Tackling health inequality, one text at a time

Year Here
Here and Now
Published in
4 min readSep 26, 2018


Appt is an intelligent appointment booking platform designed to help the NHS transform the delivery of preventative healthcare. Founder, 2016/17 Fellow, Hector Smethurst reflects on where it all started.

An example of Appt’s text message-based booking system

As a relatively fit and healthy twenty-something, I’d never really thought about what causes poor health. Not the occasional runny nose or sore throat, but pervasive, restrictive poor health.

Being able to remember more visits to A&E for snaps and strains than to my GP, I perceived poor health as a temporary inconvenience. But that worldview came crashing down during the first week of Year Here on my frontline placement at St. Paul’s Way medical centre in Tower Hamlets.

When illness meets inequality

For everyone like me, and perhaps you, who has lived a life free from serious and pervasive illness, there is someone living with one or more long-term condition.

That’s 15m people in England. And by 2025 that figure will climb to 18m. But already care for people living with long-term conditions accounts for 70% of our entire health and social care budget.

The good news is that these conditions can generally be managed by a combination of early diagnosis, regular measurement and clinical advice. Treatment will help people to live with their condition, preserving their quality of life and keeping them out of hospital.

But the big problem is that, right now, that isn’t happening. We don’t manage these conditions well. They get neglected, they get worse and people suffer. And there’s another, more alarming contributing factor: deprivation and inequality.

The truth is, if I had been raised in the community served by St. Paul’s Way, ill health would likely be more prominent in my life. Tower Hamlets is one of the most deprived boroughs in London — and has amongst the highest rates of Type II diabetes in the country.

If you come from a low-income background you are 60% more likely to develop a long-term condition in your lifetime. It is likely to develop 10–15 years earlier and likely to be more severe. And to magnify this disadvantage, people from a vulnerable or deprived background are less likely to exhibit help-seeking behaviour.

A health service for everyone

My big insight at St. Paul’s Way was that those patients with long term conditions weren’t responding to our invitations to check-ups. The system was antiquated and labour intensive — we spent afternoons sending out letters and making follow up calls.

With this understanding I persuaded the Practice to let me to experiment with a system of text messages. With my background in behavioural economics I hypothesised that the theory of “nudges” and other behavioural interventions would make patients more likely to engage with the health service.

And it did.

The promising early evidence was that patients were 4 times more likely to respond to an SMS appointment invitation than a more expensive printed letter. So I continued to develop my idea during the venture phase of Year Here and to grow it after the leaving the programme.

Today, Appt uses a combination of behavioural economics, targeted engagement and data analysis to promote the appointments that diagnose, measure and manage long term conditions — allowing individuals to understand, demand and book the appointment that suits them. Our small team of developers incorporate all of our learnings back into the system to further optimise its impact.

Year Here was critical to the development of Appt. It exposed me to a social problem that I would never have encountered.

And it forced me to be pragmatic. Any intervention would have to fit into the wants and needs of the users — the health care system and the patients.

Appt is a small intervention to tackle a huge problem but our ambitions are much bigger. We believe that primary care desperately needs significant reform. No one designing a National Health Service from scratch today would design the current system in which many of us with the greatest need struggle to access the care they deserve.

We believe that social enterprise is the perfect vehicle to drive the change that isn’t forthcoming from the political system. Developing small and effective initiatives that will cumulate to something greater, helping to create a health service that works for everyone, regardless of where you were born.

More from Year Here

Interested in applying? We have two intakes per year, in the Spring and Autumn. Find out if we’re currently open for applications.



Year Here
Here and Now

A year to test and build entrepreneurial solutions to society’s toughest problems.