It's crept up on us

 You may not have noticed. Think about it.

You need some cash; you pop to a machine in the high street, poke your card into the slot and instantly they know who you are and how much money you’ve got and they give you some of it. Take a flight; go online, figure out the time that suits you, book it, print out the ticket, go to the airport, get another ticket from a machine, park the car, check yourself in – job done. Go shopping? Pick up your own groceries and use the self-checkout.

Suddenly, bank clerks, travel agents, parking attendants and checkout assistants are as useful as lamplighters and watchwinders. What happened? 

Well, I can tell you. In industry, they are using a strategy that will be anathema to the NHS. A phrase that is almost blasphemous and may only be barely whispered in the vaulted corridors of the health service. In a National Health Service industry that is committed, dedicated and devoted to doing more for patients to improve their journey and experience, industry is going in the opposite direction.

Industry's new phrase? I'll tell you, but if you are of a nervous disposition, read no more. Here it is – 'How can the customer add value to the business?' Ooh ouch! In plain English – how can we get the customer to do what we used to do? How can we get the customer to manage and collect their own money; arrange their travel and print their own tickets; select, pack and pay for their own shopping?

The reason for this question? Well, it’s obvious, isn’t it? No retailer can afford a 'buy one get one free' offer and a shop full of shop assistants. Airlines simply can't afford budget travel and ground crew, travel agents’ fees and commissions. Banks want us online not on the high street, where rents, rates and utility costs make it impossible to give us free banking.

And, do you know what – I like it. I like not having to queue in the bank to get my cash and I like sorting out my own itinerary and I sure love speeding through the supermarket avoiding the woman with a groaning trolley. I can customise my shopping and tailor the experience. I feel like I am in charge.

The NHS? Well, The King's Fund's very own finance guru, John Appleby, has warned us about funding prospects for the service after 2015. More cash savings and perhaps not even ringfenced funding. The NHS will be forced into changing its ways by the economy (stupid)…

Pressures on budgets, costs and staffing suddenly take us into the world where we have to ask – how can we get patients to add value to their health care?

Every year in October I travel to the frozen wasteland that is Dusseldorf, to Medica, the world's biggest exhibition of medical devices. Everything you need to equip a hospital is there. And everything you need to maintain an elderly person safely in their own home or a patient with a long-term condition is there: peak-flow meters that connect with an iPhone and can send the results around the world to the best consultant, or across town to the asthma nurse or call centre; urine test paper that can be photographed by a mobile phone and whizzed for analysis to… well anyone, anywhere; apps for Blackberry and Apple that create new salad days for care and make hospitals history.

I think it is only a matter of time before the public starts to say; 'Why do I have to queue on the phone to get an appointment with my GP?' 'Tell me why I have to have a day off to speak to someone I can talk to on Skype from my desk?' 'Why can't I use near-patient testing and the technologies I take for granted in the real world outside the NHS?'

My mother is 93 years old and has an iPad. She wants to know why she can’t FaceTime the practice nurse. So do I.

Roy Lilley is an independent health policy analyst, writer, broadcaster and commentator on health and social issues.


#40221 Claire Medd
Clinical Director
Intel-GE Care Innovations

We’re already seeing this trend underway in the thousands of mobile apps developed around healthcare and fitness. The next step is to find a way to integrate this data into the larger healthcare decision-making process. This convergence will be the trend of the future, and the best part about it is that both sides benefit. Consumers become more active participants in their own care, and providers have a new set of data and information to better inform decisions. We should all be demanding this shift towards care that can be delivered outside of the four walls of the hospital.

For those who may have more difficulty actively engaging and making decisions about their healthcare, there are two ways to address this. First, newer telehealth solutions such as the Intel-GE Care Innovations Guide are built around patient engagement and behaviour change principles, to provide an easy way for people to become engaged with their own healthcare. And second, we must utilize technology to better engage other members of the care team like the family caregiver. Giving the family caregiver the tools to access care information and services is essential, as they are often the very centre of the care team.

#40223 Tim Benson
Routine Health Outcomes Ltd

Hit the bulls eye! This where Tim Kelsey's mantra about patient participation is right on too. Patients want to help themselves not just suffer patiently in the queue. The main problem lies with the culture that sees the NHS as one of the last bastions of guaranteed job security.

#40224 Richard Grimes

I have had type 1 diabetes for 37 years. In that time the treatment has changed significantly.

When I was first sent home from the hospital, at the age of 11, I had been taught to inject an orange using a glass syringe and *re-usable* needles. I had been taught to put five drops of urine and ten drops of water in a test tube, drop a caustic soda tablet into it, wait for the fizz and then find out from a colour chart the proportion of my urine that was sugar (frequently it was 2%). I used bovine insulin, and the combination of this, and the blunt needles meant that the fat (where I was supposed to inject) disappeared from my legs. I still have scar tissue on my legs from those injections.

A lot has changed since then (don't for a second believe any politician who says that we have not got a modernised NHS). I have an insulin pen, *sharp* needles! I have blood sugar sticks and a glucose monitor. I also have a pile of pills every day to control cholesterol, hypertension and to protect my kidneys.

But one thing has not changed since then: I still manage my diabetes, I am *still* the main carer of my condition.

In total, I see a clinician for my diabetes about one hour every year. (Two 20min hospital consultant appointments, two 10min GP - well, practice nurse - appointments.) That's one out of half a million hours in every year. I have had 37 years of adding value to my condition, and this has not, and will not change.

Don't reach for telehealth as a magic solution: it will not "add value". In fact, if you remote my blood sugar readings to my doctor you will be removing my independence - exactly the opposite of what you want - and it will persuade me *not* to do blood tests. I am no Luddite (in fact, I am a software developer, an early adopter of technology) and I like the technology that is helping me to manage my condition during the half a million hours a year the NHS leaves me to treat my diabetes. But don't remove control from me, don't tell me that a remote clinician will now control my diabetes.

Finally, a question for you. In 37 years what was the innovation that improved my diabetes the most, and made it easier for me to treat it? Human insulin? Analogue insulin? BM sticks, blood sugar meters? Insulin pens? Telephone access 8-5, 5 days a week to a diabetic specialist nurse at my local hospital? Lots of clinicians will argue over one or other of these as being the best innovation in the last 40 years, and they will all be wrong.

The innovation that made the biggest impact in the treatment of my diabetes was a change of government policy. It was when the tight-fisted Conservative government in the 80s *finally* decided to allow me to have disposable *sharp!* needles on prescription. Finally, it was not (literally) a pain to inject, and I no longer had the scar tissue and loss of fat on my legs, so the insulin could be absorbed and be effective.

One thing a career in software engineering has taught me is that sometimes the simplest solutions are more likely to provide the best solution, and be the most cost effective.

#40225 Loy Lobo
Director of Strategy and Innovation
BT Global Health

Roy asks why can’t we see our doctor online? The NHS is capable of providing that service today - much of the underlying technical infrastructure is already in place to support it. Take N3 – the national broadband network – which is already enabling clinicians to remotely diagnose patients. Imagine if we could find a doctor to consult online, just as we find friends to chat with. The technology is there to allow people to do this, safely and securely. The doctor will see you now.

#40226 David Doherty
mHealth Symposium, eHealth Week

Hi Roy,

Very wise words and thank you for sharing them.

We're bringing together best practice in this area from around Europe as part of the mHealth Symposium during the European eHealth Week in May (organised by HIMSS in Dublin).

The objective is to help the key decision makers in the European healthcare industry learn how they can implement systems that leverage the consumer technologies that Patients and their Carers take for granted in the real world outside their state healthcare systems.

The entire event will be video recorded and shared on YouTube. For more info visit:

#40230 MarK Norbury
Chief Exec
Chelsea and Westminster Health Charity

Great piece and commentary. This has to be the way forward, as is already demonstrated in many projects and services already underway.

Richard's remarks about not getting too caught up in the ICT, and keeping the patient's needs and aspirations at the heart of innovation design and implementation are key. We do not need more Medica showcases, we need more patient forums/workshops where patients design services based on existing technologies with industry and clinician support/enabling.

Also, we do not need big top-down innovation, we need lots of small-scale innovation and experimentation, where we can fail and learn fast. Is there a platform or forum for this does anyone know?

#40231 Peter Hope

Roy, email this to your mother:

"Social media sites cannot guarantee confidentiality whatever privacy settings are in place".

"You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else".

Doctors’ use of social media
GMC Guidance to Doctors March 2013

#40232 loy.lobo
Director of Strategy and Innovation
BT Global Health
Agree with Mark Norbury's post. The tech can help, but only so much. We need a greater willingness to use the stuff that already exists in novel ways. Simple things can make a big difference. A hospital started using audio conferencing to improve its processes for safe discharge of patients. Communication and coordination between the various teams is better. The quality and safety of the discharge process has improved. And over two years they saved more than £300,000 - fifty times the cost of the system. Simple solution. Big impact.
#40233 Roz Davies

Well said Roy!

DIgital technology is a fantastic tool to help co-create health services and products which put me as a patient/consumer in control of my health.

From connecting with people like me across country boundaries e.g. abcdeurope.ning to measuring my vital signs e.g. to students learning together e.g. teeth and volunteering not forgetting the power of electronic and personal health records and telehealth/telecare I look forward to the next few years if we can truly unlock the full potential of digital technology to create the conditions for a more empowered and therefore healthier patient!

I think government, think tanks and those with knowledge and decision making power do have a responsibility though to ensure that the digital revolution does not create greater health inequalities which could become the unintended consequence of these developments.

Key will be building offline community confidence and capacity and co-creating products and services, I.e. putting patients at the heart of developments!

(Made me smile to think that Roy is very much in tune with Tim Kelsey on this one)

#40236 Harry Longman
Chief Executive
Patient Access Ltd

Thought provoking. Technology is going to change things and health has a long way to catch up. Some of it will be technology push (until last year I didn't know I needed an iPad. Now I can't do without it), more of it will be pull (how can I do what I need to do, with some new technology). The key for me is what is the best, fastest simplest way to do the job, and technology is the means to the end. The telephone, 137 years old, has been underused in medicine and is now at last being recognised by GPs and patients as appropriate for so much work. There will be more, email and everything else. But let's think about what is appropriate, not technology for its own sake. Very often a relationship is central to health care, GP-patient for example. Patients need someone they can trust, especially when needs are complex. So how can the technology not replace that but enhance it? Make the relationship easier to manage, more accessible, and lower cost too. And let's not ask computers to do what humans do better.

#40239 A. Patient

The writer has forgotten that many people already do get first line medical advice online... it 's called NHS direct and many people use it instead of troubling their doctors. It is a really good 365 x 24hr service so it often is better than your doctor - if you need quick advice for yourself or children If you need to talk to clinical staff they will call you back. But there are (obvious) times when you really need a doctor to assess your state. Only face to face makes sense (I am assuming that most surgeries let you do your own bp and hr rates on a walk in basis.) We can book our doctors online and get repeat prescriptions online. Our NHS is wonderful but I despair of its management. It needs some greater element of rationalisation and rationing - not the dismantlement that the superannuated gurus are urging us to embrace. For example, if we introduced a twenty pound appointment charge for adults under 65 then it would decongest the waiting rooms of the worried well. They charge a small fee like this in other countries (France) with national systems. You could exempt all those who don't pay for prescriptions from the charge. That would do more to boost efficiency than any heap of IPAD or IPhones . Patients pay for prescriptions and paying a booking fee to see a doctor need mean the end of the NHS. Efficiency is the real issue... technology is just a tool.

#40240 David Doherty
mHealth Symposium, eHealth Week

@Peter Hope Doctor NHS

"Roy, email this to your mother: "Social media sites cannot guarantee confidentiality whatever privacy settings are in place". "You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else".

Peer-to-peer Skype or Facetime video calls aren't considered to be "social media" which is a term used to describe interactions that are intended to be shared with communities and networks.

I don't think the GMC regards Skype/Facetime to be Social Media but the guidance document is very vague and could well be improved with insights like yours.

BTW where's the declaration of your "financial or commercial interests in healthcare organisations or pharmaceutical and biomedical companies"??? ;)

#40241 Anna Betz
lead practitioner in dementia, holistic health practitioner, commons builder
School of Commoning, NHS, Living Medicine

Thanks to the introduction of technology that empowers people, the whole healthcare system will become naturally more decentralised and move out of hospitals into the community. Whether it becomes more democratic will depend on all of us.
If it is just seen as cheaper way of delivering healthcare then it will not achieve its potential. We need a new a governance system that enables true participation and new technologies are ideal to enable that.
" It suddenly appears to be ‘‘practical’’ and
attractive when governments can offload service
delivery to nongovernmental organizations
(NGOs) and community groups or convince
local residents to donate volunteer labor or
materials. The direct involvement of citizens
and societal groups in the core functions of
government continues to be extremely rare."

The role of experts will need to change from being prescribers for passive consumers to becoming caring professionals that
know how to interpret the data that patients share with them, that can answer questions and signpost patients to online as well as offline networks where they can get support for what they need as well as share data that could help others who are in similar situations.

NESTA has just published their proposal for a Health Knowledge Commons here:
It has huge potential providing there will be the necessary support for behavioural and culture change.
The commons provides an empowering framework for civil society to not only co-produce but also co-govern the resources we co-create for our health and wellbeing. With the wise use of technology that can integrate our learning and advance knowledge and research so much faster we also need to develop new governance models that enable participation, transparency and openness. The vast amount of knowledge and data that will be generated with the help of new technology will only advance the wellbeing of all of us if harvested, organised and managed wisely by those who produce it. For example, we could start with hosting this conversation which would include harvesting the most valuable insights, summarising important points and making them available to a wider audience that may benefit from it and develop it further. Any volunteers?

#40243 Dr Colin Browne
Retired GP

Great discussion as usual. A few thoughts. As a patient I want to have access to all of these and be able to choose which one is appropriate for a particular problem. Texting or online access, eg prescriptions and advice, is adequate for most things. Facetime is great for the non-verbal communication it allows.

I usually know who is best to give me advice - consultant, nurse or GP - for ongoing care but i can only contact my nurse or GP at present.

Now care and compassion comes in and I want more direct contact and assistance for people who can meet my increasing needs. If I am at home i do not want to become isolated. If I am admitted I want to communicate with my famiiy by text. phone and iPad. Can I do that and will I be able to have my trusty iPad recharged?

#40244 Rebecca Matthews
Organisational Development
Ashford and St. Peter's Hospitals NHS Foundation Trust

Thanks Roy for a thought provoking piece picking up on the vitally important and highly relevant theme around patient empowerment. The possibility for patients to manage their own care is certainly appealing. I don't think it's necessary to detail the reasons why (we all know them!), but suspect that the as NHS evolves so that patients are taking greater personal responsibility for their own care, it will be necessary to highlight messages around the benefits for patients in this.

I'm in my early twenties, and for an NHS which the 21st century does sometimes seem to have taken by surprise, I'm excited by this type of forward thinking. I suppose we need to be mindful of the supporting framework though.

The CIPD's recent blog on "leaders' lack of social media savvy" exemplifies, I think, the readiness of organisations to allow available technologies to launch them into the future. I see colleagues - perhaps a generation ahead of me - uncomfortable with basics of technology. I understand it, and wonder if we need to be challenging one another to move outside of our comfort zones to enable our organisations to do the same. I think there's some work to do with our staff and our leaders.

Equally, we will need to truly empower our patients. If we are opening up to them the possibility to manage their own health, we are implicitly bestowing upon them the responsibility to manage their own health. And before we can expect them to take and handle responsibility for their own health, we need to give them the capability for managing their own health by informing, which in my view the NHS does well, but also by educating. I'm not sure we're quite there yet, but will the shift in the healthcare agenda, I feel increasingly strongly about the need to prioritise this aspect of healthcare.

With a forward thinking, appropriately skilled and trained workforce and with informed, educated patients, it seems to me that technology has a very clear place in the healthcare system and environment. Thanks again Roy for highlighting the exciting opportunities it presents to us as NHS staff and NHS patients.

#40245 Simon Denegri
National Director for Public Participation and Engagement in Research

Great blog.

Three cheers for urging health and social care to becoming more responsive to people's needs, and more inclusive as a system.

No cheers for the drawing of comparisons from banking (in crisis and customer complaints rising) and online shopping (many are loss-making ventures). We can do better. We can also do better than these at accountability and responsibility because of our 'public' foundation.

#40247 John Culkin

I always feel like the naysayer when i see threads like this. I'm all for expanding the use of digital, and it can (and hopefully will) improve services for many but i think an element of realism is needed too. The fact is that for the next decade or so, a very large chunk of NHS users will not be using digital channels at all.

According to ipsos MORI "47% of 65+ age group have no internet access or can access internet but never do"*

What proportion of NHS resources in the next 20 years will be used by people who are already over 65 today? Quite high I reckon - 70%? Higher? Baby-boomers remember...

And what proportion of those over 65 today who don't use the internet today are likely to start doing so as they get older and their health fails? Not many?

The frail elderly are already "seldom heard" - they don;t speak up, they don't complain or go online to give feedback. Kudos to your 93 yr old Mother and her Ipad Roy, but she's probably not typical.

How can we make sure that we don't exclude this group further as we spread the use of digital?


#40248 Colin Burton
Service Planning Analyst
University hospital Southampton NHS FT

There are many ways of tackling this issue. We are piloting a system that allows on-line interaction and monitoring in a rather more structured and secure way than "Social Media" and lets the control of information remain with the patient.

UHS has worked with the Microsoft HealthVault platform to create My health record™ - a link between health services and a patient owned record.

My health record™ will allow patients to use a single login to access any service capable of connecting to the HealthVault platform. This unique concept does not require individual organisations to have their own store of information for the patient held record, as this data will be held by the patient in their HealthVault account. Patients can choose who to share their information with, whether that be family members or other health organisations.

UHS will use this connection to provide a better service, giving patients more control over their healthcare and care plans. It will also contribute to the remote management of many conditions, cutting out unnecessary visits to the hospital.

this link is to a video on U-Tube

Published on Sep 27, 2012

UHS has worked with the Microsoft HealthVault platform to create My health record™ - a link between health services and a patient owned record.

My health record™ will allow patients to use a single login to access any service capable of connecting to the HealthVault platform. This unique concept does not require individual organisations to have their own store of information for the patient held record, as this data will be held by the patient in their HealthVault account. Patients can choose who to share their information with, whether that be family members or other health organisations.

UHS will use this connection to provide a better service, giving patients more control over their healthcare and care plans. It will also contribute to the remote management of many conditions, cutting out unnecessary visits to the hospital.

#40249 Huw Jones

Technology can enable the required transformation. Information Governance is important but by what right does a Clinician govern how and when I share my data and with whom. Clinicians do not own data about me or my care,neither are they the subject of the data. Increasingly service users need to take control of these debates.

#40250 mikelaunce

Why travel to Dusseldorf? Surely you such visit the show virtually?

#40252 Colin Sloane
Service User

Can't agree more about the need to be realistic about the use of e technology and its use by the over 65 's. add to that a proportion of NHS users who are unable to interact in that way for a variety of reasons including, People with learning disabilities, dementia, other long term conditions that affect ability to engage in this way.

I believe technology is the way forward and we should develop it and embrace it but not at the cost of creating wider inequalities. There are cost savings to be made by encouraging our younger generations to interact with the health service through the use of technology. These cost savings need to be invested into the care of the over 65 's/elderly to ensure they receive a good quality patient centred service to suit their needs.

#40253 Ileana Welte
Director, Bosch Healthcare UK
Connecting Communities

I am heartened to read that Roy’s grandmother, at the age of 93, is a fully engaged member of the technological community; and she would be right to ask why she cannot FaceTime her nurse. In recent discussions that I have been a part of, through the Connecting Communities campaign (, it has become increasingly clear to me that the way we will build demand for more efficient and practical use of technology in health and social care will be from the ground up. Government can help open the door, or nurture the environment for its uptake – but ultimately it cannot be mandated through diktat.

We need more Grandma Lilley’s to help us in industry understand where the demand is.

#40254 Tim Benson
Routine Health Outcomes Ltd

One place where many of these ideas could usefully be tested is in care homes. Care homes have many of the most vulnerable people, including many with dementia, but they also have many care workers to support them, who unfortunately are usually paid rather poorly. In one way care homes are extremely challenging locations in which to introduce technology, but on the other hand they are much simpler than acute hospitals. We will probably discover that simple touch screen technology (such as tablets) can in fact be used successfully in care homes, provided that the apps are designed specifically for these users.

#40255 Julia Oakley

I am so hopeful about the possibility of increasing technology use in this way. Of course care needs to be taken not to create further inequality and to protect privacy, but the current system creates a devastating inequality for those of us who are totally housebound.

For us, it is often impossible to access secondary care at all, meaning that potentially treatable problems go uninvestigated and untreated.

Proper use of technology could enable access to expertise currently denied. It could quite literally save lives.

#40256 Laura Quirke
Marketing and Communications Manager
NHS London Procurement Partnership

We recently surveyed public sector organisations (not only NHS) to see what the likely uptake of tablet technology (regardless of purpose) would be in the next year. Fewer than 15 organisations responded so I don't think you'll see much change in the immediate future.

#40257 June Girvin
PVC and Dean Faculty of Health and Social Care,
Oxford Brookes University

in response to Dr Colin Brown - you can do this already as an in patient. My husband was hospitalised recently for more than two weeks. He had his IPhone, iPad and charger, I provided him with a wifi dongle and we could be in constant communication. He could also keep in touch with his friends and work colleagues and the rest of our extended family. I never had to ring the ward in the morning and wait for someone to tell me he 'oh he's fine, he's sitting out of bed' (like that means anything to a worried relative), I could call him, or text him, or email him and find out for myself. He could entertain himself when he had no visitors by texting and tweeting and when he didn't want to be disturbed by other patients he could plug in his earphones and listen to Thomas Tallis. It made a huge difference to what was otherwise a very distressing experience.

#40259 Sharuna

We talk about technology revolutionising healthcare really...I am sure that I was reading that the recent evaluation of tele-health was that it was not cost effective. What about clinicians having the skills to actually talk to patients co- creating solutions , having generative conversations being human believing that patients are active recipients- not convinced technology will shift this mind set. It's the quality of the communication and interaction, then creating more digital dependency and demands. Great to hear your comment Anna Betz ..! Will contact you. Sharuna

#40260 Sharuna

Oops meant active participants of care! Sharuna

#40261 Andrew O'Hara
Gael Ltd

The benefits of telehealth to both the service and its users shouldn't be understated, but the infrastructure through which it's delivered needs to be both robust and secure.

The current shift in employment benefit to online application is an example of how such a model needs to meet the needs of both those with access to technology and those without.

In addition, safeguarding the confidentiality of patient information is vital if the NHS is to make sure that the clinician-patient relationship can be successfully maintained with regard to telehealth.

To prevent unauthorised access, corruption or inaccessibility in terms of patient information, the N3's current information security standards have to be a foundation that's continually built upon.

That or else the terms of the relationship require to be restated moving forwards to acknowledge the change in channels and the risks, as well as the requirements, involved.

#40262 Paul Rice
Head of Technology Strategy
NHS England

Roy and commentator colleagues - be absolutely delighted to have your participation in the development and delivery of the Technology Strategy for NHS England going forward. Please direct all thoughts and to me via or

#40264 Pete Hill
Chartered Environmental Health Practitioner

Excellent blog Roy particularly liked the ipad story at the end. Certainly from a Local Government point of view there are a number of reasons why technology is not used to enhance service delivery in any great way. Number one is finance many authorities have limited budgets and others are caught in outsourcing deals that mean even the simplest task costs an exorbitant rate. This usually because some outsourcing contracts can be up to 15 years, along time anywhere but a couple of centuries in terms of IT development. There is also a great reluctance to try anything new. Social Media is a great example. In my experience the majority of staff have never used it for professional purposes and are totally unaware of its power. If I had £1 for every colleague that said "I don't have Twitter and anyway it's a young persons thing." I'd be away on a paradise island with an iMac and the works of Dickens for company by now. The fact I'm taking early retirement in a couple of weeks certainly rules out the age argument. Finally reputation is a big thing in Local Government I've been told on more than one occasion "it's about protecting the brand." Social Media is seen as dangerous and complicated and the small imagined negatives always out weigh the positives in its use. Even those that do adopt it usually scare staff away with large policy and procedure documents. Quite how far we are behind other nations was summed up for me by the argument against senior council officers being given iPads it was said that it would be bad publicity for the authority if messages appeared with "sent from my iPad" on them. The fact you can alter the message to whatever you like in 10secs had completely escaped them!

#40266 Cherry

I hope during this review of technology it will be inclusive of all new communication technology to improve real time access to a personalised preferred communication support for example for deaf/Deaf/HoH service users/staff/public who require an interpreting service. In this techno savvy world we live in with new applications coming out so frequently it seems to be almost shameful that amongst choices offered have been very slow uptake of access to remote BSL and speech to text on laptops, iPhones and other items of chosen technology, there is absolutely no reason why any person cannot now be offered access to these which do meet the compliance to IG concerns.

Access awareness needs to be increased in all services on all options of communication assistance, once options are known ensure use of the registered fully qualified companies already offering this - there are several.

The importance of such technology means that for example in an emergency situation be it ambience, walk-in centres where there is no BSL interpreter, note taker, lip speaker on site the responding health professional can access immediately via their computer/iPad/iPhone etc the service of BSL interpreter if thats the first language preferred language or palantypist/stenographer who will provide speech to text in real time.
For myself as a deaf health professional now having access to a palantypist for group meetings, forums any event typing at 200 words a minute for me to see on screen exactly whats being said means at last I can FULLY engage with exactly whats being said.
If we are to fully engage with patients/service users/customers whatever term is applied to people accessing services then the mantra of 'no decision about me without me' and commitment to choice of 'no one size fits all' then we have to move forwards, welcome technology of instant real time communication as one of the options or choices to ensure for example, informed consent, means exactly that - and not guessed at.
if no one is aware of remote BSL or STTR (speech to text relay) just email me

#40267 Patrick English
Consultant Physician
Plymouth hospitals NHS Trust

Great blog. Fully agree with most of it whilst noting comments from individual living with Diabetes. To take full advantage of new technologies however we need to commit to and deliver a full electronic patient record. In an age where we share so much on line with retailers, financial institutions, "friends" on Facebook and followers on Twitter why are we so terrified of sharing medical information with health care services? As a Diabetologist we could revolutionise the way we deliver care across the population with a shared record. Deliver Skype based consults or similar, virtual clinics to multiple GP surgeries, enhanced support to nursing homes and the house bound and all at lower financial and time cost. If I am delivered unconscious to the Emergency Department I want them to know a about me. But we seem to be getting further away from this as the technology makes it ever easier to deliver. I have seen 2 or 3 goid ways of sharing records across health care boundaries in last year which already wirk. Surely we should commit to delivering this and getting regulation right, overcome scaremongering. Once achieved many of these other developments flow ever more easily.

#40270 Sarah Amani
Youth Mental Health Lead
Surrey and Borders Partnership NHS Foundation Trust

Hi Roy

Thank you for this very timely blog covering a critical topic which needs more engagement with people who use services, frontline workers, managers and commissioners.

We recently hosted the first South Coast E-Mental Health Conference on 18th March: [Video]
and had 100 people engaging with the use of technology in mental health care.

There is a real thirst for sharing the learning in how best to harness the power of technology in order to meet the challenges facing the healthcare. I welcome more dialogue and debate so that we hopefully see better use and wider adoption of technology in health.

#40271 Clive Flashman
Global Heslthcare Specialist

While there are many silver surfers out there like Roy's mother, there are others who can use basic technology like a mobile phone, and not tablets or PCs. The trick is to be able to offer a blended approach that caters for different levels of need matched to different but appropriate types of technology.

It is this segmentation or stratification that if done properly can make all the difference (in my view) to the success or failure of a patient eHealth programme.

The technology is available, but as Roy implies, it's the NHS culture that needs to change to best make use of it. If other safety critical industries like aviation can do it, then so can Healthcare, if the motivation and incentives are there.

#40273 Harry Longman
Chief Executive
Patient Access

Comments are full of enthusiasm for new technology, and so am I. But I'm also concerned that while making healthcare easier and lower cost to access for many, we don't raise barriers for some who do not have or can't use the technology. Often these are the most needy. So... needs before nerds, if you please.

#40280 George Margelis

Great discussion Roy.
However it is important to remember that the patients with greatest need are often those with the least resources or least desire to change. As a result just making access easier does not necessarily lead to greater uptake and successful implementation.
The other challenge is to ensure that there are clinical models available via the technology that can deliver health outcomes. The analogy with banking remains flawed, because banks have limited delivery models. The take money in and give money out. That can be easily automated and pushed on to the consumer. Healthcare is much more complex, so if you want to push it out to the patient you need to firstly provide them with sufficiently functional tools, and secondly ensure they have the health literacy to deliver safe high quality care. We spend a lot of time and money training clinicians to do that, we need to ensure we have a model for educating the relevant patients to also be able to provide that for themselves. If we don't then we are being negligent by replacing high quality safe care for low cost unsafe care.
Patient empowerment and engagement is a great goal, but let's not underestimate the work involved in delivering it. Its not just make the gadgets available and they will do it. It requires clinical governance, evidence based clinical models and investment in education. That should deliver the outcomes we want., but won’t be a cheap and quick solution.

#40312 Peter Kent
UK Information Projects Manager
Macmillan Cancer Support

If we are going to empower patients we need to begin by recognising that they (we) are not an homogenous group. Many of us have only occasional and brief contacts with the health service whilst others, those with long-term chronic conditions for example, have a lifelong relationship with health services. Similarly, we have differing relationships with technology and differing attitudes towards it as well. For every 92 year-old mother that has an iPad and wants “face time” with her practice nurse there is another mother (e.g. my 88 year-old mother) that wants nothing of the sort.

“Empowerment” originally had only positive connotations but now (having been inducted into the lexicon of professional jargon) can have overtones of oppression. For every empowered person liberated by the remoteness that technology can bring there will be another that risks becoming more isolated by it. A sceptic might argue that it is the bureaucrats and the profit seekers that are empowered by the use of some technologies.

If we are to genuinely empower or liberate patients, we must also recognise the diversity that exists in the population. Apart from the difference between mothers, there are the differences in culture, class, education and income. Much of the demand for empowerment and even patient choices has been driven by the white, educated middle class. This is fine and has generally been the case over many years with the middle class driving a good deal of social, economic and political change that has benefited people of all classes. However, that does not make it entirely altruistic. Ask any parent whose child did not get into their school of choice because the sharp elbowed middle class parents worked the system better than they did.

There is evidence that the people demanding empowerment through technology do so because its use enables them to spend less time in doctors’ consulting rooms and more time at work. If you are retired or unemployed, this may not be such an important consideration and having a human interaction and conversation may be more helpful. Patients that use the internet to obtain information and make informed choices about treatment, which hospitals to attend and how to manage a health disorder are more likely to be white, educated to degree level and in a professional occupation.

Finally, if we are going to empower patients we must also empower health professionals. One reason why the nurse may not do face time is because she or he may have little or no professional or even personal experience of using the technologies involved. When we piloted information prescriptions in NHS trusts we found a wide variety of equipment much of it ancient and often unavailable to nurses when they needed access to it. We also found many of them were unfamiliar with simple actions such as use of passwords and log on procedures. This was compounded by the almost hysterical risk aversion in parts of the NHS that prevents staff using the internet fully and even communicating with patients and partner organisations by email.

So by all means let’s use technology but let’s also use it intelligently. There is a risk of creating greater inequality by thoughtless use of new technology. Much as there are people that are financially poor there are people that are technologically poor (and one often accounts for the other) and many of the people will be patients with long-term multiple conditions for whom increasingly sophisticated use of technology may not be the answer.

#40319 tony.f
Cognitive Behavioural Psychotherapist

Really interesting piece by Roy, we developed our Cognitive Behavioural Therapy App due to the enormous demands placed on primary care mental health services..I work in one and now that 50% drop out before they get to see anyone. Our app is designed to be used at the "coal face" either by G.P./Psychological Well Being Practitioner or Cognitive Behavioural Therapist as it offers treatment solutions for Anxiety, Depression ,Panic and Work Stress. The demand is there from service users but professionals (imo) are running away from digital and mobile technology in fear of their careers. To sum up 25,000 downloads to date

#40326 Charlotte Davies
Lead Analyst Healthcare & Life Sciences

There's significant engagement and tech adoption from patients and organisations and professionals who are keen to exploit technology and aren't afraid of change. But capabilities and attitudes vary and always will in different segments of the healthcare sector and in patients/consumers. Hence you need Skype plus F2F plus phone for the foreseeable future and I agree that the digital divide and IT literacy is something that backs the multi-channel approach up .

Ultimately I think the biggest challenge from an IT/workflow perspective will be managing and properly using information, akin to the 'blood' flowing around the system: accuracy, relevancy, privacy and security are hugely important here. Parallel to this, the design and procurement of IT needs to change so its better built into services and workflows.

Another key question is whether the new funding reality and efficiency targets facing the NHS will actually accelerate ICT adoption and force big changes in IT procurement as organisations look to reduce costs. There's huge potential to use IT to generate cost savings, but the devil is in the detail and I think there's a significant issue of skills shortage and complexity in the new structure that will hamper this.

#40336 Mike Maynard
Executive Editor

Technology is great, but often misused. The 0845 number and voice mail being the obvious examples. It's only a local call with a connection fee and a 40 minute wait until you actually talk to someone. A quick and easy to remember number for medical advice would cut waiting times in A&E at a stroke. Standards of care are improving in hospitals mainly because they can't ban cell phones any more. Patients aren't so isolated. When I saw my consultant a few months ago, he was using his Ipad to connect to the hospital server, because it's so much quicker. Technology can only improve things is used properly.

#42352 Keith Chapman

Why cant your mum Skype the doctor - it increases workload!!!!
Those working on the frontline having been telling those not working there this for some time.
Now the evidence backs us up - Lancet Aug 4, 2014.
And GPs are already struggling - probably a good way to bring the whole system to its knees.
And why does everyone who theorises think that all those who actually do the work have an attitude problem?
This is just plain insulting. It gets us nowhere and doesn't address why the NHS doesn't adopt technology. The paper in the Lancet suggests it's because we recognise bad ideas when we see them. Not listening to those on the frontline gets you Mid-Staffordshire.

#177995 Pawan Randev

Which paper are you referring to, Keith?

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