Digital health: so near, yet so far

“We tend to overestimate the effect of technology in the short run and underestimate the effect in the long run.” Roy Amura. 

(Thank you to James Munro of Patient Opinion for this quote).

This time last year I wrote a blog post for NHS Voices, hoping that 2015 would be the year the adoption of digital health reached a ‘tipping point’. I shared the real story of Sasha to explain how blended offline and digital resources could be used to support her to self-manage her complex set of health conditions and help to deliver an accessible, efficient and patient-centred health service. 

So did we reach the tipping point for digital health in the UK in 2015, and did anything change for Sasha?

2015 saw a continued period of growth for digital health. In financial terms, Monitor Deloitte’s market analysis showed continued significant growth, claiming that the global digital health market was worth £23 billion in 2014  (UK share 9 per cent or £2 billion) and is expected to double by 2018. From the Apple Watch to Leka Robots, there was a huge range of revolutionary and evolutionary digital health and related developments.

In England, a plethora of national policy initiatives pushed for the adoption of digital health innovations across the system, guided by the Five Year Forward View and the National Information Board. 

As of April 2015, we (should) all now have online access to the summary information of our GP records, and we can order repeat prescriptions and book appointments online.  

Fifty vanguards are being supported to ‘rethink how care is delivered, given the potential of digital technology to deliver care in radically different ways’. 

The NHS Testbeds programme competition was launched offering the ‘opportunity to combine different technologies with innovations in how services are delivered in the NHS’. 

NHS.UK Alpha began building a vision and a plan for improving the experience and efficiency of the NHS digital offer.

There were also some interesting twists and turns, including the Health Apps Library set up by NHS England, which has now been closed pending further ‘upgrading’ work. 

Elsewhere, there was much activity to stimulate, connect and grow the market through the Academic Health Science Networks, SBRI, Nominet Trust, NESTA and a whole range of accelerator programmes, such as Wayra, Dot Forge, Bethnal Green Ventures – and lots more. 

Some wonderfully creative collaborations generated innovation and profile in the digital health space. #PDDigital15, led by MHabitat, explored why digital needs to be driven by people and their real needs and aspirations, resulting in a white paper. There were some interesting spin-off projects too, including #SheffieldFlourish, led by Recovery Enterprises. #Poco10 was a tenth birthday celebration by social enterprise Patient Opinion and an opportunity to explore the power of the connected citizen in the context of health and social care. 

Digital inclusion developed over the course of the year, with the Tinder Foundation-led Widening Digital Participation programme in its third year. 

The year finished on an interesting note, with some significant recommendations from Martha Lane Fox, including provision of free Wi-Fi across the NHS and Jeremy Hunt promising that in 2016 we will have access to our whole electronic health records:

#health2016 - the year everyone in England will have access to their whole medical record online #nhstechnology pic.twitter.com/15ouOq3pgc

— Jeremy Hunt (@Jeremy_Hunt) January 1, 2016, Twitter

So how has all this activity impacted on Sasha? What has changed for her in the last year?  Did all this national, regional and sometimes local activity make a positive difference to her? The short answer is, not really! 

What has changed for Sasha is that she is now injecting insulin and has been able to stabilise her blood sugar level. She is able to access her summary record, order repeat prescriptions and book GP appointments online. She has a tablet, mobile phone, desktop PC and got a Fitbit for Christmas! 

She is still not able to upload her blood sugar level testing results and liaise with healthcare professionals online; she has never been offered a Skype, email or telephone appointment. She has had very little useful information, training or support on diet or physical activity, despite putting on significant weight. She is in constant unmanaged pain after breaking her collar bone. 

She retired recently, and so has more time to concentrate on her wellbeing, but the milestone also puts her at risk of feeling isolated. This is a significant life event which has the potential to impact both positively and negatively on her health, and on health services, but has been ignored by the system. 

The truth for Sasha is that the NHS offer has not changed significantly. The digital health potential offer has moved on, but the local NHS is still fragmented, rigid and system-focused, and in places, still not using digital resources to provide more efficient and accessible services. 

Digital health is here to stay and will increasingly become an integral part of healthcare, whether through the NHS or the wider global market. In 2015, we didn’t reach the tipping point where it counts: at the point of contact. So near, yet so far. 

Roz Davies is the managing director of We Love Life and Recovery Enterprises. Follow her on Twitter @roz_davies

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