One of the founding principles of the National Health Service was to ensure that everybody —irrespective of means, age, sex, or occupation—should have equal access to the best and most up to date health and care services available. Principles of universality, equity and quality remain at its core.
Digital technology can radically improve care, transform the relationship between clinician and patient and place power in the hands of the people to take more control of their wellbeing. But universality, equity and quality must be at the heart of how we adopt, build and scale these technologies. We must ensure that no-one is left behind.
The internet touches every area of our lives: it has made things faster, cheaper and better. Three quarters of us go online every day. But the fact remains there are over twelve million people living in the UK who lack the basic digital skills to send and receive an email or browse the internet and over six million who have never been online.
The network age brings incredible opportunities for healthcare. Digital heath tools and information can make care more accessible and help people to better manage their health and avoid unnecessary GP visits and hospital admissions. But those with the most health and social care needs are often the least likely to be online. Older people, in particular, often lack computer confidence but have high health and social care needs and 33% of those with registered disabilities have never used the internet.
Digital health and care services should be designed around the needs of the hardest to reach and the least digitally skilled. If we do this they will be easy for everyone to use.
Last autumn, the NHS’ collective vision for its future, the Five Year Forward View, told us that unless we reshape care, harness technology and drive down variations in quality and safety, patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist.
Since then, the National Information Board – which brings together organisations in the NHS, public health, clinical science, social care, local government and public representatives – has been hard at work identifying how to use technology to improve peoples’ lives and patient care.
Much has been achieved: 98.7% of GP practices now offer patients online appointment booking, ordering repeat prescriptions and access their records; NHS Choices, which has more than 50 million visits each month, offers a range of digital health resources including the first NHS ‘app store’ that has driven engagement with online tools and apps effective in improving mental health outcomes; and MyNHS, a digital tool that enables the user to compare the outcomes and effectiveness of health and care organisations across the county has revolutionised transparency of local services.
But we need to do better, faster.
The NHS can drive engagement with digital health services and tackle health inequalities by mobilising its assets: its premises and its people.
Turning on free Wi-Fi access across the NHS estate could significantly increase take up of online health tools. It would allow patients staying in hospital to self-monitor their conditions using apps and maintain contact with social networks that can support recovery and promote well-being. Wi-Fi would also reduce the administrative burden on doctors, nurses and care staff, currently estimated to take up to 70% of a junior doctor’s day, freeing up more time to be spent with patients and enable safer working practices such as e-prescribing known to reduce medication errors by 50%.
Moving on to NHS staff, we need to build the digital skills of the NHS workforce so they can make the most of the digital opportunity and feel confident to recommend these services to patients.
Despite the wide availability of digital services in primary care, awareness and take-up remains low – only 12% of appointment bookings are made online. We need a concerted drive to boost awareness and use of digital services in primary care over the next two years.
Universal free access to broadband, with the skills to use it, has the potential to be one of the great public health advances of the twenty-first century. Those who lack access to the public utility of the internet will, like those who lacked access to the public utility of clean water and sanitation in the nineteenth century, be at risk of increasing inequality and poorer health status. We need to take action now to harness the power of the network age for all to transform the NHS, and the health of our nation.