On the 75th Anniversary of the NHS, Ollie considers the contribution of the caring human, as opposed to AI.

Its birthday time, 75 years, a grand old age of wisdom and reflection for the NHS. But also a time of concern when the public opinion of the NHS is at its lowest since they started measuring opinions in the mid 80s.

People ask how we are going to fix the NHS, and much like most things at the moment a popular answer is to look to technology, and particularly AI. We are told that AI will do all the difficult things for us, free up time and improve quality. We are told it will analyse data and pick out patterns and predict problems in a way humans never could. It will allow us to make huge strides forward as the NHS recovers and improves. But I have a few concerns. 

My first worry is that AI doesn’t care. AI is logic based, depending on a combination of self-learning algorithms and number crunching. It will make incredibly good decisions, the most logical, well-balanced decisions. But it won’t care. I think human health and wellbeing depends on a system that has caring at its heart. We are feelings based. We are illogical, moody, passionate, unpredictable. It’s not logical to fall in love, or to get angry, or wallow in self-pity, but we do, and it’s the essence of being human. 

We may be able to program a computer to pretend it cares, but it never will. Do we want health care provision from a source that doesn’t care? How will it feel? Feelings matter.

My second concern is that AI is very easy to monetise. You can package it up in apps and tools and sell it large scale. I worry that this will drive unintended consequences just as we have seen with medicines. 

Medicines are great at inducing short term changes in our body’s chemistry that can give us relief and a boost. They can also stimulate recovery and long-term adaptions.  But there are limits, and in my opinion, we have gone well beyond them. We can argue why, and medical arrogance is probably in the mix (doctor loves to know best), but at its heart sits a huge commercial model. Pharmaceuticals are big money. If we can be persuaded the solution to our headache is not to slow down, or unwind, but to pop a pill and carry on there is big money to be made. Sales of medicines have driven our public and professional approach to diseases. We have a pill for every ill, and a growing list of ills. The option of listening to our bodies, adapting our thoughts or actions has been trumped by the allure of a medicine fix. 

To give one example here. We have seen Type 2 Diabetes (T2D) explode from an incidence of less than 1% 75 years ago to 10% now, on the back mostly of eating poor quality food. There are many reasons for this, but instead of focusing on these, we put them in the ‘too difficult to tackle’ box and medicate the problem instead. Most of the pathways for management of T2D, give a cursory nod to lifestyle changes, but then smile benevolently, almost saying ‘but we know that will never happen’, and skip quickly on to the sequence of medicines to pursue. But in some parts of the country, we are seeing GP practices reversing this trend, putting T2D into full remission with no medicines needed for large proportions of their patients. They have returned to lifestyle coaching with kind and careful support, addressing the root cause. It’s a human solution proving to be far more effective than a technical one. 

I hear the current narrative for AI, ‘it will free up humans from the uncaring stuff so that we can do more caring ourselves’. But in my experience, it doesn’t work like that. Washing machines were supposed to free us up to have more time to relax, cars reduce our time travelling, emails improve our communication systems. But instead, these tools of ‘liberation’ have enslaved us even more. We adapt and step up the volume, make our lives busier and more demanding, increasing our stress levels and expectations…..more, faster.

I worry these are the narratives being driven by clever marketeers, knowing the temptations that will open up lucrative markets. I am sure very well intentioned and clever people will get carried along in this journey, perhaps like doctors have in the progression to massive over medicalisation. ‘Big Money’ is extremely good at guiding even the most righteous to a reassuringly noble narrative.

But I am an optimist, and I can’t let the piece end without some hope. My hope is that as the NHS turns 75, we are maturing to an age where we recognise the need for balance. Just like we are time critical on planetary health, I think it’s the same for health care. Time to use our wisdom to maintain balance in the face of the temptation to rely on technology.

Perhaps we can regain the essence of health care….to care. We can re-establish the neglected art of making people feel good by human-to-human compassion. Perhaps we can make the most of the freedom AI could give us to recharge the bit that AI will never be able to do, offer genuine (not pretend) compassion and give attention to how people feel and thrive. I think we will need to put as much skill, thought, encouragement and refinement into how we develop these skills as we will into the science of AI and medications. Let’s take the advances of our knowledge and apply it equally to both technology and human development. Let’s ensure we remain the main players, with tech and medicines as our supporting actors not the headline stars. 

Conflict of interest. It’s important to declare that despite having spent most of my career working as a doctor, I now make most of my living out of teaching people how to use coaching approaches in health care, at www.peakhealthcoaching.com. This training supports the role that people can take themselves in looking after their own health.