If an AI system can answer calls in forty-five languages, reduce waiting times, direct patients more accurately, relieve clinicians of repetitive administrative tasks and allow them to spend more time doing the uniquely human aspects of their work, then perhaps the comparison should not be AI versus people. Perhaps it should be AI supporting people.
Mental healthcare is, after all, fundamentally relational. Empathy cannot simply be automated. Therapeutic alliance cannot be downloaded. Human judgement remains central. I doubt many would argue otherwise.
But clinicians also spend considerable amounts of time writing notes, searching records, completing forms and navigating fragmented systems. Few entered the profession because they aspired to become experts in administrative processes.
If technology can reduce some of that burden, then perhaps the greatest beneficiary is not the organisation but the patient.
What struck me most about your blog was that, despite describing yourself as “not a great fan” of AI, many of the examples you gave demonstrated precisely why people are excited by it. The multilingual conversational system was, by your own account, “very clever.” The agentic system capable of drawing together information from multiple sources was equally impressive, even if accompanied by understandable concerns about cost.
Perhaps healthy scepticism is exactly what the NHS needs—not resistance to AI, but resistance to adopting it uncritically.
Cinderella eventually made it to the ball not because she abandoned who she was, but because circumstances finally allowed others to see her potential. Maybe AI occupies a similar position today: overhyped in some respects, underestimated in others, and still finding its proper place.
Time will tell whether it proves to be another passing fashion or a genuinely transformative tool. My suspicion is that it will be neither hero nor villain, but simply another technology that succeeds only when placed in capable human hands.