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NHS Long-Term Plan: Prevention and saving lives through digital and in the community

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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.

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Tim Brazier, our Head of Service Design, shows residents in Nailsea how they can use digital health resources, as part of the NHS Widening Digital Participation programme

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.

Digital health skills: Reducing inequalities, improving society

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Today I’ll be at the House of Lords, launching our final report on the NHS Widening Digital Participation in Health programme.

Over the last three years of the programme, our aim has been to help people improve their digital skills, learn more about digital health, and improve their own health and wellbeing as a result. We have targeted those with least digital experience and most health needs in the heart of their communities.

With all of the challenges we currently face as a society, and with all of the pressures on the NHS, giving people digital health skills may seem like it’s not that much of a priority.

I’ll try and explain why it is.

There are 12.6 million people in the UK who don’t have basic digital skills and these people are those who are most likely to be suffering from poor health. They are also those most likely to be further disadvantaged by age, education, income, disability, or unemployment.

The fact is that there is a huge crossover between those who are digitally excluded, those who are socially excluded, and those at risk of poor health. The Widening Digital Participation programme aimed to see how action on one front could influence the others.

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Ron Dale from Inspire Communities

Ron first went into Inspire Communities – a UK online centre in Hull and one of our pathfinder centres for this programme – because he was about to be sanctioned by Jobcentre Plus for not meeting his job search commitments. Ron was homeless, had a gambling habit, as well as serious mental health issues, including anxiety and depression. He was living in a tent on the motorway, on the occasional Pot Noodle and coffee. He was often hungry and cold, and his physical and mental health were going downhill.

Part of the problem was that Ron’s relationship with his GP surgery had deteriorated, and he refused to go. With the help of Inspire Communities, he was able to look at NHS Choices for advice on managing his symptoms, and to find a new GP. He was able to register and make an appointment online without having to run the gauntlet of travel, receptionists, and other patients.

Plugging him back into the healthcare system was key in helping to connect him to the wider support he needed – and digital was key in doing this. Now he’s found new housing, taking an active role in his own healthcare, meeting his Jobcentre Plus obligations and dealing with his gambling addiction.

Digital matters. Digital health matters.

And Ron’s story isn’t just a one off. Throughout the programme, we’ve found that giving people the digital health skills they need means they’re empowered to take control of their health, improving the ongoing management of chronic health conditions, and helping them to interact better with health and social care services.

We’ve also seen how digital inclusion can improve the social determinants of health – with better digital skills improving prospects for employment, income generation, educational achievement, and social connections. 52% of participants said they felt less lonely or isolated, and 62% stated that they felt happier as a result of more social contact. More than half said they have since have gone on to use the internet to improve their mental health and wellbeing.

On top of this, the programme has also shown that improving digital health skills has the power to reduce the pressure on frontline NHS services. By helping people to move non-urgent medical queries from face-to-face and emergency channels to online ones, we found we could potentially save the NHS an estimated £6 million a year, representing a £6 return on investment for every £1 spent on the programme over the last three years.

In summary, The Widening Digital Participation programme – and the local partnerships between UK online centres and local health and care providers that it has nurtured – has been proven to drive up the quality of care and drive down both health inequalities and health costs, ultimately improving society as a whole. And that’s definitely a result worth celebrating.

You can read more about the programme and download a copy of the report here: nhs.tinderfoundation.org.

Everyone’s been at it recently…

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…talking about digital inclusion that is. Well, that’s how it’s felt after celebrating some important milestones over the past week.

In my last post I talked about the Digital Leaders Annual Lecture and following on from that I wrote a post for the Digital Leaders blog – which just so happened to coincide with the Digital Democracy debate at the House of Commons, led by Meg Hillier MP. It was also the first time the public (me included!) could use electronic devices during an MPs debate.

The Digital Democracy debate in Westminster Hall, March 2015

Fast forward a few days and it was back to Westminster, this time at the House of Lords, for a big day for the Tinder Foundation team. For the past six months we’ve been working with Vodafone UK and 17 UK online centres to research how mobile technology can contribute towards bridging that digital gap. The results of the project have formed a new report, “Mobile: Helping To Close The Digital Divide?”

I must admit (it’s something I talked about on Tuesday) when we first started working with Vodafone I was feeling pretty fed up of attending events to hear people saying that everything (digitally-speaking) was fine because “all the old people will die soon and everyone left already owns a mobile”. And I was definitely fed up of replying (or often shouting) that they were wrong.

But the project with Vodafone has reignited my enthusiasm for mobile as there have been some really great results.

The launch event for ‘Mobile: Helping To Close The Digital Divide?’, a report produced by Tinder Foundation and Vodafone UK

We thought the people taking part would find using a mobile more intuitive (and they did) – which has had a huge impact. But the health and wellbeing impacts, and the impacts for people with caring responsibilities – were a real ‘bonus’ finding. The below is only a taster; I hope you can have a read of the findings in full here. Let me know what you think by using the hashtag #digitalmobile:

  • 55% not only learnt in the UK online centre with the help of the brilliant staff there, but they also carried on learning and enjoying their mobile device at home (and 45% didn’t learn independently)
  • 88% improved their digital skills, with their motivations for using the internet also changing dramatically
  • 65% reported improvements to confidence and self-esteem.
  • Overcoming loneliness and isolation was a big gain, with 67% saying they had better and more frequent communication with friends and family.

And finally, on Wednesday we celebrated another important milestone in our Widening Digital Participation work with the NHS, where I was joined by Dr Ollie Hart. Ollie is a GP from Sloan Medical Centre in Sheffield and together with local partners in Sheffield he has been integral in referring his patients to the UK online centres “digital surgery”, run by the Heeley Development Trust.

I’ll be blogging more about the Widening Digital Participation programme soon, but in the meantime take a look at http://nhs.tinderfoundation.org/.

We’re also holding a great Tweetchat next Thursday to find out what GPs, CCGs and other health practitioners think of the Widening Digital Participation programme. You can find out more here, and so do join in if you’re interested using the hashtag #NHSWDP – we hope to see you there!

Closing the health gap using digital inclusion and data

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Today in the Guardian Online, I’ve got an article arguing that the preventative care revolution depends on closing the digital divide.

Across the UK, 11 million people have poor digital skills and half those who are offline have a disability. Digital inclusion is now a matter of life and death.

Read the article in full over on The Guardian Online