As strange as it sounds, I enjoy the ritual of going to the doctor. I love the crinkle and pop of badly laid lino, the smell of plastic-coated bottle green seats—harsh lights in the corridor, posters that haven’t been changed for months (sometimes even years). I treasure the chance to fill out a prescription request on top of a five-month-old copy of Hello! magazine and slot it into a prescription box sometimes made of the heavy wood of church offertories, and other times an old shoe box decorated with left-over wrapping paper from Christmases long ago.
It may be a great surprise to you, then, that I haven’t set foot in a GP surgery in over six months. Not because I have a clean bill of health, but because I now conduct all my appointments from my own home.
It's made possible by the power of technology. And by technology, I mean the digital app Babylon Health and their NHS service, “GP at Hand.” The app allows users to video call a Babylon GP, provided that they are willing to make the healthcare company their primary GP. (Those who do not wish to do so are able to sign up on a "pay as you go" basis.)
As well as their GP services, Babylon has an online chatbot that harnesses artificial intelligence to provide recommendations to their patients without the use of real doctors. Babylon stresses that this service should not be used by those with more serious concerns, but for those with busy lives, it’s can seem like a simple way to receive advice on anything from an earache to a migraine.
With its simple interface, team of over a thousand doctors, and a $2bn valuation, Babylon seems to have been a roaring success since its founding in 2013. LinkedIn believes the digital technology company to be one of the “top 10 British start-ups to work for,” and young professionals across London in particular appreciate the app’s compatibility with modern-day life. Now in the heat of a global pandemic, with GP surgeries out of bounds for many, Babylon’s GP at hand can offer a convenient alternative.
It sounds like a no-brainer: the GP surgery for a young professional about town. But how much do we really know about Babylon Health? Can artificial intelligence and trendy start-ups really be trusted on the issues that matter the most?
*** Babylon was founded by a 55-year-old British-Iranian refugee with an academic background in engineering, Dr Ali Parsa. Parsa boasts an impressive CV. Having worked for Credit Suisse, Merrill Lynch, and Goldman Sachs, he has presumably learned a thing or two about how to secure multi-million-pound deals. In 2004, he co-founded his first healthcare company: Circle Health.
Circle Health won its first NHS contract in 2011, becoming responsible for the running of Hinchingbrooke Hospital in Cambridgeshire up to 2021. But just one year after securing the contract, Parsa stepped down as CEO in order to pursue “his passion for social entrepreneurship." This was despite the significant role he played in promising to make colossal savings for the hospital, and free it of its considerable £40m debt.
The Labour government had opened the doors to private healthcare—which it saw as an opportunity to strengthen efficiency and “optimise” the NHS. But instead, Circle Health—after much pressure from trade unions and the Care Quality Commission (CQC)—withdrew from operating the hospital after just three years. The CQC had branded the hospital “inadequate” a few months earlier, citing “poor care provided to patients” and issues concerning hygiene standards. Circle stated that this did not contribute to its decision to withdraw from the contract, and instead said that the project was no longer viable due to funding reductions.
During this time Parsa was still a member of the Circle Holdings board. However, the project’s apparent failure, at least temporarily, bruised the egos of those pushing for further NHS outsourcing and privatisation. But despite this set back, the process of incremental privatisation had already begun and was only to be consolidated under the coalition government. The slow but gradual privatisation of the NHS created a new demand: artificial intelligence tools to help streamline health systems. The normalisation of private companies and relentless under-funding paved the way for healthtech. Parsa turned his attention precisely to this area, and in 2013, Babylon was born.
Upon its founding, the company’s aim was to “make healthcare accessible and affordable for every person on earth.” Fast-forward to 2020, and it is still a long way away from making that a reality. Its free "GP at Hand" services, which includes both the chatbot and the GP services are currently only available to those living in London and to just under 3,000 individuals living in Birmingham.
*** The company ran into difficulties early. A 2017 CQC report found that, in some areas, the service “was not providing safe care in accordance with relevant regulations.” The same report found that “prescribing decisions were not always made appropriately.” A series of emails revealed that Babylon had threatened to sue the CQC for damages arising from the report, implying that the then Chief Inspector of Primary Care, Steve Field, might be insufficiently impartial due to his links with Modality Partnership (an organisation which, like Babylon, seeks to develop new models of health care). Babylon later dropped the legal challenge, and in 2019 the company was "Good" by the CQC. But the story doesn’t end there. Last year, Field became the Chairman of the Royal Wolverhampton NHS; a year later, and the NHS trust he oversees signs a ten year contract with Babylon.
Babylon is, arguably, most well-known for its chatbot service. I have used the chatbot and have found it to be as helpful as any online medical quiz—sometimes instructive, but overall to be taken with a pinch of salt. The app warns that the chatbot should not be used as a substitute for a doctor, and that it does not “provide a medical diagnosis.” However, it has faced considerable criticism from numerous medical professionals and was the subject of a recent Newsnight segment. The most ardent critic of them all is Dr David Watkins, Consultant Medical Oncologist at Royal Marsden NHS, who highlights the chatbot’s flaws on his Twitter account, Dr Murphy. He has warned that the algorithms that the app relies upon fail to pick up on symptoms of, for example, heart attacks.
Babylon have since refined and improved its chatbot function. Dr Watkins, who has labelled Babylon’s software “Bad Bot,"’ was recently branded by the healthcare company as a “troll" who has posted over “6,000 misleading attacks", and the company strongly contested his accusations. Dr Watkins denies this, telling me that ‘the allegations made against Babylon Health are not false; and their ‘repeated’ attempts to actively discredit someone raising patient safety concerns raises serious questions regarding their corporate culture and trustworthiness as a healthcare provider."
But criticism about the company has not apparently prevented the likes of Matt Hancock from ostensibly endorsing the software, with the company now providing online services for the NHS via their “GP at Hand” platform. It is notable too that Dominic Cummings had an advisory role at the company until September 2018. In 2019, politicians raised concerns that Cumming’s role raised a potential “conflict of interest” at a time when Babylon seemed to be a key contender for government funding aimed at expanding AI healthcare.
*** As a result of the current Covid crisis, as well as a decade of continuous under-funding of the NHS, Babylon has been able to step into a gap in the healthcare market. Despite this, 5 per cent of its staff have been furloughed—though these did not include medical professionals. Many of Babylon’s doctors already work at home (indeed, I spoke to a doctor just a few weeks ago and was able to hear her dog bark in the garden).
However, for all the talk of coronavirus supposedly presenting an opportunity for the NHS—or even for socialism—little has been said about the role of private companies in "aiding" this. And whose pockets will we be lining through this AI healthcare revolution? Babylon’s last investment round resulted in considerable financial support from none other than Saudi Arabia’s Sovereign Wealth Fund. Regardless, Babylon looks set to grow in the coming months—it launches in New York, a city badly hit by the coronavirus, in the coming weeks.
And finally, there is nothing inherently democratic about healthtech. As Dr Watkin’s analysis shows, AI and app-based healthcare does not necessarily aid the most vulnerable in society, and is often geared towards the young. Having a GP surgery stored away in your phone, no matter where you are, can be convenient for any young professional. My grandmother, on the other hand, who is self-isolating in rural Carmarthenshire would not sacrifice the friendly face of her long-standing doctor in return for a dispassionate screen.
So, is it time to say bye bye to badly laid lino—forever? I don’t think so. But the NHS is right to consider how best to engage with its patients. Technology could be the way forward in this regard—but true healthcare democratisation means ensuring that the citizens of all four nations are able to contact GPs and medical professionals, not simply be subject to algorithmic chatbots and geographical boundaries. It is only through the careful auditing of software and increased accessibility that AI healthcare can ever become mainstream. The NHS should learn from the technology produced by private companies—but Covid-19 may mean that we will end up using more private companies, perhaps for the foreseeable future.
