Long waiting times, staff shortages, exorbitant agency fees, doctors’ working hours: it’s no secret that the NHS is facing a labour crisis. Post-Brexit it could very well get worse, with the NHS Confederation now warning of a reluctance by EU doctors and nurses to come and work in the UK.
Difficult times call for radical measures. So, with an estimated staff shortfall of 50,000 for the NHS in England, is it time to start thinking seriously about the mass adoption of robotics and other automated technologies in the health service?
So-called “collaborative robots”, or “cobots”, are already being used extensively in the life sciences industry, where their ability to undertake repetitive tasks with near-perfect consistency is helping to accelerate large-scale tests in the lab.
In the health sector, such technologies have tended to be limited to back-office operations. The idea is that if time-consuming, low-skilled tasks can be taken up by automated machines, then nurses and admin staff can then be reassigned to more value-added roles.
So argued the University Hospitals Bristol NHS Foundation Trust when it proposed introducing automated speech recognition and digital transcription services about three years ago.
Working with automated technology can improve efficiency and thus allow personnel to use their skills to greater effect
Historically, the trust’s secretarial staff spend the bulk of their time transcribing letters read into a dictaphone by the hospital’s clinicians. With the automated technology, they receive the letter already transcribed on their desktop, requiring them to simply proofread and tweak as necessary.
“A one-minute dictation takes a secretary around four and a half minutes to transcribe. The automated system takes around two and a half minutes. That frees them up to prioritise other tasks and to support other areas of the trust where their skills are needed,” says Michael Milton, project manager of the initiative.
Since the system’s phased introduction in late 2013, Milton credits it with reducing dependency on agency staff, cutting administrative backlogs and speeding up the average turnaround time for a letter from 15 days on average to five days.
Doctors and clinical nurse specialists have also seen their admin burden reduce. The speech recognition software, which is implemented by UK-based firm BigHand, offers them a selection of letter templates to choose from and automatically uploads the patient’s personal details.
Even so, Milton admits that medical staff were “slightly sceptical” about losing their secretarial support, while the secretaries themselves were downright hostile to what they saw as a direct threat to their jobs.
“Upfront, we gave assurances that this wasn’t about reducing jobs. There will always be a need for human interaction in this line of work. What working with automated technology can do is improve efficiency and thus allow personnel to use their skills to greater effect,” says Milton.
Robots and surgery
The prospect of automated technologies replacing frontline surgical staff is less immediate, but it is happening. In the private sector, a company in the US, for example, has developed a non-invasive CyberKnife to use in tumour treatments. Instead of cutting out a tumour, the CyberKnife eliminates it by targeting it with a precise beam of high-dose radiation. Where such cobots are used, however, the surgeon is almost always on hand.
Among the early adopters of robotic methods in the UK is Dr Christopher D’Souza, a hair transplant specialist at the London-based clinic Ziering Medical. D’Souza uses ARTAS, an outpatient procedure developed in the US that extracts individual hair follicles from the back of a patient’s head and then implants them towards the front.
“FUE [follicular unit extraction] involves anything up to 2,500 grafts, which, when done manually, can take three or four hours. That’s tough on my eyes and neck. With the robotic method, there’s absolutely no surgeon fatigue,” says D’Souza.
Using this automated system enables him to focus more on patient care, communication and team management, while also allowing him to redeploy one of his two assistants, he says. Not all clinicians are as comfortable with the robotic method, he admits, with many arguing that it “takes away the impression that the surgeon knows best”.
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It may only be a matter of time before we see greater use of such robotics in the NHS. However, the nascent nature of the field means that it remains a tough argument to sell clinical robotics on the basis of comprehensive cost-benefit analysis, says Mike Ouren, a cobot expert at US-based robotics firm Precise Automation. The results data simply doesn’t exist yet to compare patient outcomes for robotic surgeries with traditional methods.
“There’s a financial question around how effective is a robot in terms of the amount of money it costs and the support staff required versus whether or not we’re getting more surgeries through the hospital and so forth,” he says.
For James Kippenberger, head of market development for BigHand, the efficacy of automated tech has less to do with the tech itself and more to do with how health professionals interact with it. “These projects rarely if ever fail because of the software or hardware,” he argues. “The key determinant of success invariably relates to human behaviour.”
As a new generation of tech-savvy professionals enter the health service, he is confident that co-working – the day-to-day interaction between man and machine, individual and automaton – will become more commonplace. Until then, it’s imperative that automated systems are implemented with clear directions, full communications and appropriate training.
In the case of University Hospitals Bristol NHS Foundation Trust, the initial resistance of secretaries more or less vanished once they saw their workload reduce, according to Michael Milton. Over time, resistance among frontline surgical staff to automated equipment will likely reduce, too. That leaves just one critical audience to be convinced: patients themselves.
Why your NHS surgeon could be a robot in the future
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