Babylon Health: correcting our NW London CCG report; objects to concerns raised by CQC report (latest updates)

Correcting and commenting on our earlier report. This Editor had earlier published on 11 Dec, as follow up to the extensive coverage on Babylon Health’s ‘GP at hand’ pilot activity in London, summarizing a report in Digital Health stating that the North West London Collaboration of Clinical Commissioning Groups (CCG) ended plans for expanding a test of the Babylon video consult/symptom checker app for GP practices in that area and that the app could be ‘manipulated’ to secure GP appointments faster and would not reduce demands on GPs. The original article was first corrected at an NHS England‘s representative’s request to reinforce that this was a local CCG project and that NHS England was not involved. The second request we received last Friday was from Babylon Health’s PR representative, Giles Kenningham, principal at Trafalgar Strategy. It was certainly strong and quoted here, edited as indicated to remove the link to the original article and Mr. Kenningham’s signature:

Your recent article on Babylon is factually wrong and misleading (link removed):
You claim the babylon app was dropped after being manipulated by patients. The term ‘manipualtion’ has been removed from the board papers and is wrong. Similarly the planned pilot had never begun so there so nothing to roll out.
This story is based on incorrect board papers which have now been corrected.

Please find a spokesman quote below. (closing signature removed)

A spokesperson for Babylon said:

“No pilot was ever carried out, nor any agreement signed with Babylon for such a pilot.

“Discussions were held after Babylon was selected in a competitive procurement exercise as the best technology to trial in GP practices across North West London. Subsequently, a decision was taken not to fund the pilot.”

This Editor then checked on the Digital Health article and found it had been removed without any follow-up or correction. Thus on Friday 8 Dec, this Editor removed the article, thanked Mr. Kenningham for bringing it to attention, and added that our report cited Digital Health as the source. I also requested a reference or third-party confirmation of his corrections. (This last request was not received as of the time of this writing.)

Wanting to get to the bottom of this for our Readers–and as a marketer who’s corrected more than a few inaccurate reports, your Editor has located the CCG’s report which is here published 22 November. It corresponds with Mr. Kenningham’s full note. The CCG report appears to have been revised (the URL indicates a v3), there never was a Babylon pilot, this version does not use the word ‘manipulation’, and the end result was that the CCG decided not to proceed to the pilot stage. In short, it appears to this Editor that the Digital Health report was based on an earlier and incorrect version of the report (perhaps as early as 25 Oct) and we are of course happy to correct. My fault and apology to our Readers and to Babylon in that I should have located the 22 Nov revised report prior to publishing the article and essentially provided a correction to Digital Health‘s report.

However, the CCG’s report on their Babylon evaluation contains two findings that were included in Digital Health‘s now-deleted article and give some pause. The CCG used focus groups of potential users, which surfaced that, in the CCG’s words, “The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment. The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand for GP services.”

Our Editor Chrys has pointed out the Pulse article which also comments on this and was corrected for the CCG’s revised report. The comments here by practicing GPs are worth reading. Scroll down and you’ll see that  ‘gaming the system’ has happened using direct triage in practices using personal phone consults–no app required. Can this even work?

Focus groups are highly subjective, but they are great ways of surfacing the flaws that developers and companies have gone blind to.

We hope that Babylon Health does take this feedback seriously. This Editor makes no secret of her advocacy of technology that can speed the obtaining of care, but based on her experience with early-stage companies, every critique, every hole that can be kicked in a service, delivery, and logistics, exposing a weakness should be appreciated–and ruthlessly scrutinized for flaws that need solutions. This becomes harder to do when you’ve achieved Big Funding. Babylon is typically burning a hole through it (The Times, 1 Oct–hat tip to Chrys). The pressure on now to find The Road to Breakeven must be stunning.

Important updates: Speaking of finding solutions, Babylon differs strongly with the findings of the Care Quality Commission (CQC)(not to be confused with the CCG), in the CQC report on their service published on Friday 8 December. 

The CQC is the independent regulator of all health and social care services in England; the closest US equivalent would be the Joint Commission. The CQC uses a five-point evaluation measure (page 3) developed via staff, stakeholders, organizational documents, and sample medical records. Their comprehensive report on Babylon is published here.

The HSJ (paid subscription only) on 8 December reported that “Babylon Health Services has failed to stop the publication of a Care Quality Commission report that states it is not providing a safe service in some areas.” The CQC report was published after an injunction was lifted by the High Court on 8 December.

In most aspects, it’s a highly favorable and glowing in parts evaluation by the CQC. For the most part, services were found to be safe, effective, caring, responsive and well-led. The exceptions were in three care areas: prescribing decisions were not always made appropriately based on a thorough medical history, that prescribing information wasn’t always shared with the patient’s GP to ensure safety, and there was no system in place to give assurance that patients’ conditions were being appropriately monitored. This means to the CQC that Babylon is not meeting Regulation 12 HSCA (RA) Regulations 2014 ‘Safe care and treatment’ in three aspects which are summarized on page 13 and detailed in the report.

There are obviously strong opinions on both sides that remain unresolved. It is one thing to publicly differ with the findings, entirely another to use legal action in the High Court to stop a regulator’s report, an action which was ultimately denied by the court. At the core of it may well be the limitations of a telehealth/telemedicine service, information sharing, and differing expections in a regulated environment.

Babylon has published a statement on their website (13 Dec) delineating the differences they have with the CQC report. They maintain that they tried to work with the CQC to correct inaccuracies in the report. “We are concerned that the regulator has found it so difficult to assess digital healthcare in its most recent round of inspections. Because of this, we have had no choice but to challenge the validity of the report in court – to defend our staff, our reputation, and innovation across healthcare.” Their critique of the report is that the CQC does not understand digital healthcare, how it operates, GMC guidelines on data sharing/consent, and the limitations it shares with other services such as NHS out of hours, private GPs, and pharmacists. Whew! See the link here for Babylon’s full statementAlso Digital Health.

Update: In today’s (14 Dec) NHS Managers.net newsletter, Roy Lilley’s thought on Babylon’s statement is “if what B’lon is saying is right, it’s hard to see how the CQC can get away with this? Have a look.” (link to statement above) We’ll agree with what he’s hearing–this is far from over.

This Editor is standing by for further reports on this matter and Reader citations of further information. Hat tips to Roy Lilley, Editor Emeritus Steve Hards, and Editor Chrys.

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