Improving access to healthcare is one of the biggest challenges facing the NHS. Wide variations in demand make it hard for trusts to predict and provide cover. In winter, the growing toll of seasonal illness multiplies the burden on overstretched resources. Outbreaks of viral and microbial pathogens can shut hospitals to admissions for weeks at a time. And summer brings its own challenges: June 2016 was the busiest since NHS records began, with almost two million people attending A&E.1 Across England, the service again failed to meet its target of seeing 95 per cent of patients within four hours.
Against this background, one of the UK’s busiest A&E departments began a trial to divert non-urgent patients away from A&E. After assessment by a senior doctor, non-emergencies arriving at Queen’s Q&E in Romford would be redirected to their GP or local pharmacy. In essence, Queen’s would take out the ‘Accident’ and concentrate on the ‘Emergency’ in A&E.
In practice, around 60 patients a day were redirected and, of these, 20 were found to require no medical intervention at all: many were routinely turning up at A&E with relatively trivial complaints such as colds, coughs and mouth ulcers3.
The trial was well received by patients and reduced some of the pressure on the hospital’s A&E. But for me the significant thing is how the trial focused attention on the role of A&E and challenged people to think about how they used the service.
Improving access to healthcare
Over the years we’ve developed an unsustainable culture of expectation towards A&E, and around the NHS as a whole. We’ve come to rely on this service to provide care in every instance – even when it would be quicker, simpler and more effective for us to take care of ourselves, freeing up A&E to focus on true emergencies.
Technology gives us powerful tools to tackle these unsustainable expectations and improve access to healthcare through digital transformation. Deploying connected technology can give individuals unprecedented control over their health and healthcare. Devices can monitor a growing range of conditions in real time. These same devices mean expertise and answers to health queries are always at your fingertips.
For the NHS and A&Es, increasing the role of technology in the management and diagnosis of many conditions – including using social media platforms to improve interactions with citizens - would mean fewer non-emergency cases filling up waiting rooms and less pressure on limited resources.
For patients, taking greater responsibility for their healthcare would mean faster access to treatment and less waiting around in crowded A&Es. These are compelling and meaningful benefits – and raising public awareness of them will drive adoption and demand.
Show and tell
So how can the NHS promote the benefits of self-management technology? Surely the most effective way is to put it into practice and talk about the positive difference it is making to real patients.
A good example is the Patient Portal, developed by CGI for University College Hospital’s Macmillan Cancer Centre. Cancer can feel like an endurance course with complex and physically demanding therapies involving multiple appointments. The Patient Portal cuts through the complexity and, at a time when people can feel powerless, gives them more control over their treatment plan.
Using the portal, patients can arrange appointments online and meet several specialists in one day to make the best use of their visit. Once on site, a self-service check-in system updates patients about their personal schedules, allowing them to escape the waiting room and walk around the gardens or visit the café between consultations.
The Patient Portal improves the patient experience and supports the smooth running of a busy clinic, helping administrative staff and clinicians focus on patient care. It shows how self-management technologies can simultaneously improve efficiency and deliver better patient outcomes.
Just imagine the gain for the NHS if we deployed this kind of approach more widely. Managers and clinicians could make much more efficient use of resources, targeting care where it is needed most, and citizens who need that care would receive it more promptly. We know the technology exists to deliver these benefits and we’ve seen the principle work at Queen’s Romford – it’s now time to put it into practice across the nation’s A&E clinics.
1 NHS meltdown continues: A&E departments busier than ever as bed-blocking hits record high. Daily Mail. 11 August 2016.
2 ‘Take wasp stings to GP and leave A&E for emergencies’. Evening Standard. 29 July 2016.
3 Pressure on A&E at Queen’s Hospital as thousands do not require urgent care. Romford Recorder. 19 December 2016.