Government looks to ‘predictive prevention’ within NHS to boost health of the nation
The Department of Health and Social Care has released a policy paper talking about the benefits of prevention over cure within the NHS - with a strong emphasis on digital technologies and predictive measures. However, can the NHS avoid mistakes of the past?
Hancock recently took up his position as Minister at the Department following a promotion over the summer during a Cabinet reshuffle, having previously served as Secretary of State for Digital, Culture, Media and Sport.
Since joining he has already committed more than £400 million towards ‘tech transformation’ within the NHS.
However, the NHS has a chequered past when it comes to technology agendas instigated by the top of government. And Hancock’s policy paper released today will no doubt ring alarm bells for those of us that have been following the industry for a while, particularly of the failed care.data programme, which aimed to use data to better predict service and care provision across the UK.
In his ministerial forward for the document, Hancock said:
“When I became Secretary of State for Health and Social Care, I made prevention one of my early priorities for the NHS and social care. This vision document sets out areas where we need action, and how prevention can help us meet the Ageing Society Grand Challenge Mission - which was set out by the Prime Minister earlier this year as part of our ambitious Industrial Strategy. This Mission is to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.
“We cannot continue to invest in the same service models of the past. We will not meet our mission with 'business as usual'. This vision sets out that greater focus, and spending, is needed on prevention, not just cure. With an ageing society and people living with multiple complex conditions it is imperative that this rebalancing happens - to keeping people well, living in the community, and out of hospital for longer.
“This means services which target the root causes of poor health and promote the health of the whole individual, not just treating single acute illnesses. In practice this requires greater funding for pre-primary, primary and community care - and support for the staff who work in these services.”
The document notes how technology can be used on a personal level to better promote a healthy lifestyle, prevent illness and create greater independence for individuals. For example, it cites the growth of remote monitoring, how technology can be used for virtual or video consultations, and the use of online communities to allow patients to share experiences and get advice.
However, it’s the section on predictive preventive care that’s particularly interesting.
Learning from past mistakes
As noted above, it’s not the first time that the Department for Health and Social Care has attempted to make better use of data and technology to improve care and services across the NHS.
Care.data was cited as a “moral obligation” for the NHS when it was launched, given its potential to ensure the quality and safety of services across the NHS.
The idea behind care.data was to pull together all of the UK public’s GP health records, store them in a central database and share them with the Health and Social Care Information Centre. It was also believed that this sharing and analysis of information would highlight different diseases and conditions that may require more NHS investment going forward.
However, the NHS ran a poor PR campaign surrounding care.data and privacy advocates successfully argued that although the data being stored would be pseudonymised, where it would only reveal details such as age, location and gender, this wouldn’t stop the data being matched with other databases and patients being ‘re-identified’.
As concerns were mounting, a leaked NHS document outlined that the data could potentially result in patients being identified. The nail in the coffin, as it were.
And although the NHS argued that it had carried out a publicity campaign by delivering leaflets on care.data to 26 million households across the UK, polls found that two-thirds of people had not had seen them. Ultimately, the project failed and had to be canned, despite its potential benefits.
However, today’s document seems to hint at making use of data and technology to rethink how the NHS delivers care and services - albeit, without any commitment to a national database similar to care.data.
It appears to focus more on individual use of data and makes a point of emphasising security and privacy.
The document states:
“We want to have the most advanced healthcare system in the world - so as part of our long-term plan for a 21sr century health and social care system, the way we view public health must evolve. Moving to the next phase means a more intelligent and personalised approach to improve the health of the nation.
“Predictive prevention will transform public health by harnessing digital technology and personal data - appropriately safeguarded - to prevent people becoming patients. The availability of public data, combined with the existing understanding of wider determinants of health, means we can use digital tools to better identify risks and then help the behaviours of people most in need - before they become patients.”
“Historically, public health has dealt with populations as a whole - a one-size fits all approach. The power of predictive prevention comes from enabling people to look at their health in the context of their own life, their own circumstances, and their own behaviour.”
The Department states that this means a world where everyone can understand their own risks, both in their genetic make-up and their personal behaviour. For example, the government wants to see health and social care exploring digital services that use information to offer people precise and targeted health advice - specifically designed for their demographic and their location; their lifestyle and their circumstances; their health needs and their health goals.
The ambition, it states, is to prevent people becoming patients through “personalised, ongoing dialogue about their health”.
To enable this, Public Health England will bring together a range of experts to build, evaluate and model “predictive prevention at scale”.
It makes a specific note on privacy and security. The document states:
“This will be a person-centric programme, putting individuals first and founded on the highest standards of data privacy. Where possible, it will go beyond our regulatory requirements to make sure that people’s data is used in ways that a are consensual, open and transparent - putting consent at the heart of this programme.”
I’m all for making use of data and technology to improve services and care within the NHS. In fact, I think it’s probably essential to the sustainability of the healthcare system. That being said, it’s about informed consent and putting people in control. Care.data assumed people would be okay with their data being used - and they weren’t. If the government had taken a more proactive approach and involved the public in a way that they felt like they had control over their data, things may have turned out differently.