Blockchaining the NHS? Interview with Stewart Southey

“Blockchain could transform the NHS from a paternalistic organisation with passive patients to one in which everyone has much more choice and control”

Dr Stewart Southey is an NHS Consultant Anaesthetist and an Advisor to Medicalchain. He is currently completing an MSc in Digital Currencies which will make him one of a handful doctors in the world with such a qualification.

How does a consultant anaesthetist working in the NHS end up getting involved with blockchain technology?

I enjoy my day job and I enjoy helping individual patients but I realised fairly early on in my career that I was really more interested in the bigger picture of how healthcare systems work and in being able to make an impact on that aspect of the NHS. In my first few years as a consultant I did an MBA and got involved in trying to improve service delivery. As a result I became very interested in both eHealth and mHealth and in using these technologies to create a new paradigm in healthcare rather than just constantly trying to tweak the current broken, unsustainable model. I began immersing myself more and more in technology and came across Don Tapscott’s TED talk about blockchain and his book Blockchain Revolution. I was intrigued by the possibilities he painted and the vision of the future he outlined, so I began reading up more and more about blockchain. As a result I have made it a personal mission to spread awareness and understanding of blockchain among doctors, healthcare managers and others working in healthcare systems and to engage with implementation of some key blockchain projects that I hope can change the NHS for the better.

What was it that attracted you to work in this field and do you think this technology has the power to reform the NHS in a way that politics can’t?

If we talk specifically about the NHS, it really is a paradox in the way that it is structured. By name, it is a ‘national’ health service which might make it seem like there is one unified national structure but that is not at all the case. Due to a succession of different government attempts to reform the NHS and introduce various types of internal markets or forms of competition, what we actually have is a kind of pseudo market economy where CEOs of NHS trusts are not really independent in the same way as a company CEO. Instead they are stuck between two competing priorities of the drive for competition on one hand and yet still working within a heavily regulated system where Monitor places a lot of constraints on what they can actually do in practice. What blockchain could offer is the possibility to break down some of the funding, information and administrative silos that exist. Blockchain lends itself to better co-operation and collaboration on things like supply chains, procurement and data sharing. If we take compliance documentation for staff as just one example, a huge amount of time and resources are wasted by HR departments on compiling documentation for a doctor who then moves on after 6 months. Why do we need to reinvent that wheel every time?

What are the types of new innovations which blockchain healthcare companies like Medicalchain are trying to bring in?

As one of my projects, I am working in an advisory capacity with Medicalchain, a new UK-based platform built to securely store and share electronic health records. This service will empower both providers and patients and encourage patients not only to have access to their own healthcare data but hopefully also to a feel a sense of ownership of their own healthcare. Longer-term, such services may, for example, allow patients to upload their personal health data from wearable devices so that a diabetic patient could keep in touch with their doctor to monitor blood sugar levels and modify lifestyles accordingly. Companies like Babylon, Vitality Health and Push Doctor already offer telemedicine services but what they don’t have is access to electronic medical records. Medicalchain aims to change all that.

Many people have said 2018 is a make or break year for blockchain in terms of implementation of real world projects. Can Blockchain technology – and the huge wave of interest in Initial Coin Offerings (ICOs) – live up to the hype?

I’d like to think so but even 5 minutes is a long time in blockchain! Sadly much of the discussion around ICOs and token sales is fuelled by speculation and greed and not really based on a deep understanding of the underlying potential of blockchain. I believe many of the proposed use cases will show value and are already showing potential and the media needs to reflect that as well as simply reporting on the hype. I don’t think that 2018 will be the year that everything comes to fruition though – that is probably too unrealistic. The technology is still immature and there are still issues of scaling, the energy consumption required, a shortage of developers and so on but a huge amount of good work will nevertheless be done this year. We are still learning what this technology can do, use cases are starting to come out of Beta and more good pilots are being launched. Now is the time to measure success and publish it responsibly. As a result we will gradually get people to a deeper understanding of the underpinnings of what blockchain can do.

Do you think there is political will to implement cutting edge technologies in the NHS and if so how can we get movement on this issue at a time when the demand for healthcare is growing beyond the capacity of the NHS to deal with it?

Again, I’d love to think so. Sir Mark Walport’s report on the use of Distributed Ledger Technology across the public sector was published a while ago now but it set up an important benchmark showing that the UK government is taking blockchain and DLT seriously, at least in theory. Money has also been invested in trying to make sure the UK is a good place for blockchain businesses to start up. Policymakers are certainly interested in the idea of providing more integrated welfare services, which means they ought to be taking notice of how blockchain can help deliver that objective. Certainly throwing more money at the existing NHS structure won’t work and what we are doing now is offering less money to the existing NHS structure, which is even worse. As a doctor with some blockchain knowledge, I’d love to get together a group of like-minded doctors and sit down with the Health Secretary to pool our thinking – he’s welcome to invite us in for a chat anytime! If we compare the arrival of bitcoin to being a way for the public to take back control of their finances at a time when banks were no longer trusted, we could make the same analogy for blockchain in healthcare. Over time, blockchain technology could transform the NHS from a paternalistic organisation with passive patients to one in which people have much more choice and control of their own healthcare, empowering both patients and doctors.

What is your predicted landscape for Blockchain in the public sector in 5 years time?

I think we may see movement on some key areas like, for example, more efficient delivery of welfare benefits. If we look at the example of Estonia, it shows there is a way for governments to take control of a complex bureaucratic tangle and find new ways of doing things. It would be great if the UK public sector could take inspiration from that. Trust is, of course, the biggest issue in healthcare and if we are going to create a new layer of trust using technology we need to be confident that we trust that trust layer! I think smaller scale pilots will be helpful and will show some added value but they need to be carefully thought through because all eyes will be on their success or failure. It would be great to pilot something in a small health community and link up a set of institutions who don’t normally interact directly. If you could get a pharmacy, an NHS hospital and a private sector provider to collaborate, for example, on sharing data and show that they can all gain from it, it would really show the benefits of such collaborations.

Last but not least, tell us something that people may not know about you?

I study martial arts and spent time in a Shaolin temple in China, which was one of the most peaceful times of my life. I think practising a martial art is something everyone should do, if they can, because it is so beneficial to overall wellbeing. I have also climbed 2 of the 7 summits and would like to climb the rest, if I had the time and money. And I speak quite a few languages including Afrikaans, Hebrew, Zulu and a bit of Mandarin Chinese! I suspect reforming the NHS through blockchain is not unlike climbing a mountain while speaking a foreign language so I guess these skills are going to come in quite handy over the next few years.

If you would like to contact Stewart, you can find him on Twitter or find out more about Medicalchain on their website.

For further reading on blockchain applications in healthcare, visit our Resources page.

Please note – Stewart was speaking to Unblocked in a personal capacity and his views do not represent any official position on behalf of the NHS.

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