As we look back over the past 10 years or so, we can also see that there are some things have not progressed as anticipated, and consider why that is. Back in the 1990’s the government and the NHS were actively supporting the development of digitally enabled ‘telehealth’ and ‘telecare’ as a key factor in delivering more efficient and consistent services to patients[1] and to shift health record keeping from paper to digital. The reality has been slow and patchy adoption by our health service providers, both public and private, and the evidence of value and benefits has been mixed at best[2].
More recently health tech policies have focused on the drive for greater participation and transparency through digital channels, driving the move to online service delivery, such as the Patient Online[3] programme to promote the shift of GP services online; and numerous initiatives making health service performance information more readily available to inform peoples’ choices and support greater accountability. The current policy focus has shifted back towards digital and information technology as the enabler of more efficient services that are increasingly personalised. The NHS CEO Simon Stevens and the Health Secretary Jeremy Hunt have both spoken consistently on this topic, including recently at the NHS Expo in Manchester, where AXA PPP HT&Y launched their third year Award categories[4].
An important factor in slow take-up has consistently been acknowledged as insufficient time and focus on the end users of the technology, both health care professionals and their patients. This has affected both the design of technology healthcare solutions and the approach to implementing technology; even well designed technology can be badly implemented and poorly used. Failure to really put the person or patient at centre of design remains a significant issue. Although almost all health IT solutions and personal health Apps contain personal records, they are not easily joined up. Hospital and GP records remain bounded within the organisations that create them and whilst personal data in Apps might upload to your laptop or smartphone, as yet it is not easy to integrate all the data to create a holistic picture useful to individuals themselves or their health care professionals and community healthcare planners and commissioners. A third key factor is the variability of progress in gaining people’s confidence in government and tech suppliers’ ability to maintain the confidentiality and security of personal information and ensuring an acceptable balance between surveillance and support.
Looking ahead, what is important is that we learn from our mistakes as well as build on success. In line with personal wellbeing goals, prompted by my own Fitbit, my summer holiday this year included getting up early to walk in the cool of the day, before the obligatory loafing by the pool. The effort was rewarded with classically beautiful views across Tuscan hills and valleys sprinkled with picturesque medieval towns. It also highlighted that for every climb achieved, and dish of pasta justified, another higher peak was revealed. As Newton understood, to advance human knowledge we need to look beyond the current horizon, and acknowledge the development of those who went before, as he remarked about his own achievements he was “standing on the shoulders of giants”[5].
[1] http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4014469.pdf
[2] http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/nhs-it-report-/
[3] https://www.england.nhs.uk/ourwork/pe/patient-online/
[4] https://www.england.nhs.uk/expo/
[5]https://en.wikipedia.org/wiki/Standing_on_the_shoulders_of_giants
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