THE GREAT NHS GAMBLE: Technology is only part of the solution

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Forget “Physician Heal Thyself”, plans to shake up health services and save the NHS millions seem to hinge on patients either not getting ill in the first place or looking after themselves with an increased use of technology.

However, campaigners are warning of the dangers of the tech revolution and say patients will suffer if health bosses try to replace staff with apps.

Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS

Chris Moulton

A leading GP believes the health service is gambling millions on plans to use apps, benevolent Big Brother-style monitoring devices and video-link surgeries to bridge a five-year funding gap.

Health bosses around the UK are drawing up plans to shake up the patient-doctor relationship by limiting “face-to-face” interactions, both in the NHS a nd in drastically under-funded council-run social care.

An investigation by The i and sister Johnston Press titles has found all 44 Sustainability Transformation Plans (STP), produced by regional NHS bodies, plan to meet strict five-year savings targets by increasing the use of new digital technologies to deliver health services.

Regions are proposing to increase “virtual appointments,” where patients can talk to their GP, or take part in a group therapy session via video-call.

“Artificial intelligence” apps are already starting to deliver diagnoses on the private market and are already being discussed by Clinical Commissioning Groups (CCGs) looking to assess patients without the need for a face-to-face meeting.

But leading GPs are not convinced the move is the magic formula in helping the NHS meet its £22 billion shortfall.

Helen Stokes-Lampard, chairman of the Royal College of GPs, believes video-link doctors’ appointments could actually increase their workloads. She said: “While these might be convenient, they don’t actually reduce a GP’s workload as a 10-minute patient consultation takes 10 minutes whether face-to face-or over the phone - and in some cases virtual consultations can increase workload, if a follow up face-to-face consultation is necessary.”

Mrs Stokes-Lampard says she broadly supports the idea of increasing technology in the NHS, but she fears it could alienate patients who are not “tech savvy.”

She said: “Whatever happens, the GP-patient relationship is unique in medicine and there is no app, algorithm or technological innovation that can, or will, replace it in the foreseeable future.”

All 44 STPs are seeking to drastically reduce accident and emergency admissions, scheduled visits and “face-to-face” care in part, by moving towards a model of what has been labelled “self care.”

Vice-president at the Royal College of Emergency Medicine, Chris Moulton, believes types of preventive treatment are “absolutely the morally and medically correct thing to do.” But he warned they should not be used as a way of saving the NHS money.

He said: “When a 60-year-old person takes statins and other drugs to avoid having a heart attack, they don’t sign a pledge saying that they will never use the health service again for the next two decades.

“Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS.”

In adult social care the STPs talk of plans to increase “telecare,” where elderly or disabled people can be monitored by devices in their own home.

One union leader fears the ploy, which campaigners fear is a move for cash-strapped councils to reduce home visits, is flawed.

Guy Collis, health policy officer at Unison, said new technology would require staff to undergo extensive, costly raining, before it is rolled out.

“I think too often there’s this idea that they can be a quick shortcut for savings or improving patient experiences,” he said. “That’s all well and good as long as you have the right people.

“The NHS doesn’t have a great track record for IT.”

On the other hand director of innovation at national charity Carers UK, Madeleine Starr MBE, said the move to self-administered healthcare is “inevitable” considering the huge deficit in the NHS.

Patients, she believes, will simply need to adjust.

“We need to move away from the idea that a GP is a sacred cow you’ve got to sit in front of,” she said. “You are never not going to need an expert when the time comes. But very often the GP is not providing expert support. Much of the time they are simply answering questions.”

Mrs Starr believes also new innovations in home “telecare” will be key to reducing the workload of carers.

The UK, she says, is languishing behind other developed nations, such as Japan, which is already rolling out “carebots” that can detect falls , assist mobility and provide company.

Brand names set to be more prevalent in the home care market including Canary, Oysta and JustChecking are now purporting to offer much more than the current neck-worn emergency buzzers and toilet pull cords - which have been in circulation for a number of years.

As a result, cash-strapped councils, which have the responsibility for looking after vulnerable adults and the elderly in their areas, are keen to increase their use of monitoring tech. Aside from the savings Editor of OurNHS, OpenDemocracy, Caroline Molloy says GPs have deep concerns that a move away from “face-to-face contact with a GP will see patient’s ailments missed. She said: “The real thing they worry about comes out of that lack of human interaction.

“I’ve had people who are strong advocates of this sort of thing admit they are worried. As soon as you are not seeing someone in a room in front of you - you are losing out on their skin colour, their smell, whether they are looking after themselves properly, whether they are tapping their foot under the table because they are not giving you the full picture.

“All of these little clues are really important.”

She also believes the sheer capital costs needed to invest in the new software could negate any savings benefit as well. But the jury is also out on the effectiveness of apps that used to remotely monitor people with mental health conditions.

Scientists at the University of York said a trial of mood-monitoring therapy software, where patients update a system with how they are feeling at a given time, showed it offered “little or no benefit over usual GP care,” as many users were not willing to log in.

Chris Moulton, vice-president of the RCEM, said: “Preventive medicine is absolutely the morally and medically correct thing to do. But it is not a way of saving money for the NHS.

When a 60-year-old person takes statins and other drugs to avoid having a heart attack, they don’t sign a pledge saying that they will never use the health service again for the next two decades. Statistically there is a considerable chance that that person will then go on to need treatment for cancer in the 70s or maybe develop a condition needing expensive long-term care like dementia in their 80s. Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS.”

CASE STUDY:

Clare Gosling, 35, is a Zumba instructor. She was diagnosed with Type 1 diabetes in 2009. She writes:

When I was first diagnosed in 2009 by first initial contact was with my GP and it was face to face. In that first week I had telephone conversations every day to give them my sugars so we could get together a plan of action. I was then referred over to the diabetes centre where it was confirmed it was type one instead of type two. I had a meeting with them and went to meet the consultant a couple of weeks later. Ever since it has been face to face most of the time. But there are a lot of phone calls involved in an initial diagnosis and in getting the condition under control and manageable.

Personally I quite like the idea of video interaction. I’m not too far from my local hospital where my diabetes centre is but I know others do have mobility issues, it may be better for them. Saying that, initially, when you first have the diagnosis and are starting to get things under control you need to be able to meet your consultant and the nurses, the people who are going to be dealing with your care.

They need to know what you’re like, what your background is, and you need to know about them, that you can build a relationship with them. To manage a long term condition it’s important to have a working relationship with the people who are helping you.

If you’re both singing from the same page and you both agree with how things work then perhaps you could move fto over the phone in a six month period. But it can be a struggle to deal with a diagnosis. With type 1 diabetes some people have what’s known as a honeymoon period where your body is still producing some insulin. That lasts anywhere between six months and two years. During that time everything’s great, your sugars are nice and level and then all of a sudden, boom - it’s not. At that point you might need to go back to face to face - when you start to struggle as a person dealing with it on your own. You need support and you need help. Often the best way to get that is in person. It can be deliverable over a telephone, or sometimes over a video screen, but it really does come down to the individual person, the individual consultant and nurse.

Don’t get me wrong, if I have a big problem I know I can call my consultant or nurse and they can advise me on the best thing to do. The fact that they are just at the end of the phone is really good to know.

Regarding video consultations over Skype, I’d worry about having a secure connection, a lot of people, particularly the older generation aren’t as happy to interact over modern technology. I understand. If it’s somebody I’d never met before I’d be a little dubious. If it was somebody I knew I’d probably be a bit happier but it would depend on what it was for.

Complications with diabetes can involve anything from sight loss to toe loss to kidney problems,

For the older generation actually going out and seeing people is a good thing. They shouldn’t be pressured into telephone consultations because sometimes going out for their check up will be the only interaction they’ll have in a week - that one trip to the doctor’s to see the diabetic nurse to get their feet checked over.

I have a yearly review at my GP with my diabetic nurse. She checks my feet to make sure I still have feeling and I’m not suffering from diabetic neuropathy. It is very, very important, that an older person goes to see someone and is checked by a professional. They can say ‘Yes I’m fine’, but not actually be fine. I’m of a generation that grew up with technology. I had my first mobile when I was 13 or 14, so I’ve grown up as technology has developed. I’m quite comfortable with technology, my kids are really comfortable with it. I think as time goes on the NHS will probably find it beneficial to move toward a lot more video screens but there will always be those who find it very impersonal and don’t like it, even in my kids’ generation. Everyone’s different.

A lot of people like the personal interaction with others.