The Growth of Digital Technology in the National Health Service (NHS)
The EMJ team were in attendance at this year’s Digital Health Technology Show, which took place at the Excel Centre in London, UK, from 13th–14th March 2018. There was a plethora of insightful presentations throughout the 2-day event by experts on digital technology in the healthcare setting. These included clinicians, researchers, NHS providers, technology companies, and cyber security specialists. With the 70th anniversary of the founding of the NHS now fast approaching, we were particularly enlightened by a presentation from Mr Cleveland Henry, Programme Director of the Innovations, Digital Futures & Digital Collaboration Service at NHS Digital, entitled: ‘Using Digital Technology for Inclusion and Patient Benefit’. This outlined the aims and work of the service, and their vision for the future. As can be deduced from the title of the presentation, a key overall aim of the initiatives is to enhance patient empowerment, although, as we discovered, there is plenty being done to incorporate digital technology into the work of healthcare professionals as well.
Mr Henry began by explaining the context in which this digitisation is taking place and why it is so necessary. He reminded the audience that that the NHS is the biggest employer in the UK, and the fifth largest in the world, with around 1.7 million staff members.1 He then outlined the UK’s changing societal demographic, with the number of people >60 years old expected to exceed 20 million by 2030, and the number >85 year-olds projected to double in the next 23 years.2 This will have major implications for the provision of care in the NHS, and Mr Henry stated that there are already increases in chronic conditions that have to be treated, and in total, those over the age of 65 years are two-thirds of all patients omitted to hospital. Additionally, there has been a huge rise in lifestyle-related conditions, such as diabetes, in recent times. Unsurprisingly, there are major concerns about the ability to fund care in the future.
However, Mr Henry views digital technology as a potential means of at least easing the economic and social costs of the NHS. “We’re in a great technology-changing landscape, the mobile and technology revolution has taken abound,” he elucidated. “It seems crazy that the iPhone was only launched in 2007 and the iPad in 2010. So, what we’ve got right now is the significant evolution of technology that we should be taking advantage of in health and care.”
He pointed out that there appears to be much scope for incorporating health technologies to enable the general population to better manage their own health. Smartphone use is vast, with 85% of the UK population estimated to own a smartphone,3 and the NHS estimate that 65% of these people have apps that use some form of machine learning.
Changing Patient Behaviour
Mr Henry also explained the changing nature of patient behaviour; rather than simply making an appointment to see a general practitioner, many now use the internet to find out more information about their ailment before deciding whether to make a trip to the doctors. The NHS are taking this emerging phenomenon into account; the NHS Choices website provides detailed and reliable information about all medical conditions and receives around 48 million visits per month. “So, what we’re seeing right now is real change and reliance on digital technology,” he commented. “We’re all using technology now in our everyday lives: banking, shopping, travel etc. And health is no different, although a bit behind the curve I would say. But it’s becoming the norm.”
Greater Technological Utilisation
There has also been greater use of digital technology in the administration of patient care in recent years. For example, an increasing proportion of referrals from general practitioners to hospitals is undertaken electronically. NHS Digital have a service called Spine, which joins together >23,000 healthcare IT systems in 20,500 organisations and is at the centre of transporting information about every individual that has entered the healthcare setting.4
Despite this, Mr Henry emphasised that health is still quite a long way behind other industries in this respect, and NHS Digital is working on long-term plans to transform the delivery of healthcare. A major vision is to enable patients to take responsibility for their own care, in a manner akin to the way people manage their bank accounts. Additionally, they want to support clinicians, particularly through sharing information more quickly and easily, and also enable more effective organisational management throughout the vast number of bodies that make up the NHS. He went on to describe some of the innovations they had brought in and are working on in this respect.
One of these has been the creation of an app library.5 This assesses and recommends health apps to help guide people make the right choice for them. “There’s 165,000 health-related apps available on various platforms,” explained Mr Henry. “So, choosing one of those, which ones are appropriate and of good quality, is quite difficult.” He acknowledged that this is potentially an effective way of preventing conditions occurring, as well as helping people better manage their conditions themselves.
He also informed the audience of the broadening scope of the NHS Choices website, becoming NHS.uk. This falls very much into line with the aim of giving patients the opportunity to manage and take control of their own health and care. “We’re focussing quite predominantly on evolving NHS Choices into NHS.uk, and really created a single channel for entry so individuals can not only read and see information around symptoms, medicines, and the rest, but actually be able to interact with health and care: create your own appointments, look at your own medical records, and also, very importantly, be able to set your own preferences on how and what your data can be used for,” he outlined. “There’s some great opportunities but we’ve got to be sure that we’re clear to the public on what we can and will do with that data, because data is the oil in delivering health and care in the future. That, and a lot of other things in there, will assist in empowering patients to take more care of themselves and become the CEO of their own health.”
In regard to clinicians, there is a focus on utilising the opportunities that are offered by the advances in technologies such as artificial intelligence and machine in supporting their decision-making capabilities. One example of this is the partnership between Moorfields Eye Hospital and Deepmind Health to improve the speed and accuracy of eye condition diagnoses.7
Communication is another area that could benefit from the greater use of digital technologies, with methods such as sending letters and faxes still commonplace between health professionals. This can lead to diagnosis and subsequently treatment initiation taking longer than necessary. He gave an example of a Skype pilot in the neurology department of the Royal Free Hospital. This enabled a neurologist to get a second opinion before making a diagnosis, subsequently being able to inform the patient instantaneously. “Using Skype, we had a neurologist available at all times,” he explained. “So, we shortened the decision-making span from what could have been 3–5 days, with the resulting anxiety of that, to 20 minutes, and the impact that had on both the patient and the people providing the service, was huge.”
Mr Henry concluded that in the 70th year of the existence of the NHS, it is vital to reflect on the achievements and advancements that have been made by this organisation. Although the NHS is not always associated with innovation, he pointed out that numerous technological breakthroughs have occurred within this unique organisation. “There’s things that we take for granted now; for example, a GP patient record was first introduced in 1975. There’s no nurse or doctor right now who doesn’t work with an electronic record, and there’s magnetic resonance imaging scans (introduced into the NHS in 1980). We’ve been introducing technology in health for many years and I think we’ll continue to do so. And now we’ve got a greater potential to do it at a greater speed and scale than ever before,” he commented.
“Unleash the Data”
Nevertheless, there is still plenty to do in this regard. While there are increasing online services being offered by the NHS, a sizeable portion of the population are not utilising it in the way they do in other sectors, such as banking. He outlined that the NHS must collaborate more with others, including academics and private companies, to continue progress in this direction. Mr Henry reiterated that data are the key (the “oil”, as he terms it) to ensuring the vision of patient control and responsibility for their health and care a reality. He added: “We need to unleash the data and improve the way that healthcare professionals access information and data to improve health and care. And we need to ensure we embed public trust in the use of data, so in terms of cyber security and, also what it is going to mean for an individual about using their data, either in research and/or for the general improvement of services and giving individuals the opportunity to opt out of having data used easily without having to write several letters to several people.”
It was fascinating listening to Mr Henry talk about the work of NHS Digital and their aims for the future. There are many well-documented challenges facing the NHS as we head into 70th anniversary since the institution was first established by Nye Bevan. Implementing the use of digital technologies appears to be one way of combatting the problems brought on by an ageing population and more lifestyle-related diseases, and we look forward to seeing how these continue to develop in the future.
- Nuffield Trust. The NHS workforce in numbers. 2018. Available at: https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers. Last accessed: 15 June 2018.
- AGE UK. Later Life in the United Kingdom. 2018. Available at: https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf. Last accessed: 15 June 2018.
- Consultancy.uk. UK smartphone penetration continues to rise to 85% of adult population. 2017. Available at: https://www.consultancy.uk/news/14113/uk-smartphone-penetration-continues-to-rise-to-85-of-adult-population. Last accessed: 15 June 2018.
- NHS Digital. Spine. Available at: https://digital.nhs.uk/services/spine. Last accessed: 15 June 2018.
- NHS. Find digital tools to help you manage and improve your health. Available at: https://apps.beta.nhs.uk/. Last accessed: 15 June 2018.
- NHS England. A&E Attendances and Emergency Admissions December 2017 Statistical Commentary. 2017. Available at: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2018/01/Statistical-commentary-December-2017-11Jys.pdf. Last accessed: 15 June 2018.
- Moorfields Eye Hospital. DeepMind Health research partnership. Available at: https://www.moorfields.nhs.uk/landing-page/deepmind-health-research-partnership. Last accessed: 15 June 2018.