This morning, I got a letter from my doctor. I’m perfectly well, so it was a bit of a surprise to receive. The letter said (I paraphrase) that he hadn’t seen me for a while and he was wondering how I was getting on, that he knew I was busy and so if I preferred having a chat on the phone that would be fine. This has never happened to me before and asking around the team, it doesn’t seem to have happened to any of my colleagues either. Is this a new approach to preventing illness rather than just curing it? As it happened on the same day as the NHS’s Long-Term Plan, it definitely got me thinking about the importance of prevention and personalised care, and the role both digital and community support can play in this.
The Long Term Plan really resonated with me. It’s great to see the level of ambition and the focus on digital, prevention and community. It’s really well thought through, it’s clear, and it should help to save lives. It has also made me realise (again) just how lucky we are to have a world class health service that’s free at the point of use. All praise for the NHS.
There are three big things that jumped out at me from the Plan: digital, prevention and community.
Digital, Prevention, Community
Digital, prevention, and community have been cornerstones of our approach over the last decade. We believe in a world where everyone benefits from digital, so it’s not surprising this is central to the work we do. And we achieve this through a movement of community-based organisations across the country who can tailor support based on the needs of the people they’re helping. By doing this, we are helping to prevent a range of issues – from loneliness through to mental health issues, poverty and a lack of skills. We’re preventing people from becoming even more excluded. I’m pleased that the NHS is recognising the importance and value of both digital and community, and the crucial role they can play in the prevention of illness.
Opportunities and risks
There is no doubt that digital technology offers huge opportunities to improve health and healthcare in the UK. But there is a word of warning to those who are hoping to build a digital-first service – and there are some hard lessons to be learned from the digitalisation of Universal Credit as we build a ‘digital first’ NHS.
The plan states that the NHS will ensure technologies work for everyone including people who are the most ‘technology averse’. But this is no simple feat. Digital First is a great ambition as long as it’s for everybody. Understanding and building services for those with no or very low digital skills is a huge challenge – but one that must be met in order to ensure that this ambitious plan can be realised.
A digital NHS for everybody
There are 11.3m people in the UK who do not have basic online skills such as being able to search for information, fill out a form or send an email. These people are more likely to be older, poorer and living with disabilities, to be at risk of conditions like type 2 diabetes, depression and anxiety, and so it follows that they are more likely to need health services and support.
Our research shows that there is a complex set of digital and social barriers to people engaging with and using digital technology. Factors such as poverty, low literacy levels, lack of basic English skills, poor mental health and low confidence and self-esteem can all play a part. I want these people to enjoy a great health service and better health, as well as people like me who know how to navigate the health services I need (although my GP preferred letters and a chat over the phone.
The good news for Matt Hancock is that we’re here to help. I hope 2019 is the year that we can do just that, helping Matt, Simon Stevens, and their team to understand how to join up the hyperlocal informal health ecosystem and the formal work of the NHS. We really think we’ve discovered a way to blend the very human-centred support (offline) with the great online and offline formal support on offer from the NHS. Through our delivery of the NHS Widening Digital Participation Programme, working in partnership with local health systems, community and voluntary sector partners and national partners, we have been learning about the potential of technology to create the conditions where people feel more empowered to manage and improve their health and wellbeing and to access services where and when they need them.
Prevention in the community
It’s not just the NHS that has a role in helping people to find their own journey to better health and to avoiding potential health issues. We work with thousands of community partners, in some of the most disadvantaged areas of the country, who are helping these people every day. Often this is about partnerships between the NHS and local community partners. Simon Harris, for example, has lost weight and reduced his blood sugar level by developing his digital confidence after being diagnosed with type 2 diabetes.
In the first phase of our NHS Widening Digital Participation Programme (2013-2016) over 221,000 people were supported to go online and use digital health resources saving over £6m for the NHS in just one year and just by shifting the channel they used away from more expensive NHS support to the cheaper and more appropriate support channel – which might be online or the local pharmacist.
Over the last 18 months, we have supported a range of innovative pathfinders across the country, testing new ways of enabling some of the most excluded groups in our society to benefit from digital health resources. All the findings are available on our Digital Health Lab site.
We worked with Stoke CCG to explore using social media to increase the uptake of breast cancer screening where early detection can significantly improve outcomes. The results saw a 13% increase in uptake of screenings in a deprived area, against a declining national trend.
We supported Nailsea Town Council to bring digital health to the high street developing a high street digital health hub – connecting people with each other and with the digital resources they need to live well. One man living with dementia was able to learn how to use Skype to communicate with his family. As he was able to read visual signs, this was a much more successful way of communicating.
In Hastings, we worked with the Seaview Project and their partners to enable people who are sleeping rough to access the health services and information they need – resulting in a whole range of positive results which will have a preventative impact in the long term, including improving eating habits to help prevent diabetes to learning how to take blood pressure medication correctly.
The learnings from NHS Widening Digital Participation, and our wider digital and social inclusion programmes, show us that to fully harness the potential of a ‘digital first’ NHS for the most socially and digitally excluded people in our society, approaches to lifting barriers need to be person-centred, community-based and enabled through trusted relationships.
Launching the next five pathfinders
We are pleased to announce that in the next 18 months we will be spreading this hyperlocal digital health hub model in five more local health and care systems across the country;
North West London, Liverpool, Middlesbrough, Staffordshire, Blackburn.
We’ll be stress testing what we’ve learned in other areas to see if this digital health hub model could be replicated and scaled up. There will be more news on our Digital Health Lab as these hyperlocal pathfinders get underway.
Better health for everyone: digital, prevention, community
So well done Matt, Simon and your hard-working teams. Well done for delivering a world-class health service every day for all of us. Well done for a great Ten Year Plan. Well done for consulting with people outside the NHS. But, I think you can do better. Let’s work for a truly hyperlocal health system that joins up informal and formal support – both locally and nationally – to help us build a digital health service, run by the NHS with the community. That will really be a world-class health system that works for everyone.