Abstract
During the lifetime of the NHS, advances in medical technology have transformed the substance of healthcare in the UK, but the way the NHS delivers care and communicates with patients has not kept pace with the IT revolution. This leaves the NHS out of step with most of its patients and lagging behind the way patients choose to manage other important aspects of their lives.
Pre-NHS the biggest improvements in human health were the result of public health rather than medical advances, partly because medical care was available to a relatively small proportion of the population. During the lifetime of the NHS, acceleration in the pace of medical advance has coincided with the existence of a mechanism for universal access, with the result that ordinary people have reaped the benefit of mind-boggling advances in medical technologies.
Computers are now an essential tool, underpinning advances in medicine as well as research in almost every other field of human endeavour. The significance of computers as a tool for medical advance has been well documented.
1
Without computers and the internet, researchers would be profoundly disabled, severely limited in their ability to assemble information, analyse and communicate it. As Chris Somers puts it: ‘The computer is not just an information gathering tool but is able to help through the comparative analysis of information stored within its systems while working out at phenomenal speeds, a whole raft of information that would take eons to comprehend; thereby saving us huge amounts of valuable time while we get on with the implications of the knowledge gained.’
2
The combination of massive analytical power at our fingertips (laptop computers) and the global communications network (the internet, wireless networks, mobile phones, digital TV) has revolutionized medical research and also affected the way that most people in the UK communicate, organize and live their lives. Somewhere in between, the NHS endeavours to deliver extraordinarily sophisticated medical technologies to millions of IT-enabled patients, largely through systems which remain more or less untouched by the IT revolution. It is therefore unsurprising that interacting with the NHS is confusing and frustrating for so many 21st century patients.
Information and communications technology has transformed what the NHS can deliver, but not how it is delivered. In 2001, the Audit Commission observed that the technology for electronic patient records in hospitals had been around for more than ten years, but only a handful of hospitals had implemented Electronic Patient Record (EPR) systems effectively. 3 It attributed this failure to, among other things, inability to sustain commitment to EPR in the face of competing priorities and insufficient emphasis on changing the behaviour of large numbers of staff across the full range of clinical specialties. The situation has improved thanks to the National Programme for IT, 4 but we have yet to see universal joined-up health records – a basic requirement for safe, effective, integrated healthcare.
Direct interactions between clinicians and patients remain almost untouched by IT. Very few doctors use email, text, instant messaging or even the telephone to communicate with patients. NHS Direct is supposedly the high-tech doorway to the NHS. It consists of call centres and a comprehensive but fairly basic website, and there is currently limited connectivity between the two. Patients who call the service are not directed to the website to find the information they need next time, nor encouraged to look in more detail online or revisit information provided on the phone, in their own time and with family. There is no email follow-up to reinforce telephone advice. Conversely, patients cannot yet book a telephone call from the internet nor, beyond limited pilot projects, contact NHS Direct via instant messaging, Skype or text. NHS Direct nurses have very restricted ability to book face-to-face appointments and the 5 million patient records maintained by NHS Direct are not interconnected with the rest of the NHS, nor available to the people whose data they contain.
In the traditional bricks-and-mortar NHS, the situation is, if anything, rather worse. My own general practice does have a website but it is a basic shop window of the kind that businesses created in the very earliest days of e-commerce, before even the smallest enterprise had worked out how to sell online. You cannot use the website to register with the practice, book an appointment or contact the surgery by email. The only genuinely functional elements consist of click-through advertisements for local businesses and applications to advertise on the site. If you imagined that you could submit an online complaint to the practice about this unsatisfactory situation you would be disappointed. You could, of course, telephone during the working week, but the site carries a helpful reminder: ‘PLEASE NOTE THAT THE SURGERY RECORDED MESSAGE SYSTEM DOES NOT TAKE MESSAGES’.
Technology seems to be everywhere, except the NHS. While writing this I have just been interrupted by a message from an old colleague, apparently now in Canberra, who has looked me up on Facebook. My dentist and hairdresser routinely text to remind me of appointment times, but not my GP, practice nurse or NHS hospital. We patients are constantly told that missing appointments wastes precious NHS resources, but as text reminders become the norm in other spheres of life, NHS ‘did not attend’ rates are only likely to get worse.
Forty seven percent of households in the UK are now not only connected to the internet but have broadband. 5 Mobile phone penetration is close to 100%. Four out of ten people have access to and regularly use all available communication channels, including internet, phone and digital TV. A further 16% of people, mainly young people, have sporadic access to the internet and rely on their mobile for contact and to organize their lives. 6 Technology is not just for the young: surfing the internet has taken over from more traditional pastimes as the number one retirement hobby. 7
Obviously, health behaviours are affected by these trends. Home and mobile-based communication with healthcare providers have the potential to transform the experience of people living with debilitating long term conditions and those who care for them, helping to fit healthcare around their lives rather than vice versa. 27% of adults searched the internet for health information in a three-month period in 2006. 5 Not everyone can or wants to use new media for their health, but those who do are no longer the minority. Technology puts information and access that used to be the preserve of the well-connected few into the hands of the many. Ignoring these trends will make health inequality worse, not better.
A focus group of young men recently questioned about how they used technology agreed that the main value of email was to keep in touch with Grandma. 8 The NHS is about Grandma's age: it's about time she got on the internet to communicate with the rest of us.
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