Published by David Champeaux on 26 May 2016
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- The Reformer Blog
26 May 2016
Over the weekend, Andrew Marr pressed Simon Stevens on progress of the NHS’s efficiency programme. The Chief Executive of NHS England sounded confident the health service would meet its ambitious targets, but the initial signs do not look promising. Of the £15 billion of local efficiencies that need to be generated by 2020-21, only £1 billion has been secured. If a step-change in productivity isn’t delivered, the health service will be faced with a £22 billion black hole by the end of the Parliament.
One plank of the efficiency plan published by NHS England in 2014 concerned ‘patient activation’. Ever since the Wanless review, the health service has emphasised the gains that could be delivered by engaging patients in their own health. As Reform reported last year, those with low health literacy have poorer health, go to hospital more frequently and are less likely to use preventative services.
By helping consumers stay healthy and encouraging effective self-care, mobile tools are seen as a vehicle through which the NHS can unlock the gains of patient engagement. Diabetics are now using wearables to track their glucose levels instead of the traditional finger prick. Apps are helping asthmatics better understand and monitor their condition.
The good news is that consumers are increasingly taking advantage of digital health products. Data from Accenture indicates the number of consumers using health apps doubled between 2014 and 2016; for wearables, usage tripled. Less positive is the fact that under half of users willing to share their data with clinicians end up doing so. This is limiting the value of digital products, particularly for those with chronic conditions. Access to user generated data will give clinicians a better sense of how patients are doing between consultations and enrich conversations about managing symptoms.
This soon may change. Since March 2016, patients have had access to their full, uncoded health record. As today’s report The future of public services: digital patients argues, this seemingly innocuous development might fundamentally change the patient-clinician relationship. With permission from their GP, patients will have the ability to upload user-generated data directly onto their health record. According to Beverley Bryant, Director of Digital Technology at the NHS, this mechanism might become the de facto way of interacting with the health service.
To deliver this vision, the NHS will need to overcome a series of challenges. The clinical community is divided on the question of whether digital products will save the health service money. This scepticism is problematic. The Scottish Government recently recognised the critical role clinical leadership plays in the adoption of technology. In Australia, a digital health record programme underperformed in part because government did not consult sufficiently with the clinical community.
A connected problem is knowing which products have genuine clinical value and which do not. The NHS has adopted a series of ‘command and control’ approaches to quality assuring apps and wearables, but this runs against the current direction of travel. The Faculty of 1,000 group gives biomedical researchers the ability to publish academic articles provided a few minimum standards are met, but whether any given article is taken seriously depends on the quantity and quality of peer reviews. With a rapid, transparent and accountable feedback loop, applying this approach to the health market may attract greater public trust than the current ‘kitemarking’ model.
William Mosseri-Marlio, Researcher, Reform