Why 'Zoom medicine' is not the answer to all our ills

Telemedicine has arrived in the NHS. The pandemic has seen a dramatic shift in the provision of healthcare, away from in-person appointments and towards remote arrangements. While this might appear to be a temporary measure for social-distancing purposes, at the end of last month, the health secretary Matt Hancock, said the changes are here to stay. The UK needs “more Zoom medicine,” he said, telling the Royal College of Physicians that “from now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to”.

While Covid-19 has catalysed the shift towards telemedicine, it is not the cause. The virtualisation of healthcare has been on the cards for some time, and a small but non-negligible group of NHS patients were already receiving care through e-consulting apps such as Livi and Babylon. But the scale of the change is significant and unexpected, with GPs reporting that a transition that they had imagined would take years had in effect happened within just a few weeks.

Doctors’ and patients’ groups are not convinced. Martin Marshall, head of the Royal College of General Practitioners, told the BBC that “remote consultations, whether by telephone or video, won’t be suitable for everyone,” while Mencap have warned that the proposals could be disastrous for those with learning disabilities. And yet the government persists.

Related: All GP consultations should be remote by default, says Matt Hancock

Hancock’s enthusiasm for telemedicine makes a lot of sense when one considers his longstanding tech-solutionist streak. In 2018 he infamously launched his own app, simply titled Matt Hancock MP. As Wired reported at the time, it collected reams of user data including photos, videos, contact information, and “check-ins”. Big Brother Watch said it “steals” data, and called it a “fascinating comedy of errors”.

Of course, the “Matt App” is just the ego-massaging tip of the tech-solutionist iceberg. As Sean McDonald has argued, we are in the era of “technology theatre”, in which governments launch tech-enabled “solutions” to problems they are fundamentally incapable of solving or unwilling to actually tackle. The NHS Covid-19 app is the perfect example: a project from the health service’s “digital transformation” unit that was loudly hailed as the fix for coronavirus, only to be abandoned months later after being found to be almost entirely useless in comparison to human foot-soldiers carrying out contact-tracing. Meanwhile “virtual therapy” apps are now a staple part of mental healthcare provision, with patients self-referring to online cognitive behavioural therapy companies so they can have counselling delivered through their phone rather than languish for years on NHS waiting lists.

Indeed, it is in areas like mental healthcare that the paucity of tech-solutionist thinking becomes most apparent. Technologies like telemedicine tend only to work for the median case. If you fit within the narrow boundaries of the patient profile for which these services are designed, you will probably benefit from them. But, as is so often the case in healthcare, those with serious or complex health problems will be left out in the cold – an experience that is all too familiar to patients with chronic and long-term mental health needs. For this group, as for so many other high-risk patient demographics, face-to-face contact is an absolute necessity for effective ongoing care.

For many, healthcare appointments are the closest thing to a routine, while healthcare professionals are the very fundament of patients’ personal support networks. Mental healthcare in the UK is already in a parlous state. Care for children and young people with mental illnesses lags dramatically behind much of Europe. In a report in January, the Children’s Commissioner for NHS England found that the NHS spends just £92 per child per year on mental health services, while the UK has just 4.5 psychiatrists per 100,000 young people – far below Finland’s 36 or Estonia’s 16.8. Any move away from in-person care will significantly compound the problems already faced by people who have mental health problems.

The government will insist that those who require in-person consultations will still be able to get them, but in reality remote care will almost certainly be foisted upon those who don’t want it but who realise that “Zoom medicine” is suddenly the quickest or only reliable way to access care from an overworked and underfunded health service.

Zoom medicine, disastrous “digital transformation” projects, and virtual therapy are all part of a trend in which shiny new apps are used to mitigate the symptoms of serious structural problems. Decades of underinvestment have left the health service struggling for survival, and getting GPs on Zoom is not going to solve much. Post-pandemic, telemedicine is seen as the route forward in great part because it will ease the burden on under-resourced GPs. Virtual therapy, meanwhile, is popular not because there is any real evidence to suggest that a bot delivering cognitive behavioural therapy through your smartphone can actually cure your anxiety, but simply because it is all but impossible to get a timely NHS therapy referral in most areas of the UK. These are not solutions – they are diversions.

• Josh Hall writes about technology, mental health and the future of work