AI to solve Scotland's health problems? Get real, says the man leading national innovation mission

“Just because you can do something digitally doesn’t mean you should,” says the man leading Scotland’s healthcare innovation mission. “Let’s get real about it.”

It is not, perhaps, what you’d expect to hear from the chief executive of the body charged with using tech as a catalyst for change in our health services. But Professor George Crooks – a fast-talking former GP who previously headed NHS24 – is prescribing a dose of “common sense” when it comes to what digital advances mean in practice. 

Because as much as he’s an advocate for adaptation, he’s determined that the road to progress is fundamentally about people. “I’m as sceptical as the next person, I’m not on a crusade here,” he says. 

“When people talk about technology in the context of healthcare they don’t know what they mean. They use it as a catch-all term and immediately jump to conclusions about science-fiction-type application – ‘Big Brother is watching you’. We need to take a step back.”

Crooks is the chief executive of the Digital Health and Care Innovation Centre (DHI), a Glasgow-based unit which brings together expertise from the University of Strathclyde and Glasgow School of Art. With a headcount of less than 50, the centre’s staff include designers from a range of specialisms – automotive, architecture, fashion. It’s a lesson in skillset and focus that’s been taken from big tech. “For IBM and Apple, design is at the heart of what they do. They learned that 20 or 30 years ago. Public services are getting better at it,” Crooks says.

“What technology should do is make face-to-face, human-to-human interaction more accessible to those who need it, when they need it, and where they need it. It’s never about technology, it’s about the service design that wraps around that.”

AI is not going to solve the problems in health and social care in my lifetime, yours or our children’s children’s lifetimes

Founded in 2013, DHI takes its finance from the Scottish Funding Council and the Scottish Government. A not-for-profit organisation, it works on helping companies get their digital health and care innovations to market across areas from brain health and healthy ageing to chronic diseases and rural communities. Projects so far include the self-service contact tracing form used to address the spread of Covid-19, as well as digital inclusion for drug users and AI assistance for dermatology.

The potential applications of AI in healthcare have been much-extolled. And though Crooks is ready to harness that potential, he says “common sense” is needed. “Never a conversation goes past that somebody doesn’t mention AI almost as if it’s going to be the panacea and solve all problems,” he says.

“AI is not going to solve the problems in health and social care in my lifetime, yours or our children’s children’s lifetimes. AI is a fantastic tool which needs to be understood and developed where it can add most value. It can do admin, carry out repetitive tasks incredibly effectively and efficiently, and it follows rules to the letter, which humans don’t do. It can also interpret huge amounts of data and come up with guidance as to what that data is telling us. But what we need to recognise is AI is not and should not ever be the master. AI will be a very capable apprentice and support.

“I’m an absolute advocate for AI but we have to take it step-by-step and learn as we go.”

It’s an approach that’s served Crooks well during his career. A former GP, Crooks – who was made an OBE in 2011 – was inspired to get into medicine by his father, a runner on the Glasgow Stock Exchange whose outlook on life was irrevocably changed by his experiences as a Japanese prisoner of war. Crooks Senior survived the horrors of the Burma Railway, in which captured Allied soldiers and civilians were forced into labouring through mountainous jungle to create a rail link from Thailand to Burma. “All the suffering and death on the railway made him go into medicine and he did an accelerated course and became a doctor,” says Crooks. “That experience of growing up and seeing my father get into medicine was the real concentrator.

“It’s going to sound trite – I wanted to make a difference. In the 1970s, when I started my training, going into medicine was a very clear and open road. I was lucky enough to get good grades, and then you were on a clear progression. What I never thought was that I would get involved in this aspect of healthcare provision. That was completely out of left-field.

“A lot of the health and social care challenges now are very similar to those before. A lot are more exaggerated now than they were then. The rise in long-term conditions like diabetes, cardiovascular disease, cancers, is more to the fore. We are living longer so the challenges around frailty are more than they have ever been. Medicine and the science of medicine have advanced significantly across the modalities.”

Crooks spent more than two decades in general practice in Aberdeen, also serving as director of primary care for Grampian in the latter years of that role before going on to hold leading posts in key health bodies: director of the Scottish Ambulance Service; director of the Scottish Centre for Telehealth and Telecare; advisor to the World Bank; adjunct professor at the University of Southern Denmark; board member of the European Connected Health Alliance.

Amongst all this, he was also medical director for NHS24 in its early days and remembers well the headlines about the apparent dangers of the round-the-clock telephone service. Founded in 2001, its call handling triage team connects patients to nurses, pharmacy advisors and mental health experts, as necessary. Appointments can be made for attendance at A&E or minor injuries units, or for phone and video consultations.

Crooks joined a ministerial review of the service’s first two years. It was supposed to be a three-month stint, but he says he “couldn’t get away”. Much of the rhetoric around the teleservice was “people are going to die”, he recalls. “It was far from that. What it did get right at the start was getting the service design right and taking everybody with it. That wasn’t just the public, it was doctors and nurses and those working across the healthcare system to understand the capabilities it had and the opportunities it could create. NHS24 used a technology which had been around for about 100 years – the telephone. Even today we’re probably not using the telephone as well as we could.”

Still, the telephone can seem positively antiquated given the advances in communication technology that have since taken place, with the mobile in most people’s pockets now fulfilling all sorts of needs from messaging and photography to finding train times and buying trainers. It has been a massive shift which has changed consumer behaviour. Crooks is working towards a future where our experience of healthcare undergoes a similar shift. That, he says, will require persuading patients that it’s worth their while to create the level of buy-in needed for success.

“Forty years ago the centre of any living room was the fire. The centre of a living room now is, generally speaking, a 40-plus inch flatscreen LCD TV which has direct connection to Freeview or a satellite provider and often to the internet, where it’s connected to a whole host of cloud-based services,” says Crooks. “We accept that as just part of day-to-day life. We think that these services help us in day-to-day life. Most people are streaming films, viewing programmes not in real time. They absolutely like those services because they can see a direct benefit to their use. 

The more we know about you, the better we can personalise the service offering

“The way these services have been built is to make your life easier because what the big tech companies realised very early on is the more they learn about you, the more they can personalise services using algorithms,” he goes on. “What we’re trying to do is to take that ability but apply it with an ethical lens. The more we know about you, the better we can personalise the service offering to make it more acceptable to you to do the right thing, to make it more convenient for you to access services. 

“The reason big tech use these capabilities is to create dependency. They want to keep you as a consumer and they want to lock you into their services. What we are trying to do in healthcare is turn that on its head but use exactly the same technology for what that can do to activate and empower you, to allow you to make better health and wellbeing choices, to access services on your own terms and book appointments at times that serve you.”

The Scottish Government has pledged that this is on its way. John Swinney promised an app acting as a “digital front door” will launch by the end of the year, starting in Lanarkshire. 

The app has been in the pipeline since 2022 and it’s understood that it will have limited functionality at its launch, unlike the more advanced model already running in England. Crooks says its use of cloud-based services will give Scotland’s system flexibility to develop, suggesting the result will be “potentially more future-proof”. But there has been no clarity on exactly what will be delivered, or when, leading to questions about what patients can really expect.

Crooks says the app “will be able to recreate all the things that England can do at the moment”, an offering which spans appointment scheduling, test results, and repeat prescriptions, with information shared across hundreds of GP surgeries.

It is information sharing where he sees huge potential for public benefits. He says people in Scotland are “happy to share their data with specialist ‘others’ where it will benefit their health”. That fact that we’re not doing that well, he says, not only frustrates patients but slows down our systems. 

He says it’s not a new issue. “All my patients assumed that their data was shared between general practice and the hospital. They were stunned when they found out that wasn’t the case, then frustrated and angry – ‘what do you mean you don’t know my blood test result?’ I’d have to say, ‘sorry, they haven’t written to me yet’.

“These conversations are played out all over the place. Data-sharing is incredibly important but what we are advocating for is that that needs to be a free consent driven model where we have the ability to share our data with whoever we want to share it with – the GP, the hospital doctor, your brother, sister, mother, father or wee Jeannie down the road who is your principal carer. That opens a great number of opportunities for us.

“In the US the citizens don’t trust their government to hold their data. Citizens in the UK are more understanding of government, but they have much more trust in the NHS as an institution.”

He raises the example of Estonia, the Baltic region’s digital powerhouse. There digitisation is so well-advanced that people don’t have to apply for certain benefits, because the joined-up systems know when someone has hit an entitlement threshold. “They see the direct benefit of sharing their data because they personally get something back from it in return,” Crooks says. “We could do that in this country, if we so choose. It’s not about the technology, it’s about engaging in open and honest conversations with citizens, sharing the art of the possible, debunking the myths. There are a lot of urban myths. Getting rid of all of those will inform us to get better. It’s all about building trust.”

On the question of whether Scotland can afford this shift, Crooks argues that we can’t afford not to. DHI has secured funding for 10 years, and Crooks says he has no intention “to replace doctors, nurses or carers with bits of tech”.

“There’s no doubt that public service finance has changed not just in Scotland, it’s changed in every country in the world, whether you are in the global north or the global south. The percentage of a nation’s GDP being consumed through the provision of healthcare is increasingly almost exponentially year on year. That’s not sustainable.

We can’t continue to simply throw money at the problem

“We can’t continue to simply throw money at the problem, which is what we did before, and we can’t simply recruit more doctors, nurses and therapists, which is what we tried to do before, and we can’t work the system any harder or faster, which is what we are still trying to do. We’ve got a workforce which is under significant pressure, we have got to find 21st century solutions to the problems of today. A lot of our lords and masters haven’t quite clocked that, intellectually. 

“There’s a mistaken belief that using digital technologies to address some of the challenges is really expensive. A lot of things we are talking about aren’t expensive at all – it’s how they are used that’s important.”