It's crept up on us

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Part of Time to Think Differently

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.

Comments

Claire Medd

Position
Clinical Director,
Organisation
Intel-GE Care Innovations
Comment date
25 March 2013
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.

Tim Benson

Position
Founder,
Organisation
Routine Health Outcomes Ltd
Comment date
25 March 2013
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.

Richard Grimes

Comment date
25 March 2013
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.

Loy Lobo

Position
Director of Strategy and Innovation,
Organisation
BT Global Health
Comment date
25 March 2013
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.

David Doherty

Position
Organiser,
Organisation
mHealth Symposium, eHealth Week
Comment date
25 March 2013
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:

http://mhealthinsight.com/mhealth-symposium/

MarK Norbury

Position
Chief Exec,
Organisation
Chelsea and Westminster Health Charity
Comment date
25 March 2013
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?

Peter Hope

Position
Doctor,
Organisation
NHS
Comment date
25 March 2013
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

loy.lobo

Position
Director of Strategy and Innovation,
Organisation
BT Global Health
Comment date
25 March 2013
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.

Roz Davies

Comment date
25 March 2013
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. scanadu.com to students learning together e.g. teeth geek.com and volunteering selfless.org.uk not forgetting the power of electronic and personal health records htmc.co.uk 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)

Harry Longman

Position
Chief Executive,
Organisation
Patient Access Ltd
Comment date
25 March 2013
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.

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