It’s been a relatively quiet week in digital health in Australia and New Zealand so we’ve cast our eye further afield, all the way to the UK where newly elected Prime Minister Keir Starmer made one of his most significant policy statements this week, promising a three-stage course of action to right the ship of the rapidly sinking NHS in England and move the venerable institution from “an analogue to a digital system” over the next decade.

Coming off another of his new government’s pledges to means test the winter fuel payment to pensioners – thus consigning millions of OAPs to a very cold death come Christmas, according to star reporter Bob Cratchit in the Daily Mail – the statement was a significant one. It was in response to a quick fire but quite devastating report by surgeon and member of the House of Lords Ara Darzi, who led a review to raise the quality of healthcare provision in the NHS back in 2008.

In 2024, it seems that things have worsened, and Dr Darzi puts a lot of this down to the 2012 Health and Social Care Act, which he describes as “a calamity without international precedent”. This mainly had to do with management structures in the NHS, but it also led to a situation where clinical staffing levels in NHS hospitals are higher than ever, but the workforce is thoroughly demoralised and unproductive.

It also devastated primary care, and it seems there has been no recovery from this. The concentration as always is on hospitals, and we in the media are more to blame than most for that focus, but Dr Darzi’s report lays bare just how desperate the situation is for general practice, community mental health and social care, which encompasses aged care in the UK.

“Too many people end up in hospital, because too little is spent in the community,” he writes. “We have almost 16 per cent fewer fully qualified GPs than other high income countries relative to our population. Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community. In practice, the reverse has happened.”

Capital investment, despite certain wild claims about building 40 new hospitals, has been non-existent, leading to “crumbling buildings, mental health patients being accommodated in Victoria-era cells infested with vermin with 17 men sharing two showers, and parts of the NHS operating in decrepit portacabins. Twenty per cent of the primary care estate predates the founding of the health service in 1948.”

And digital health investment has often been redirected to operational expenditure, with new AI and virtual ward projects being raided for other needs. (The profligate spending for little return of the National Programme for IT (NPfIT) in the 2000s reminds us that the reverse can be true too.)

“There are too many outdated scanners, too little automation, and parts of the NHS are yet to enter the digital era,” he says. “Over the past 15 years, many sectors of the economy have been radically reshaped by digital technologies. Yet the NHS is in the foothills of digital transformation.”

He laments the NHS app, which 80 per cent of the population has registered for but is little used, and the lack of use of what is the world’s best and largest collection of clinical and population health data. The UK needs to “tilt towards technology” – is a tilt stronger or weaker than a “pivot” or a “lean”? – and it seems the government agrees.

In his response to the report, Mr Starmer highlighted “three big shifts” that his government will prioritise over the next 10 years: number one is moving from “an analogue to a digital NHS”. “We’ve got to use technology to empower patients and give them control over their healthcare,” he said.

The second shift is moving the focus from hospitals to community services, including improving access to GPs and “bringing back the family doctor” (loads of them battling it out down here, Keir). The third is to move from sickness to prevention.

We believe the second shift is the most important in the immediate term, but as Dr Darzi said, promises have been made before. And prevention rather than cure just does not command the big bucks, which every health system on the planet is grappling with.

So analogue to digital it is. Good luck with that.

Back closer to home, and this week Australia has seen historic reforms to its aged care sector finally moving through Parliament, thankfully with bipartisan support. The new Age Care Act will see residents of aged care homes paying higher service charges, depending on their means, but their care costs will still be covered 100 per cent by the government.

The big move in the new act is to consolidate the various home care packages through the new Support at Home program, which will require significant investment in technology over the coming decade to ensure that the already stretched community aged care sector can handle any new requirements.

Unfortunately, most attention is still paid to the very expensive residential aged care sector, much like hospitals, despite the vast majority of care being provided in the community. The hoops that non-institutional care has to jump through to garner anywhere near the attention or funding is quite extraordinary, the new general practice aged care incentive being a case in point.

Elsewhere, there was a really interesting report from Ireland’s Health Information and Quality Agency about views on digital literacy in that country, with fears for both consumers and clinicians that a lack of digital literacy will hold back the roll out of digital health. Again, something every health system is grappling with.

And AI continues to dominate the discourse. The Royal Australian New Zealand College of Radiologists released two reports recently about their views on AI, and there was also a really interesting report from Microsoft and Accenture on AI and how it affects New Zealand economically and in terms of productivity.

That brings us to our poll question for the week:

Can a move from analogue to digital help save the NHS?

Vote here, and leave your comments below.

Last week, we asked: Are sector-specific rules on general purpose AI needed? More than 80 per cent of respondents agreed. Here’s what you said.