Hunt challenges the NHS to deliver digital services by 2018

Adobe Spark (6)The Health Secretary, Jeremy Hunt, has challenged the NHS to deliver digital services nationwide by 2018 to coincide with the NHS’ 70th anniversary next year.

Hunt used September’s Health and Care Innovation Expo in Manchester to highlight the opportunity of technology in creating ‘The patient power decade’. The Health Secretary painted a pixelated portrait of a future shift in power within the NHS from doctor to patient, with the patient ‘Using technology to put themselves in the driving seat of their own healthcare destiny.’

Hunt stated that by the end of 2018, patients will be able to use an integrated smartphone app to access services such as NHS 111, book a GP appointment and even have the ability to view healthcare records online.

Currently, according to NHS Digital, 680,000 patients are viewing their medical records online every month.

In this keynote speech, he further acknowledged how ‘People should be able to access their own medical records 24/7, show their full medical history to anyone they choose and book basic services like GP appointments or repeat prescriptions online.’

Mr Hunt also stated that the app could be used to order repeat prescriptions, access support for managing long-term conditions, or express preferences on organ donation, data sharing, and end-of-life.

Hunt emphasised how the ‘master-servant relationship’ between doctors and patients that has existed for three millennia will be ‘turned on its head’, and patients will use the information that becomes available at their fingertips, ‘to exert real control in a way that will transform the prospects of everyone.’

Overcoming hurdles

If the NHS is to successfully deliver digital health services, there are a number of potential hurdles to overcome. Firstly, there are concerns over the accessibility of services for those unfamiliar with smartphone technology, or from those of disadvantaged backgrounds who cannot afford to buy a smartphone. For this reason, Hunt stressed how the new services will be for everyone:

‘If the NHS is not there for everyone, it is nothing,’ he said. ‘We recognise that not everyone is comfortable using a smartphone. So we will always make sure that when we introduce new services, there is a face-to-face or telephone alternative, for people who do not use smartphones.’

While many older people struggle with online technology, it is worth pointing out this is not always for want of trying. Hunt outlined how 400 000 people have already been trained to help get them online, and over the next 3 years, a further 20 000 digital inclusion hubs will be rolled out. Additionally, wifi will be introduced across primary care this year and secondary care next year, which is hoped will help support people accessing online resources.

Secondly, in lieu of the NHS cyber attacks earlier this year, Hunt conceded that a lot needs to be done to win back the public’s trust:

‘We have to recognise that we still have a lot to do to earn the public’s trust that their patient data is safe with us,’ he said.

As part of this, the Government announced its response to the National Data Guardian and Care Quality Commission report on data security in July. Among the initiatives are 10 new data security standards, a £21 million investment to protect trauma centres from cyber attack and new national support for unsupported Microsoft systems that were part of the original problem that caused the cyber attacks.

The role of mobile technology in delivering health services was also highlighted in a keynote speech from Professor Sir Bruce Keogh, medical director of the NHS. He said we run our social lives, financial lives, travel lives and retail lives online, so why not our health? Keogh welcomed the idea of being able to book GP appointments, get blood results or see X-rays online. However, he also recognised that it brings with it some challenges.

The first challenge is digital therapy, particularly in the area of mental health. According to Keogh, this will involve activities patients can do on their mobile phone that will improve their health, such as talking therapies, so that they do not have to visit a psychologist, psychiatrist or your GP. The NHS will have to work out how it assesses these, but importantly it needs to work out the payment mechanisms behind them so that they are available for everyone on the NHS.

The second challenge concerns what happens when people can get advice and treatment outside normal geographical boundaries. Currently, the way the NHS is structured means a GP is determined by where a patient lives. However, Keogh highlighted how already many are visiting GPs outside the area where they live. He therefore questioned what happens as more people start to access health care not just beyond their local area but beyond their regional area and possibly internationally. He stressed the need to work out who pays for what, the duties of Government and arm’s length bodies with respect to ensuring the safety of those transactions, and the legal implications. The issue is how this can be made part of the NHS, rather than creating a two-tier ‘pay for it if you can’ service.

Looking to the future

Pilot schemes are already underway, with ongoing evaluation before the digital service is introduced nationally. According to Hunt, initial results from pilots in north London, Leeds, London and Suffolk, show that when NHS 111 services are transferred online it is safe. He also pointed out that if digital health services are introduced in the right way, it will save the NHS money. He said: ‘The 6% of people who use the 111 app, rather than speaking to the call handler, save the NHS money. That’s more resources for doctors and nurse.’

Looking to the future, Hunt confirmed that the Government are trying to build the safest, highest quality health system in the world. The role of technology, therefore, is one that he believes is of the utmost importance in making this a reality:

‘As we grapple with the challenges of resources, challenges to improve patient safety, challenges to improve quality and challenges to improve changing consumer expectation, technology can be our friend if we recognise it as a means to an end and not an end in itself, and that end is safer, healthier patients,’ he said.

Taken from British Journal of Healthcare Management, published October 2017.

Advertisements

The A&E crisis: the burgeoning effect on paramedics

As demands rise and resource pressures grow, NHS emergency services have found themselves placed under increasing pressure. This culminated in the failure of emergency departments to meet national waiting time targets in the early months of this year. The combination of these trends with claims concerning the improved outcomes that are possible by specialist trauma centres, begs the question as to the future of community and primary care services, ambulance services and hospital A&E departments. As a result, the NHS Commissioning Board (NHS England) is reviewing the future configuration of urgent and emergency services in England.

The report, drawn up by the House of Commons Health Committee, suggests that growing demand on A&E departments will make them unsustainable if effective action is not taken quickly to relieve the pressures they face (House of Commons Health Committee (HCHH), 2013a). Concerns were also raised by the committee as to the low numbers of staff in emergency departments, and the role of NHS 111.

Urgent Care Boards
The Government’s response to the pressure in emergency and urgent care revolves around improving local system management in the short term and restructuring care for the medium term. Urgent Care Boards (UCBs) have been created to implement emergency care improvement plans in the local area. However, it was felt by the Committee that UCBs would not be able to implement reforms and influence commissioning. Confusion over a number of features of UCBs, including whether they are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups, has led the committee to conclude that although UCBs have the potential to provide local system management, they currently lack clear direction or executive power (HCHH, 2013a).

NHS 111
NHS 111 is the three-digit telephone service that was introduced earlier this year in an attempt to improve access to NHS urgent care services. At a critical time in the NHS when health economies are facing financial and clinical constraints, its aim is to provide patients with a number they can call when they need help or advice that is not urgent enough to use the conventional 999 service. NHS 111 operates 24 hours a day, 365 days a year, and is free to use from a landline or a mobile.

However, the Health Committee report emphasises the consensus that NHS 111 was instated by ministers prematurely, without any real understanding of the impact that it would have on other parts of the NHS, including emergency and urgent care (HCHH, 2013a). It is felt that because NHS 111 is based around triage by a call handler who is not clinically trained, it does not embody the principle of early assessment by a clinician qualified to a level where they can appropriately quantify the balance and risk. The outcome is a potential for patients to remain dissatisfied or unsure of the instructions they have been given and so remain inclined to attend A&E when it really isn’t necessary.

Despite this, it can be argued that a number of potential benefits could be seen were the ambulance service to assume a more significant role in national 111 provision. Some of the more notable benefits include (HCHH, 2013b):

  • Confidence in a universally recognised professional
  • Experienced and capable function l Whole system effectiveness and value for money
  • Appropriate management of demand across the urgent and emergency care system.

Ambulance services
Along with emergency departments, ambulance services are also being met with ever increasing demands. According to the Association of Ambulance Chief Executives (AACE), in 2011–12, the total number of emergency calls was 8.49 million; this was an increase of 415 487 (5.1%) over 2011–12 (HCHH, 2013b).

Delays in ambulance to A&E handovers or transfers within urgent care are a major everyday issue for ambulance services. Currently, patients have found themselves having to wait up to eight hours in ambulances outside A&E departments. Official figures from eight of England’s ten ambulance trusts show that 3 424 patients waited more than two hours before being handed over to hospital staff during 2012/13, compared with 2 061 patients the year before (Donnelly, 2013).

The AACE recognise that the cause of these delays varies from hospital to hospital but include:

  • Ownership by hospital/health system leaders
  • A&E capacity
  • A&E integration with the rest of the hospital
  • Timeliness of in-Trust escalation
  • Reductions in physical bed capacity within hospitals and the community
  • Attitude and behaviour towards handover delays within the hospital
  • The effectiveness of urgent care pathways keeping demand away from the front door (HCHH, 2013a).

As the paramedic profession takes on broadening responsibilities, ambulance services need to be recognised as a care provider and not simply a transport service for emergency departments. The committee believes that this can be achieved in part through increasing the number of fully qualified paramedics (HCHH, 2013a). By having paramedics who are able to treat patients on-scene, conveyance rates to emergency departments can be reduced, and, therefore, pressure alleviated. In addition, paramedics would be in a position to make the difficult judgement about when to bypass the nearest A&E in favour of specialist units that offer stroke, heart attack, major trauma and specialist children’s services.

In comparison to ambulance technicians, paramedics are trained to make better clinical judgments and administer care more appropriately. It is therefore imperative that ambulance services demonstrate a commitment to establishing a ratio of paramedics to technicians, which ensures that ambulance crews are able to regard conveyance to an emergency department as only one of a range of clinical options open to them (HCHH, 2013b). The report recommends that NHS England undertakes research to establish the precise relationship between more highly-skilled ambulance crews and reduced conveyance rates (HCHH, 2013a). By making full use of the potential of ambulance services, demand pressures in emergency departments could be more easily managed and new care models developed.

References:
Donnelly L (2013) Patients facing eight-hour waits in ambulances outside A&E departments. The Telegraph. http://www.telegraph.co.uk/health/healthnews/10150635/Patients-facing-eight-hour-waits-in-ambulances-outside-AandE-departments.html

House of Commons Health Committee (2013a) Urgent and emergency services: Second report of session 2013–14. Vol 1: Report, together with formal minutes, oral and written evidence. The Stationery Office, London

House of Commons Health Committee (2013b) Written evidence from Association of Ambulance Chief Executives. ES 19. The Stationery Office, London

Taken from Journal of Paramedic Practice, published 2 August 2013.