By Paris Marx
The provincial government says a Big Reset is coming for Newfoundland and Labrador. As they set the stage for big cuts to public services — healthcare being chief among them — new technologies are promised to soften the blow. But that is very unlikely.
In May, the Premier’s Economic Recovery Team (PERT) recommended a 25% cut to healthcare funding over six years, which is far deeper than any province has attempted in at least 40 years. Economist David MacDonald found the real cut is closer to 35% after accounting for inflation, and it would require cutting essential services to the bone.
After releasing the report, PERT Chair Moya Greene dismissed concerns about what those cuts would mean for patients. Responding to a journalist, she said that “money is not the answer” and “we can probably do a lot more with the technologies that are available,” then referenced the experience of the pandemic.
There’s no doubt that many people had telephone and virtual doctor appointments for the first time in 2020, but that isn’t going to revolutionize the delivery of healthcare.
Hundreds of new tools using artificial intelligence were rolled out during the pandemic to make things easier on doctors, but a series of studies found they were useless, and in some cases potentially harmful to patients. Similarly, contact-tracing apps were hailed as a technological solution, but were found to be marginally helpful at best. The real work was done by human contact tracers, like those at the regional health authorities.
Technology is not neutral. It can be developed to empower workers and strengthen the services they deliver, but it can also be used against them, to serve private companies ahead of the public.
Greene has a history of doing the latter. As CEO of Canada Post, she wanted to privatize the post office, but Prime Minister Stephen Harper rejected the idea. Instead, Greene turned to technology as part of her “modernization” plan, but it did not deliver the expected cost savings, while increasing worker injuries and grievances.
In reality, technology is all too often used as a cover for austerity and to pave the way for a further privatization of healthcare delivery that’s very profitable for certain companies, but rarely works in the public interest.
We’ve already seen the start of this in the province. Earlier this year, it was revealed the health authorities signed a contract with a US company for health scheduling software, and would provide a bonus based on the savings it achieves. But when Manitoba contracted with the same company, it resulted in significant job cuts to an already stretched health staff. And it could get even worse.
In Alberta, Jason Kenney’s government is trying to privatize parts of the public healthcare system, including outsourcing 11,000 jobs in the middle of pandemic. Earlier this year, the Alberta Union of Provincial Employees warned that the government was also coming for Alberta Health Services’ information technology (IT) systems.
The union argued that privatizing IT would have implications for workers and patients alike. Shifting IT to private companies would not only lead to job losses, it would leave data hosted in the cloud more vulnerable to cybersecurity threats and increase the rate of errors and failures, which affects patient care.
One of the beneficiaries of Alberta’s increased reliance on the private sector for health services is Telus, which used to be Alberta’s public telecom company and is now heavily investing in health technology. But the province’s privacy commissioner found the app it deployed in Alberta with Babylon, a London-based digital health company, showed blatant disregard for privacy laws.
Babylon’s technologies have also been deployed in the United Kingdom, where there are ongoing concerns about privatization in the National Health Service (NHS). In The Lancet Digital Health, Paul Watson explained that Babylon was diverting patients from the public system toward “NHS-funded virtualised care delivered through Babylon’s ‘GP at Hand’ suite of proprietary digital technologies.”
Journalists found that Babylon cherry-picked healthy patients and that its technologies did not work as promised. In February 2019, the British Medical Association criticized the expansion of Babylon’s virtual service without proper evaluation, and called for the government to invest in upgrading IT at doctors’ offices instead of outsourcing their services. Meanwhile, as the pandemic began in Canada, the Alberta Medical Association expressed concerns about how Telus’ Babylon app severed the relationship between patients and their family doctors.
In a recent paper, health innovation researcher Rosie Collington found that when governments open up their public services to the private sector to increase efficiency, they are typically also trying to foster a local tech industry that can later export its products. But in transferring IT functions to private companies, public services are not able to respond as effectively to public needs and can get locked into digital systems that are ill-suited to the task.
Newfoundland and Labrador may have weathered the pandemic well, but we are not immune from the digital health trends we see elsewhere. Guided by the PERT’s report, the government seems intent on using technology to distract from significant cuts to health services while enriching private companies whose digital tools will get built into the healthcare system.
Technology can be used for beneficial purposes, including the improvement of service delivery within our public healthcare system. But that will require fighting the planned cuts, then working with staff and patients to figure out what technology is needed, and developing the capacity within the health system to create and maintain it.