The advance of the digital age has transformed the way we communicate and, for a healthcare sector under pressure to reduce costs, presents a huge opportunity – opening up a host of new ways to meet patient needs more effectively. As a provider of funding information services to NHS Trusts, local government and the Higher Education sector, Idox attended the Digital Health Summit hosted by the University of Salford to gain insight into how technology is being harnessed for patient benefit.
Rising healthcare inflation, an ageing population and increasing public expectations will inevitably make the current way of working in the healthcare system unaffordable. However, the UK leads the world in many aspects of digital health thanks to its academic base, the private companies and public organisations active in the field, and the NHS, which is responsible for commissioning and delivering the majority of care services. Well-placed to evolve and to take advantage of technologies widely used in other sectors, the summit showcased how the NHS can employ the latest innovations and exploit the benefits of evidence-based, value-conscious initiatives, better preventative care, and enhanced, more personalised treatment.
An area of particular interest at the summit was how technology can be developed in the public and private sectors to support the concept of ‘whole-person care’. A talk by Professor Simon Jones of New York University raised the issue of the lack of discussion about technology by any political party during the 2015 General Election campaign. It was evident that ideas that had been developed in collaboration with experts had not made their way into manifestos; nor were they particularly explored in the Leaders’ Debates. It would seem that the role technology and innovation are playing in the health sector is being somewhat taken for granted. At a time when their profile needs to be raised, aligning with the concept of giving the individual greater power and control – not least over their own health and healthcare – this is far from ideal. As Professor Jones noted, when the NHS was founded, average life expectancy was 65 and many people died of infectious diseases and accidents. Now one in three babies will live to 100 and the challenge is addressing long-term chronic diseases. That crisis, Professor Jones offered, can be staved off with technology. This springs from a greater understanding of the importance of ‘linked data’ – a term used to describe a recommended best practice for exposing, sharing, and connecting pieces of data, information, and knowledge – across the health network. When this happens effectively throughout community care, hospital care and primary care it has benefits for the individual, system management and wider public health and wellbeing.
Lord Victor Adebowale, Chief Executive, Turning Point & Non-Executive Director, NHS England, spoke about the mismatching of services and a lack of robustness. Failing to enter into reform wholeheartedly will lead to a serious inability for services to meet the demands placed upon them. For Lord Adebowale, a major problem lies in the NHS having not yet ‘brought together the right people’ – those who have an incentive to keep people healthy and those who know how the technology works – and he is quite clear that ‘huge changes’ are required for that to happen. Having yet to implement even the most nominally successful system through which an individual’s health history is available at all points of contact in the process is holding back the evolution of a truly empowering service. It was still possible for the information collected, for example, from heart and blood pressure tests taken at one clinic to be lost before reaching another, as the health service is not yet able to deal with each individual having a universal ‘online account’ of their health history. The ethical considerations of unifying information in this way and which parties should have access to it remain to be explored. But for Lord Adebowale and others, the advantages this would bring to patients and the healthcare sector cannot be overlooked.
The benefits of Big Data
A talk from the coordinators of the Salford Lung Study, designed to test the safety and effectiveness of a new treatment for chronic obstructive pulmonary disease (COPD), expanded on the theme of effective digital implementation. Sponsored by GlaxoSmithKline (GSK), the study was run with a research team called North West e-Health (NWeH), a part of Salford Royal NHS Foundation Trust (SRFT) and the University of Manchester. NWeH has developed an electronic system that is helping GSK collect information for this study. A demonstration of where study participants had accessed services in terms of geographical data showed how, with improved resource distribution, considered prioritisation and genuine management buy-in, sensible investment of funding would have highly beneficial outcomes for local healthcare. Surrounding this is the emerging culture of app development and other services based on anonymised data arising out of research projects and health initiatives. As the Salford study showed, advances in genetics, biomedics and computing technology are ushering in an era of more effective personalised medicine and treatments tailored to patients’ individual characteristics. Exploiting these opportunities requires the savvy use of data, which has been a long-term objective for healthcare providers, noted for working with some of the most complex and disconnected data sets of any industry. The Salford study builds on the concept that innovative companies in the private sector – along with a host of public health bodies – can collaborate on tools that create value and benefit for all stakeholders.
As their technological capabilities and understanding advance, innovators will develop ever more interesting ideas for using data. This was examined in a talk from Alex Walter, Managing Partner for Health, O2 (Telefonica UK) who shed light on how Big Mobile Data had the potential to improve aspects of healthcare as diverse as waiting times in A&E, clinical outcomes and end-user experience. Such data could be analysed to identify, for example, how accessible key healthcare services are to residents of a particular area (and therein identify pockets of deprivation), while data on population and transport movement could be used to tackle disease incidents or in crisis management. Expanding on this theme, a look at the Local Government Digital Fund showed how councils could use technology to improve their work with their communities. In an O2 survey, almost half (48%) of participants said that when it comes to essentials like paying council tax or getting information on local services such as social care and education, they would like to use the internet, mobile apps or social media. But as it stands, councils across the country aren’t yet successfully delivering on this digital experience when it comes to engagement. In the preceding 12 months, less than one in ten people (7%) said they had interacted with their local authority through the web, mobile apps or social media. By contrast, nearly two thirds (61%) had opted to use more traditional methods to get the information or support they need, such as going into the council offices or telephone, because they felt the digital services provided by their council were either unreliable, or simply unavailable. By extension, improving the availability of apps and technology to access healthcare services would open up the potential of this area considerably.
Placing citizens at the centre of health and social care
A key talk from Professor David Haslam, Chair, National Institute for Health and Care Excellence (NICE) reflected on whether consistently excellent care can be delivered in the context of an ageing population and multimorbidities, alongside driving efficiency savings. As Professor Haslam outlined, making patient-centeredness more than just a soundbite represents a particular challenge and supporting the innovation of the NHS and other health organisations, as well as the information staff have access to, needs specific focus. A further challenge lies in the fact that different parts of the NHS – and, indeed, private healthcare providers – are multi-tiered, fragmented and by nature, not integrated. This is a significant factor that has also been observed in the adult social care services delivered by local government. In light of a number of councils already becoming so-called ‘commissioning authorities’ to cut costs, and where adult social care and children’s social care will come under tight scrutiny, the prospect of these services too having to embrace reform is at hand. The Local Government Association estimates that the current £1.6 billion gap between adult social care demand and resource availability will widen to £4.3 billion by 2019/20. As noted by NHS England Chief Executive, Simon Stevens in the NHS Five Year Forward View, there are even more acute challenges facing the NHS – for example, NHS England and independent analysts have calculated that a combination of growing demand and flat real-terms funding would produce a shortfall of nearly £30 billion a year by 2020/21. Clearly, advancing technology’s role in the NHS and care services to alleviate this pressure is becoming ever more important.
One of the biggest challenges is to use technology not just to manage conditions but to prevent health problems developing in the first instance. If health services were to allow the possibilities of monitoring data about genetics and susceptibility to diseases, for example, then the principle of owning and controlling one’s own data becomes realistic. Such initiatives have the potential to give patients more control over their lives and help them to manage their conditions. In the fields of social care and mental health, support groups can benefit from using digital communication tools such as Skype, which, say technologists, help to tackle the related depression and isolation that often affects sufferers. What is more, it is not just the economically wealthy who benefit from health tracking. Technology helps give people individualised care, and for those in difficult circumstances, the prospect of being able to use technology that can improve their situation is encouraging. Meanwhile, the NHS has a huge incentive to support these initiatives because treatment costs are high and they present a way to help reduce their impact.
Indeed, telecommunications will potentially open up the way that doctors can consult with their patients. For example, rather than making repeated hospital visits to receive care, patients can be monitored in their own homes and data sent back to a team of specialist nurses, who would then advise on adjustments to treatment or visit the patient at home. Many councils offer the facility to be contacted by the public via video calls and a similar use of technology could become more widespread in the health service. Using videoconferencing in such a way could help experts from across a health network to collaborate regardless of their geographical location, improving efficiency and delivering better outcomes for patients. Here, the same forces that have made instant messaging and video calls part of daily life for millions of people can be applied to basic medical care. It is not impossible to imagine a health system that is able to offer video consultations for routine ailments, potentially saving money and relieving pressure on overextended primary care systems in cities and rural areas alike. What is more, a new generation, fluent in Skype and FaceTime and eager for accessible, convenient medical care is ready to embrace these innovations.
As Lord Adebowale commented, most of the technology systems that have become widespread in the health sector relate to administration – and many organisations have been slow to fully exploit these, let alone make meaningful progress towards the creation of a true ‘digital’ health service. Without a change in mindset and proper reform, the health sector is likely to find itself in the same position and asking the same questions of itself in another decade, by which time operational costs will have increased further and demographic shifts will put the network under even greater strain. This makes it all the more important for businesses and the public sector to work closely with health organisations and help them get closer to their communities, utilising technology that supports better connectivity and interaction.
In designing a future that is fit for purpose, the health sector must embrace innovation. There are many who feel that the best way to meet the evolving needs of a changing population is to lead by technological example. Technology is crucial to tackling inequality and giving people life chances, as well as getting the best value for public money.
As ever within the health sector, focusing on just one aspect of service delivery can be too simplistic, when issues including its funding, operation and level of innovation are all under scrutiny. Yet an effective implementation of technology could go a long way towards improving all areas of its progress. As Mike Farrar, former Chief Executive, NHS Confederation commented, the principle of ‘technology with empathy’ should apply. It is becoming increasingly evident that healthcare providers in the UK need to explore ways of introducing technology to support both the pathological side of care and joining up the practicalities of the administrative network so as to best serve the people at the heart of the system. The speed and scale of the challenges and demands facing the healthcare industry are unprecedented. Yet in this period of rapid change, solutions are emerging that not only surmount these issues but also open new avenues to higher-value care.
By Sion Stedman, Idox
Idox supports NHS Trusts, local government and universities in their bid for funding via a dedicated suite of funding solutions including GRANTfinder and RESEARCHconnect. For further details, please email firstname.lastname@example.org