On designing an algorithmically enhanced NHS: towards a conceptual model for the successful implementation of algorithmic clinical decision support software in the National Health Service

Established in 1948, the National Health Service (NHS) has lasted 75 years. It is, however, under considerable strain: facing chronic staff shortages; record numbers of emergency attendances; an ambulance wait-time crisis; and more. Increasingly, policymakers are of the view that the solution to these problems is to rely more heavily on one of the NHS’s greatest resources: its data. It is hoped that by combining the NHS’s data riches with the latest techniques in artificial intelligence (AI), that the means to make the NHS more effective, more efficient, and more consistent, can be identified and acted upon via the implementation of Algorithmic Clinical Decision Support Software (ACDSS). Yet, getting this implementation right will be both technically and ethically difficult. It will require a careful re-design of the NHS’s information infrastructure to ensure the implementation of ACDSS results in intended positive emergence (benefits), and not unintended negative emergence (harms and risks). This then is the purpose of my thesis. I seek to help policymakers with this re-design process by answering the research question ‘What are the information infrastructure requirements for the successful implementation of ACDSS in the NHS?’. I adopt a mixed-methods, theory-informed, and interpretive approach, and weave the results into a narrative policy synthesis. I start with an analysis of why current attempts to implement ACDSS into the NHS’s information infrastructure are failing and what needs to change to increase the chances of success; anticipate what might happen if these changes are not made; identify the exact requirements for bringing forth the changes; explain why the likelihood of these requirements being met by current policy is limited; and conclude by explaining how the likelihood of policy meeting the identified requirements can be increased by designing the ACDSS’s supporting information infrastructure around the core concepts of ‘utility, usability, efficacy, and trustworthiness’