The Digital NHS
In 2016 Health Secretary Jeremy Hunt appointed Baroness Martha Lane Fox to look at how the take-up of internet services could be made widely available and include the 10 million people who currently have no internet access.
Martha, of lastminute.com fame, presented her recommendations to the National Information Board chaired by Tim Kelsey.
Her recommendations included free Wi-Fi access from health and social care settings, after all, as she suggests, ‘it’s basic infrastructure’. Martha wants a digital health service to be inclusive of those who do not have internet access and start with the disadvantaged first.
Martha says: “One of the founding principles of the NHS was to ensure that everyone — irrespective of means, age, sex, or occupation — should have equal opportunity to benefit from the best and most up-to-date medical and allied services available.”
There’s no question Martha is excited and impassioned about digital change in the NHS. Martha Lane-Fox says every GP should have at least 10 per cent of its patients using online services by March 2017 and 90 per cent of patients by 2025. She wants to encourage this different way of interaction between doctor and patient by training GPs in digital skills.
The Next Steps
Following on from these recommendations, Jeremy Hunt has announced a £4.2 billion investment to bring the NHS into the digital age.
Areas of improvement include an ambition to have a paper-free NHS, investment in cyber security and data consent, a new NHS website and apps for patients, development of a new click-and-collect service for prescriptions, and, of course, free Wi-Fi in all NHS buildings.
Mr Hunt said: “The NHS has the opportunity to become a world leader in introducing new technology — which means better patient outcomes and a revolution in healthcare at home.”
Running in parallel to this ambition are the seven workstreams of the National Information Board. These include objectives such as providing patients and the public with digital access to health and care information and transactions, with a focus on prevention and self-care. This will include a national experiment to give patients a personalised, mobile care record which they control and can edit, but which is also available in real time to their clinicians.
In supporting better decision making on behalf of the patient, workstream 1.2 focuses on providing citizens with access to an endorsed set of NHS and social care apps. The workstream suggests that endorsement can encourage health and care professionals to recommend the use of safe and effective digital applications and give greater confidence to patients and citizens to select and use them.
Returning to Martha’s key recommendations, they do appear quite simple; and perhaps obvious to many, after all you can get free Wi-Fi almost anywhere, and in fact many GP practices already offer this. We all use online appointment booking systems to book travel, order grocery deliveries and to reserve a table at our favourite restaurant. But the obviousness of these recommendations perhaps suggests that there is a struggle to move things forward.
There are, of course, numerous siloed successes where forward thinking health professionals and CIOs have taken it upon themselves to deliver digital services. Take for example the MyMR (My Medical Record) Personal Health Record initiative implemented by University Hospital Southampton. The service allows a patient to send secure messages via a portal to contact their clinical support team, as well as access to an online journal to track and record patient activity or behaviours based on the condition being treated. Comprehensive guides and advice are provided and tailored for the specific health episode.
MyMR also allows the patient to view hospital appointments both past and future, check medications, weights and test results and a two-way upload of medical documents. As one MyMR patient suggests: “self-management is empowering, liberating and informative.”
Linking up with commercial digital solutions will also be essential. For example, Philips has just announced its plans to make it easier for patients to self-monitor their health using Amazon Web Services (AWS) Cloud and Internet of Things (IoT) technologies. Philips believe this is a key way to reduce the burden on the NHS as it will reduce the number of repeat appointments with a health professional simply to collect statistics. GPs and hospitals will need to be in a position to consume such data in real-time if they are to benefit from this approach.
On a very practical level there are challenges involved in delivering digital solutions such as upskilling health professionals with necessary technical skills and creating patient awareness in order to adopt new services.
On the matter of digital exclusion, there will be technical constraints to overcome in rural areas that struggle with poor infrastructure, numerous factors come into play such as distances from exchanges and even the type of cabling as many struggle with poor broadband speeds over aluminium (as opposed to copper) wiring. In such cases technology will likely be designed to operate in an offline mode, collecting data and uploading when the patient happens to be in a Wi-Fi area. The alternative could be investment in additional 4G mobile masts in such areas to truly enable digital services.
The NHS to be…
Speaking to UK eHealth Week, Beverley Bryant, director of digital technology at NHS England, said: “With the Summary Care Record, almost 96 per cent of the population now has one and, particularly in emergency or secondary care, the use of this is really transforming patient care.”
She continued: “Our greatest challenge is delivering at scale. We cannot impose top down technology and information services on the NHS. It all needs to be owned locally. It needs to be the day-to-day business of all of the NHS organisations that are delivering care. We know our care organisations need interconnected systems and services to deliver better outcomes for patients, so we will support them to ensure they are ready with the capabilities and infrastructure needed. Strong leadership is vital to delivery of the paper free agenda, from clinical and business leaders who really understand the nature of the NHS and how technology can support their provision of care. For patients, we need to build public awareness of how digital tools and accessing their record can help them if we are to make this work.
“The priority is that we join the NHS up to itself and we join the NHS up to social care and we allow information about patients, like discharge summaries to transfer electronically back to primary care for example. Citizens’ information needs to be transferring across care boundaries between the acute and community and back to primary care. And so we’ve put responsibility at CCG level via the Local Digital Roadmaps to support this across the system.”
The future does seem positive and there is a sense of real focus in delivering digital solutions for patient benefit; especially those that perhaps came under the banner of digital exclusion. The focus must, of course, remain on patient’s wishes and needs.
To this end, many groups such as BCS Health will be working closely with the National Information Board and other partners to support and assist in making a digital NHS a reality and working hard to ensure that digital exclusion is a thing of the past.
Gareth Baxendale FBCS CITP
Head of Technology NIHR Clinical Research Network.
Vice Chair BCS Health and Care Executive