16th March 2026

Newsletter Monday

There were two stories competing for my attention this week.

At first they felt unrelated.

The more I thought about them, the more they seemed to describe the same problem from two different angles.

The first was the moral outrage that has erupted over the prospect of NHS England paying around £330 million to a US tech company for software designed to improve hospital efficiency.

The anger seems to have focused largely on the political allegiances of some of the people involved rather than the technology itself.

But the story did tap into something I discussed recently with my podcast guest, Professor Rob Galloway.

We appear to be spending more and more money in healthcare while the experience of the system for patients – and staff – feels like it is getting worse, not better.

That conversation goes out on the podcast tomorrow.

​The second story I read this week was about plans to expand “hospital at home” services across London after early success with the model.

The tone of the article is positive.

Treating patients at home can be better for them, it can reduce admissions and it can save money.

All of those things are true.

But if we are being honest, this expansion is also happening because our hospitals are in crisis.

Corridor care has become normal.

Ambulances queue outside emergency departments.

Trolley waits stretch into many hours.

This was another theme that came up when I spoke to Rob.

He wrote about it in the Daily Mail Health section.
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In general practice we have actually been trying to keep people out of hospital for decades.

Not because we are trying to ration care, but because we know that many frail patients simply do not do well there.

Hospital is not a neutral place.

For someone who is already vulnerable it can aggravate confusion, accelerate loss of mobility and become physically exhausting.

People may spend hours on a trolley waiting to be admitted, move between wards several times (often in the middle of the night) undergo repeated blood tests and scans, and then wait again for the relevant team to review the results before they can finally go home.

This weekend I was working out-of-hours doing home visits and had two conversations with families about exactly this.

Both expected that hospital would be the safest option.

In both cases we talked through the reality that admission might actually cause more harm than good.

That doesn’t mean hospital is the wrong place.

Sometimes it is absolutely necessary.

Sometimes there simply isn’t another option.

Patients may no longer be coping at home.

A fall, an infection or a sudden deterioration means they need investigations and monitoring that can only happen in hospital.

And sometimes the real challenge begins when they are ready to leave.

Suddenly the four steps up to the front door are no longer manageable.

The bed has to be moved downstairs.

A care package that once involved a single daily visit now needs four carers a day.

Arranging that support, and the funding that goes with it, can take weeks.

These are the quiet realities behind many admissions.

Which brings me back to that £330 million technology story.

Software that improves hospital efficiency may well have value.

Hospitals absolutely need better systems.

But it is hard not to wonder what difference that kind of money could make if it were directed at some of these much more human bottlenecks in the system – the frailty care, rehabilitation support and social care infrastructure that often determine whether someone can safely stay at home or return there after illness.

For now, the conversation about hospital care needs a little more nuance.

Hospital is an extraordinary place when you truly need it.

But it isn’t always the safest place for recovery.

​Tomorrow’s podcast episode with Professor Rob Galloway explores this reality in much more depth – why emergency departments have reached the point they have, and what it really takes to keep people well enough to avoid ending up there in the first place.

I hope you enjoy it.