Putting digital to work for patients

Since the publication of this blog Tim Kelsey has left NHS England.

NHS England’s National Director for Patients and Information looks at how unleashing the power of technology and data can improve patient care:

Published in October 2014, the Five Year Forward View sets out a clear direction for the NHS – showing why change is needed and what it would look like.

Since then, the National Information Board (NIB) has been examining how the NHS can harness the power of data and technology to transform health and care services and deliver greater quality and efficiency.

In November 2014, the NIB launched its framework for action – Personalised Health and Care 2020: Using data and technology to transform outcomes for patients and citizens setting out a bold vision for how technology should work harder and better for the NHS by 2020.

Today we go a step further by publishing detailed plans for how we will deliver on these commitments including offering patients the chance to view and take control of their full health records online; increasing the offer of digital health services and extending the provision of remote care provided through online platforms.

These plans are for discussion with the public and every part of the NHS. The aim is not to create a single rigid course of action. That would miss the point. It’s the energy and commitment of NHS staff, of our patients and our partners that can generate the solutions to the challenges the NHS faces. As Simon Stevens, the NHS’s Chief Executive, has stressed, we offer “direction without dictation”.

The NHS faces three fundamental challenges: a growing and ageing population, the rapid rise of long-term conditions and the expectation that the NHS will deliver ever more expansive and expensive treatments. These challenges do not present themselves uniformly across the nation and accordingly the NHS’s response has to be diverse and different.

Since the publication of Personalised Health and Care 2020, we have seen local teams embrace enthusiastically the offering of digital services to patients. Data released last month revealed that over 97% of GPs now offer online appointments, repeat prescriptions and access to summary information in medical records, benefitting more than 55 million patients across England.  This is up from the 3% just over a year ago. We hope that giving people the opportunity to cancel and rebook appointments online will help to reduce the number of missed appointments, currently estimated to cost the NHS around £160 million per year.

We’re delighted that more than a third of all ambulance services now share patients’ records digitally with Accident and Emergency departments in summary form, granting doctors, nurses and care staff speedy access to critical clinical information, a huge increase on this time last year.

At the NHS Confederation annual conference earlier this month, NHS leaders re-confirmed their support for a paper-free NHS where all clinical information is shared electronically across health and care settings, ensuring patients only ever tell their story once.

Under the proposals set out today, doctors and nurses will be able to access the most up-to-date lifesaving information wherever they are in England by 2018 for primary, urgent and emergency care services and by 2020 for all other NHS funded services.

The National Information Board meets today at an open event at the Kings Fund to commit the NHS to a range of next steps, including our intention to investigate the feasibility of converting the entire NHS estate into a free Wi-fi zone. This will allow doctors, nurses and care staff to develop modern and dynamic ways of working, such as using tablets to record vital signs, helping to reduce the administrative burden currently estimated to take up to 70% of a junior doctor’s day, freeing up more time to be spent with patients.

The installation of Wi-Fi will open up the possibilities for wearables to be used to monitor patients in clinical settings. For example, research shows that over a fifth of patients with diabetes will have experienced a largely avoidable hypoglycemic episode whilst in hospital. This technology will help doctors to detect deterioration early and act without delay.

In the future, Wi-Fi will allow doctors and managers to track patients on their journey through hospital, helping to ensure that they are always taken to the right ward and giving a more accurate picture of patient flow.

Building on the success of NHS Choices, which gathers 50 million hits per month, the NHS will expand digital health services for patients to help make their lives easier.

Soon every citizen in the UK will be able to register for a GP; book services and order prescriptions; access apps and digital tools; speak to their doctor online or via video link and view and take control of their full health record through a single online portal: ‘’.

In the future, people with long term conditions such as diabetes, heart failure, liver disease or asthma will wear devices, skin sensors or clothes to monitor their health and this information will be uploaded directly into patients’ records through the platform.

These proposals mark the next steps for the NHS on its journey to harness the power of data and technology to transform citizens’ experiences of health and care services, deliver greater quality and efficiency and put patients firmly in the driving seat of their own care.

Tim Kelsey was previously National Director for Patients and Information, since the publication of these blogs he has left NHS England.

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  1. Trevor Fernandes says:

    Hi Tim – I am a Patient Engagement Representative for a number of patient groups and local and national organisations, including the NHS. In Mid Essex, we are set to have a ‘GP Provision’ crisis in the next 3 years. 40% of GPs are retiring or going part time. There doesn’t appear to be any visible plans to sustain this element of the workforce. I have alerted HEE, who are tasked with developing the workforce, as I understand it. From the HEE 2014/2015 Workforce Plan, 50% of Post Grad doctor training will be for general Practice. That’s 3,250 doctors in General Practice by end of 2015. Will this target be met?

    Regarding Telehealth as detailed in Personalised Health & Care 2020, you must be aware that many GPs are quite cynical about using technology and remote facilities for patient diagnosis. They feel they don’t get sufficient support from NHSE to take on these changes and initiatives. I have attended a number of presentations about Telehealth, the most recent by Dr Clive Prince, who is the NHSE Digital Clinical Champion. I would like to organise a similar forum for my local GP partners and other surgeries too. As a Patient Engagement Representative, I can see the benefits to patient outcomes, so will keep trying to influence our GPs and Commissioners.

    I must comment on M Mezey’s points about the FFT. I fully concur with his view & sentiment. Whilst I accept the need to keep patient surveys simple, the FFT appears to offer little value in terms of learning and continuous improvement. Staff, GPs and patients appear puzzled by how the FFT will improve services. In my Patient Participant Group, we have reverted to the old survey methodology and have produced a survey of just 6 questions. We want to know what patients think of the services, so that we can make improvements for all of us.

  2. Matthew Mezey says:

    Hi Tim,

    More data sounds good in theory – but are you doing what you should be with the data you already have? Making full use of it?

    For example, the NHS Friends and Family Test is the biggest assessment of patient opinion by any health service in the world ever, as you told us last year.

    But many – most? – FFT surveys don’t actually seem to ask what actual service improvements would make the person more likely to recommend a service. (And the newer staff FFT doesn’t appear to ask this vital question ever – quite bizarre to leave it off).

    If you’re not even asking people what improvements are needed, it’s not really an improvement process – but, some might say, the biggest waste of patient opinion by any health service in the world ever 😉

    But that’s not true, luckily – as a fair number of FFT surveys do in fact include a question asking what the most-needed improvements are.

    Then the question becomes – does the service act on the improvements (following up with individual problems, fixing bigger process issues etc).

    And – for a full ‘closed loop’ improvement process: do they continually feedback to patients about the improvements that have been made?

    James Paget University Hospitals seems to be a fine example of a fully mature ‘closed loop’ FFT improvement process:

    But how many NHS services have such a fully mature ‘closed loop’ improvement process – do we know? Or rather, do YOU know?

    90% 80%… 50%… 20%… 10%.. 5%…?

    Is anyone even asking this question?

    If not, we need a survey to gauge the maturity of the FFT improvement systems nationally. And to begin to explicitly encourage full improvement systems, not token ones that don’t ‘close the loop’ by feeding back to patients.

    It was good to see your 7 examples of improvements that have been made around the country as a result of FFT – but this misses the point: how many services have full FFT improvement systems? Is the number growing, or reducing?

    (NB Sheffield hospitals I’ve visited don’t even ask the improvement question on their nice FFT survey cards).

    I hope I’m wrong about some of this – and making improvements and telling patients about them is the norm, but from what I’ve gleaned so far it doesn’t appear to be so. It should be – and you have the power to make sure it is.

    Go for it!

    Matthew Mezey

    (NB this is a personal view – not that of the health-related employer I work for)

  3. Ellinor says:

    Hi Tim, when you say “Data released last month revealed that over 97% of GPs now offer online appointments, repeat prescriptions and access to summary information in medical records” is this correct, or should it read “OR” access to summary information in medical records, as from my knowledge many GPs offer online repeat prescriptions &/or appointments, but NOT summary information in medical records. Can you post a link to where the data is published? Thank you.