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This is a guest blog.
Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.


It's crept up on us


You may not have noticed. Think about it.

You need some cash; you pop to a machine in the high street, poke your card into the slot and instantly they know who you are and how much money you’ve got and they give you some of it. Take a flight; go online, figure out the time that suits you, book it, print out the ticket, go to the airport, get another ticket from a machine, park the car, check yourself in – job done. Go shopping? Pick up your own groceries and use the self-checkout.

Suddenly, bank clerks, travel agents, parking attendants and checkout assistants are as useful as lamplighters and watchwinders. What happened?

Well, I can tell you. In industry, they are using a strategy that will be anathema to the NHS. A phrase that is almost blasphemous and may only be barely whispered in the vaulted corridors of the health service. In a National Health Service industry that is committed, dedicated and devoted to doing more for patients to improve their journey and experience, industry is going in the opposite direction.

Industry's new phrase? I'll tell you, but if you are of a nervous disposition, read no more. Here it is – 'How can the customer add value to the business?' Ooh ouch! In plain English – how can we get the customer to do what we used to do? How can we get the customer to manage and collect their own money; arrange their travel and print their own tickets; select, pack and pay for their own shopping?

The reason for this question? Well, it’s obvious, isn’t it? No retailer can afford a 'buy one get one free' offer and a shop full of shop assistants. Airlines simply can't afford budget travel and ground crew, travel agents’ fees and commissions. Banks want us online not on the high street, where rents, rates and utility costs make it impossible to give us free banking.

And, do you know what – I like it. I like not having to queue in the bank to get my cash and I like sorting out my own itinerary and I sure love speeding through the supermarket avoiding the woman with a groaning trolley. I can customise my shopping and tailor the experience. I feel like I am in charge.

The NHS? Well, The King's Fund's very own finance guru, John Appleby, has warned us about funding prospects for the service after 2015. More cash savings and perhaps not even ringfenced funding. The NHS will be forced into changing its ways by the economy (stupid)…

Pressures on budgets, costs and staffing suddenly take us into the world where we have to ask – how can we get patients to add value to their health care?

Every year in October I travel to the frozen wasteland that is Dusseldorf, to Medica, the world's biggest exhibition of medical devices. Everything you need to equip a hospital is there. And everything you need to maintain an elderly person safely in their own home or a patient with a long-term condition is there: peak-flow meters that connect with an iPhone and can send the results around the world to the best consultant, or across town to the asthma nurse or call centre; urine test paper that can be photographed by a mobile phone and whizzed for analysis to… well anyone, anywhere; apps for Blackberry and Apple that create new salad days for care and make hospitals history.

I think it is only a matter of time before the public starts to say; 'Why do I have to queue on the phone to get an appointment with my GP?' 'Tell me why I have to have a day off to speak to someone I can talk to on Skype from my desk?' 'Why can't I use near-patient testing and the technologies I take for granted in the real world outside the NHS?'

My mother is 93 years old and has an iPad. She wants to know why she can’t FaceTime the practice nurse. So do I.

Roy Lilley is an independent health policy analyst, writer, broadcaster and commentator on health and social issues.