What is stopping a digital revolution in health and social care? The Guardian gives its account.
The NHS can streamline, innovate, cut and chivvy all it wants to improve quality and save money but only citizens can change how they use the service.
The NHS is a collective social insurance scheme that requires a sense of ownership and responsibility from all who pay into it, not just those who run it. And the only people who can truly save the NHS are the people who use it. Millions of citizens need to drive a paradigm shift in the provision of health and care.
The late Derek Wanless recognised this in his seminal report Securing our Future Health: Taking a Long-Term View. He created the concept of the fully engaged healthcare economy that would cost £30bn less a year by 2022. A figure that neatly meets the projected £30bn NHS funding shortfall.
If the public wants to maintain an NHS free at the point of need then people have to accept that they are responsible for the service and do some of the heavy lifting. Wanless went further, he said patients “should ensure their actions do not add unnecessarily to the cost of the service”.
What is the first step? Help the NHS adopt technology. In a world where digital innovation can sweep the globe in months, the NHS is one of the most non-viral institutions in the world.
In 2015 the public needs to do for the NHS what it has done for the banking, airline, holiday and insurance industries – adopt and demand digital approaches to the management of healthcare.
People need to bring their technology to the NHS’s door. Ask why appointments can’t be booked by phone. Send a secure message to ask if it’s really necessary to see a doctor. Use a video call without having to leave work. Demand to know why you can’t record the way you want to be treated in an emergency in advance of a crisis.
And like a parent, the NHS has to let go and trust its children. The NHS needs to believe people can make their own trade-offs between convenience and security. Understand that individuals will know when it’s appropriate to use technology and when it is not.
In 2015 the willing and responsible among the 64m users of the NHS need to help the service’s 1.4 million employees run the NHS more efficiently and effectively by: creating advance statements and decisions, filling out pre-consultation questionnaires, booking appointments online and asking clinicians to work with the digital tools the public use in their daily lives.
A GP who insists on always seeing a patient face-to-face can’t be argued with but a patient who is willing to fill in a questionnaire and receive a call back within an hour should be encouraged.
If the NHS lets go, the public could revolutionise the running of the service. Simple measures could save billions. Different approaches could drive adoption including reductions in national insurance contributions or shared saving deals for companies willing to link their products to the NHS for free.
These are approach already being taken in the US. In an attempt to create an all-digital national register of advance decisions and statements, both houses of Congress in the US are currently debating bills that will pay every US citizen who creates an advance directive. Once ratified, Congress is happy for the citizen to find the right product and industry to make it available to clinicians 24 hours a day.
MyDirectives.com, which provides a free, global all-digital emergency and advance care platform, estimates a UK national register dovetailed with the organ donor register would save the NHS £2bn a year in reduced bed days and increased organ donations.
Does the engaged patient exist? An impressive 20 million have signed the organ donor register, one of the 11 questions contained in an advance decision and statement, and more than 20 million unique users look up health information on NHS Choices every month. Reach out to these people and the odds are good they will respond. Especially if clinical leaders, who already support advance decisions and statements, encourage the public to sign up.
A fully-engaged patient is possible. 2015 is the year to start. 2015 is the year the NHS needs to let go and let the public lead it to safety.