Digital health for a divided digital nation
- The NHS in the UK is 65 years old. If it is to survive for another 65 years, a digital revolution is needed. But where are the digital skills needed, both within and outside of the health service.
Introduced after World War II, the NHS is 65 years old this year, has expanded well beyond its original remit of ensuring that no-one went without healthcare regardless of their wealth or status and now costs the nation an absolute fortune to maintain.
The NHS is pretty much untouchable by governments of any creed. Every administration talks about improving efficiencies and reforming the way the service works, but to criticise the NHS is regarded as political suicide.
But efficiencies are needed. The outgoing CEO of the NHS this week warned that a £30 billion funding gap will open up in the NHS over the next seven years without “radical” changes.
IT needs to play its part in that, but here the NHS has an appalling track record. The infamous National Programme for IT, kicked off by then Prime Minister Tony Blair back in 2000 before being killed off (but not really) in 2012 after delivering two thirds of faff all.
We won't be doing that one again, promised ministers last year - before cutting another cheque to the suppliers who were savagely criticised for lack of delivery.
But a 21st century health service needs technology to underpin it so alternative approaches need to be found.
This week a report from NHS England (entitled The NHS belongs to the people: a call to action ) argued that the service needs to learn from the way online channels have change the way people deal with things like finance and travel.
The report states:
This is not about unnecessary structural change; it is about finding ways of doing things differently: harnessing technology to fundamentally improve productivity; putting people in charge of their own health and care; integrating more heath and care services; and much more besides. It’s about changing the physiology of the NHS, not its anatomy.
The digital revolution can give patients control over their own care. Patients should have the same level of access, information and control over their healthcare matters as they do in the rest of their lives.
The NHS must learn from the way online services help people to take control over other important parts of their lives, whether financial or social, such as online banking or travel services. First introduced to the UK in 1998, now more than 55% of internet users use online banking services.
A comparable model in health would offer online access to individual medical records, online test results and appointment booking, and email consultations with individual clinicians. Some of the best international providers already do this. This approach could extend to keeping people healthy and independent through at-home monitoring, for example.
These innovations would not only give patients more control, they would also make the NHS more efficient and effective in the way that it serves the public.
For all this to work of course there would need to be major advances in digital inclusion so as not to isolate those most in need but who might lack the necessary skills or technology to access services.
To that end, the report adds that 50 existing UK online centres in local settings, such as libraries, community centres, cafes and pubs, will receive additional funding to develop as digital health hubs.
But will that be enough? The digital inclusion theme was picked up on in the House of Lords by Martha Lane-Fox, Baroness of Soho, who is charged with closing the notorious digital divide around the UK.
She told fellow peers:
"I am also someone who fervently believes in harnessing the power of technology to improve public services – it is through its more effective deployment that will we provide world class healthcare in the future at a dramatically lower cost.
"I am not talking about expensive and costly top down NHS IT projects but instead about better use of data, open standards, more agile development and a more digitally minded culture in our healthcare sector."
Some of what Lane-Fox talked about are pretty familiar 'digi-medicine' notions:
"Over 70% of us look on the web before we go to the doctor and every day millions of people are using health apps on their mobile phones, logging into websites to find out health information and chatting to other people with similar conditions in online forums.
"New technologies such as Up or jawbone or Nike Fuel Band allow people to gather their own data and make better lifestyle choices and therefore prevent health issues.
"It is vital the NHS is able to deliver services of the same quality as citizens find on the web and on their smartphones or we will be danger of undermining our valued public services."
Other ideas were more 'back-room' in nature. Lane-Fox produced a practical example of what she means in the shape of an initiative out of the Open Data Institute:
"In 2011-12 the NHS in England shelled out more than £400m on statins out of a total drug budget of £12.7 billion.In collaboration with Mastodon C, Open Health Care UK (a start-up founded by a doctor and a programmer) examined a vast open data set: the prescriptions written by every family doctor in England. They looked at regional patterns in the prescription of statins.
"The researchers estimated that, had every doctor prescribed white label as opposed to branded statins, the drugs bill would have been more than £200m lower. The variation is remarkable—imagine the potential savings if the exercise was repeated for other classes of drugs.
"As The Economist recently wrote 'A study in the British Medical Journal in 2010 reckoned that the NHS could save more than £1 billion by switching from branded drugs to generic equivalents'. The new analysis backs up that claim. Smart use of more datasets will fuel many improvements – as long as interoperability of systems is central to improvements."
But Lane-Fox identified a digital divide within the NHS itself which she detected after spending time in hospital after a near fatal car crash:
"While I spent two years in hospitals rebuilding my body I met some of the most remarkable people – from doctors to nurses to healthcare assistants but even then there was a gap between the technical advances in the commercial sector and what I observed in hospitals.
"All staff should be helped to be digitally literate and the internet must be put at the heart of design of services, surgeries and hospitals."
"On this the 65th anniversary of the NHS – surely one of the greatest innovations in the UK’s history, I believe it is imperative to be even more imaginative in how we incorporate another of the UK’s great inventions – the web into its future – this will help us to meet the future funding challenges.”
Fine words as ever from Baroness Soho and no-one doubts her sincerity.
But that enduring national digital divide and the digital skills shortage within the NHS itself conspire to undermine the basic principles of revolutionising health service provision in the UK.