With capabilities not even imagined in 1948, the NHS is leaping forward with technology not just to heal, but to prevent and manage. Rachael Rowe reports
It’s 75 years since the NHS was established in 1948, providing free healthcare for British people. The service has completely changed over its lifetime as healthcare has continued to evolve, and it has seen incredible developments – from the first pacemakers to the introduction of robotic surgery.
One of the most exciting is how digital technology is transforming care and preventing people from getting sick or having an accident. We should all start seeing more technology in the NHS in the next few years.
Where technology is working
Many people are already benefitting. The innovations taking place go far beyond automated phone lines and appointments on Zoom. For example, 10,000 people with diabetes in Somerset use a digital platform to monitor their condition and learn more about how to help themselves – that’s a quarter of the county’s adult diabetes sufferers. The My Way Diabetes site is linked to GP data, so users can also see their medical records.
Hospital at Home is another major development in the NHS, enabling people who are medically stable to be cared for and monitored in their own homes, using a range of devices such as blood pressure monitors, oximeters (to measure the level of oxygen in the blood) and more. The clinical teams looking after the hospital patients also care for those being monitored through the Hospital at Home programme, so there is continuity of care and even home visits where appropriate. In Dorset, the scheme has been extended to supporting oncology patients. Oncology consultant Dr Amelie Harle said: ’This innovative system, designed by patients and oncology teams together, provides patients with early advice at the onset of symptoms to empower a patient to safely manage milder symptoms at home or, when symptoms are more significant, to seek urgent advice from the Acute Oncology Hotline Service.’
Meet the Dorset DIIS
Heather Case is head of the Dorset Intelligence and Insight Service (DIIS) at NHS Dorset and works alongside Janine Ord, head of population health management. The DIIS sounds mysterious, but is simply a database that has been developed to use anonymised NHS and social care data to pick up trends.
There are no large management consultancy fees here, or outside companies offering to build technical systems with a hefty price tag. Instead, staff in Dorset have created ways of using data to identify trends in the population. The population health management team then works collaboratively with GPs and hospital colleagues to detect where attention is needed.
Janine gives an example of how the use of their data and technology is making a difference in North Dorset specifically. ‘We looked at ways of preventing falls, by predicting the types of patient who were at risk of falling in the next 12 months. First, we looked at data from those people aged over 65 who had experienced an injurious fall, and we reviewed hospital data on fractured wrists and hips. Then we checked out any commonalities between them to identify those at highest risk of falling.’
But it’s what happened next that shows how the Dorset database is working its preventative magic. Heather says: ‘We gave our anonymised data to the North Dorset GPs, who were able to identify the people most at risk of falling using our model and invite them to an event where they could get help and advice to prevent falls.
‘For example, one of the common reasons people fall is that they are taking so many different types of medicines, so a pharmacist was there to provide support and answer questions. We also had physiotherapists and occupational therapists with advice on exercises to improve balance and strength.’
The data analysis helped the team to identify the common factors in those at risk of falling. Heather found increasing age, combined with having multiple chronic conditions, was a significant major factor.
They also found some surprising information. ‘Depression and social isolation were a feature in some of those who had experienced falls. Probably because depressed or lonely people move less, they become medically de-conditioned. And another factor was those with urine infections – they were getting up to use the loo frequently in the dark, risking a fall.’
Asking the right questions
The team can tailor the Dorset database to look at any condition from asthma to high blood pressure, and then identify the gaps where work could be done to prevent ill health.
‘However, we’re also working with clinical teams – who need the time and head-space to be able do the work,’ added Heather. They work collaboratively with local clinicians to refine their data models, making use of the clinical expertise to ask the right questions. When they initially reviewed the falls model, the data team could only find five per cent of the patients. But when the GP asked additional questions of the data, that rose to 33 per cent.
So what’s next for this exciting database in Dorset?
Heather has some priorities: ‘We’d like to look more at social care pathways (how people access both residential and community care in their home) and acute care, where a patient receives active, short-term treatment for a condition. Most of the work to date has been in primary care – general practice, community pharmacy, dental and optometry services.’
Janine has additional thoughts on the recent findings of the programme: ‘We’re working with social prescribers to try and identify the early signs of depression. It’s linked to social isolation, and it’s now understood that being socially isolated is the equivalent of smoking 15 cigarettes a day.
‘It would be wonderful to be able to prevent problems instead of constantly being on the back foot with chronic disease.’
As the NHS celebrates its 75th birthday, the once-futuristic opportunities for keeping people healthy and preventing chronic disease are already here – and need to be used!