A review of the government’s Digital Health and Care Plan

Dr Lloyd Humphreys examines the government’s Digital Health and Care Plan, which was released in June

At the end of June, poised to launch his long-awaited Digital Health and Care Plan, then health secretary Savid Javid told an audience that: “We can combine valuable lessons from the pandemic with incredible new technology and innovative ways of working... It’s a small window of time where we can make a big difference.”
    
He was right. Now is the time to capitalise on the momentum achieved by digital health during the pandemic. ORCHA research published by the British Medical Journal noted a striking 343 per cent increase in recommendations of digital tools by healthcare professionals during the first months of lockdown.
    
Whilst a new secretary of state finds her feet, it’s up to those of us in the health tech sector to make sure Javid’s laudable plan makes its mark.
    
If you look at the big picture, the spirit of this plan is as important as its individual parts. We want its very existence to propel digital to the forefront of minds. Digital tools are already being activated across the NHS to help tackle the elective backlog. One app has the potential to save 1.7m hours of nursing time if deployed for use in eye services alone. Another reduces the need for pre-operative assessment appointments in MSK by 60 per cent.
    
In various parts of the health system, there are different modalities of intervention.  In some areas there will be pharmacotherapy, where patients will be prescribed medicines, in others you may be given physiotherapy, speech and language therapy or talking therapies. All these are embedded in pathways – and now we need to add digital health.
    
So much potential is literally at our fingertips. I look forward to the day when all this incredible tech is par for the course – utterly embedded in our healthcare systems and considered to be merely a different modality for a health intervention.
    
This is already happening successfully in mental health. Patients going into step two IAPT services might have talking therapies prescribed (on the telephone, online or in a group) or might be given a digital intervention. This is one area of healthcare where digital health is fully integrated and has parity of esteem.

Scaling digital health
Looking now at the detail of the plan: it describes how the government intends to scale digital health. It takes existing schemes and approaches and builds upon them in a way that drives the sector forward. The new EVA – the early value assessment for digital health products – makes sense (test and perfect a new product before rolling it out at scale). The NHS Innovation Accelerator Programme has been doing excellent work on this front, but a fresh approach should boost the profile of innovation still further and is a way to formalise the process using NICE. It’s noteworthy that the original scheme was set up because it takes up to 17 years to get an innovation working within the NHS. So, the new EVA is laudable and will hopefully give developers a boost.
    
Additionally, the plan flags that digital products with strong evidence for clinical and cost effectiveness will potentially be commissioned nationally, building on what NICE has done with the Rapid Uptake Programme and the Accelerated Access Collaborative with the Innovation Technology Tariff/Payment schemes. If this can be scaled then this is a significant and positive change away from the previous locally commissioned model and mirrors approaches elsewhere, for example in Germany.
    
The challenge, though, is that evidence can be hard to measure. If you run a mole-tracking device, it could be straightforward to track its impact as it can speed up identifying a tumour. But what if you provide an educational and signposting app, how do you measure the effectiveness of that technology?
    
Finally, it appears that some further work will be done on the regulatory approvals developers need to meet, such as the Digital Technology Assessment Criteria (DTAC). The DTAC has had a solid start, with many ORCHA clients having passed its tough benchmarking criteria. Some developments are needed, as would be the case with any new standard. A key issue is that aspects of the DTAC are interpretive rather than objective. Any developer asked to self-certify an app will, naturally, look at it very positively.

Privacy and ethics
Javid’s plan flags the issue of privacy and ethics in digital health and rightly so as there’s a hill to climb. ORCHA’s recent report into period tracking apps found that 84 per cent share data with third parties.
    
Period tracking apps have made headlines recently, yet the privacy issues flagged in this case are not distinct to this case, they apply across the board.
    
The government makes more than a hundred commitments to make better use of data whilst maintaining privacy and ethics standards – and developers must take responsibility here, too. There’s an industry-wide issue with where and when users are asked for their permission to share their data. This often comes at the beginning of the app registration process, with new users being asked to tick overall consent to Terms and Conditions and the Privacy Policy. Having signed away control of their personal data within minutes of downloading a new app, it can then become hard to regain control.
    
It would be best practice for an app to have a ‘consent’ page that’s easily accessed from the main menu. Each individual permission could then be ticked or unticked at any time. This is an area where developers can lead the charge, recognising their ethical responsibilities.

Being inclusive
A welcome addition to the plan is the focus on digital inclusion and the grass roots approach of working through local connections and existing programmes to uncover and address fears about using digital health products.
    
The plan says that ‘lack of trust in the security and reliability of digital technologies can be a barrier to their uptake’. However, independent surveys commissioned by ORCHA have found overwhelming support from the public for the introduction of digital tools. Sixty-one per cent of respondents questioned earlier this year supported the introduction of digital tools to help the NHS.
    
Yet the same research found that healthcare professionals are recommending just a small percentage of the health apps being used. We expect to see the number of referrals increase as access to digital health training improves and doctors and nurses become more familiar with the technologies now available. NHS providers such as the Greater Manchester Mental Health Foundation Trust and the Chelsea and Westminster Hospital Foundation Trust (through its charity arm, CW+) are at the forefront of digital health adoption, having commissioned digital health libraries so their staff can safely find and recommend the best apps.
    
Other frontline workers wanting to improve their digital skills can take advantage of the country’s first online digital health training academy, freely available to all via the Health Education England learning hub.
    
To conclude, let’s return to the big picture. The government has commissioned and published its first ever digital health and care plan for the NHS and this is a landmark statement of intent in terms of digitising healthcare. There may be details to iron out, but the potential offered by these digital tools is revolutionary and our NHS needs nothing short of a revolution.

 


Dr Lloyd Humphreys is a clinical psychologist and managing director of ORCHA, the Organisation for the Review of Care and Health Apps

 

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