Filed Under (Healthcare delivery, Innovation) by Paul on 15-10-2012
Last week I chaired the afternoon session of a conference organised by GovNet. The conference was about increasing healthcare efficiency through technology. As I commented in my talk technology promises a lot of savings for healthcare but whilst it delivers improvements in care it has rarely delivered the savings it has promised, and what we need now is a lot of efficiency delivery – not promises.
As at many of these conferences there were hundreds of exhibitor stands but on this occasion it is the exhibition that pays for the conference. Since this provides free entrance the audience contained a different range of members – those people who do not have a training budget and are much more likely to be doing the actual work of IT.
The session I chaired had speakers from both England and Scotland talking about their relative NHS Directs and I spoke at the end of the session about how IT needs to move on to deliver real and not hypothetical savings (Paul Hodgkin gave a talk from Patient Concern which I will post about separately).
There was a simple message – contained in the title above – which is a profound shift from the model of health care that we have.
I remember, and have mentioned before on my blog, that a GP in Somerset once said in a public meeting I attended that the business model of healthcare that he and traditional GP services are part of is to wait in a room until people who think they are sick come in to see me.
When I suggest this to GPs they either look sheepish because they recognise it or fly into a rage and protest about how much else they do, but for me it does sum up our model of health care.
Medical staff wait in various rooms to see people who they, or someone else, have seen and think are sick.
This model of health care is passive. And it does involve sitting in a room until people come and see you.
The issue for today’s post is that our current health care model is based upon one particular channel of a relationship – which is face-to-face. The patient meets the medical practitioner in the same room.
I want to say at the outset of my argument, as the NHS continues to progress into the 21st century, that a lot of health care continues to be experienced in this way - through the channel of face-to-face interaction. But it is also the case that increasing amounts of health care will be carried out through other channels of relationship and communication.
Increasingly health care professionals have recognised that the telephone is a form of communication that can be initiated in both directions. Not only can patients ring up a health care professional to ask for advice or have a discussion, the health care professional can ring up the patient and initiate that discussion.
The phone has been around for a while. In that sense it is not new technology. But in 2012 there are many more phone consultations carried out by GPs than there were 10 years ago. It’s not the technology that has created this new channel of communication, it’s the willingness of GPs to use it.
The same is true of the many more email consultations that are going on in 2012 than were ten years ago, even though email had been around for a good few years before that.
What is important here is the range of channels that we need to use to deliver healthcare NOT the belief that this will be only one channel.
When you are having an operation it is true that a doctor needs to be in the room. But the doctor in the room may not be in charge of the operation. The doctor in charge may be many miles away from the operation and giving advice through telemedicine.
There were some interesting examples of the necessity of a multi-channel approach in these talks.
NHS Direct in England had evidence that patients in London were the least likely of any region in the country to act on advice that they were given over the phone. As a Londoner myself this was an interesting and surprising piece of evidence. Did it mean that in the capital city we needed much more face-to-face interaction before we would trust a healthcare intervention sufficiently to act on it?
Apparently not, because the next piece of evidence said that patients in London are the MOST likely to act on advice they receive from the web. So we trust phones least and the web most of any region.
What this means is what NHS 24 from Scotland stressed so strongly. If you want to create a more universal approach to health care then you need to use more than one channel.
Further statistics made for even more interesting possibilities.
Over the last 10 years the NHS has spent about £10 billion on various aspects of communications and IT. It’s a lot of money. But it is dwarfed by the £75 billion that private citizens have spent over the same period of time.
If we believe that the only communication channels we have to work with are the ones that we own as an NHS, then we turn our backs on the £75 billion that is out there in private hands.
Our colleague from Scotland, with heavy irony, congratulated Rupert Murdoch for laying out the channel for future NHS communications through Sky TV. Aggressive Sky selling means that 80% of the population live in a house that has Sky TV. This has provided a very strong platform for two way communication.
He then pointed out something that I did not know, nor had ever thought of. The digital photo displays sold to many people from Boots and other locations themselves form a platform for giving and receiving information. But we, and certainly I, don’t see them that way. What we were exploring is the range of digital equipment that exists as part of people’s households and that therefore can become part of possible indigenous communication.
He then went on to stress that if the NHS is daft enough to think it is setting up its own stand-alone channel alongside all of these existing organic channels of communication then it will never work because we will never have the money to implement it.
We not only need to use the existing channels of communication that the public have bought for their entertainment and communication, but we need to recognise when we use them that they can also be used for something else.
As we were told. It is really daft to expect a channel to be used, for example, for reporting diagnostic tests for an older person with diabetes and not use that same channel to arrange a walking club for the older person with other people in their locality. The main life problem for people with long term conditions is becoming isolated. Better communications will improve their health by decreasing that isolation AND it should improve the efficacy of their health care.
This was a rich discussion. With a lot to learn from it.
My closing contribution concerned the necessity for IT (or ‘gizmos’ as I called them) to develop as a full part of very new integrated patient pathways. If the IT industry expected their gizmos to work and improve health care or save money without being a part of a new pathway, it will not happen.
More information about the conference can be found here.