The increasing adoption of MyClinic.com Rooms has been fantastic, and we thank all of you who have helped share and increase awareness about it. We are now operating across the globe. NHS users are the most prolific users of MyClinic.com. Further, we are being used by wide-reaching medical specialities, from Dermatology to Physiotherapy to Mental Health.
We released MyClinic.com Rooms in response to the current coronavirus pandemic. Rooms is a simple tool designed by us to allow for a virtual waiting room where patients can be directed to ‘check into’ whilst they wait for their doctor to begin the video consultation. We are now being used by several NHS hospital trusts in the UK to support the delivery of their secondary care clinics and research activities.
We are proud to share with you some updated numbers about our usage globally. We have now been used in over 78 countries worldwide! Check out a heatmap of all the countries below.
Whenever you hear the word “intervention” you may automatically think of an ‘addiction intervention’’, or a ‘surgical intervention’, as these terms have almost become synonymous with the word. But how about a lifestyle intervention?
Currently, the NHS England spends around 10% of its budget on treating diabetes, with recent projections showing that the growing number of people with the condition could result in nearly 39,000 people suffering a heart attack and over 50,000 people suffering a stroke by 2035.
There is progress within the sector to redress the prevalence of type 2 diabetes (T2DM) in particular, through a prescription of- lifestyle changes.
There are plans proposed by the NHS to roll out a national Diabetes Prevention Programme (DPP) in the form of ‘lifestyle interventions’ to curb the demand the health service is under. The evidence shows that diabetes prevention programmes significantly reduce progression to T2DM compared to traditional care by ~26%.
The approach will involve GPs prescribing a liquid diet of just over 800 kilocalories a day for three months, then a period of follow-up support to ultimately help achieve remission of their Type 2 diabetes. NHS England’s chief executive, Simon Stevens, announced the program on 30th November. It will first be offered to 5000 patients before being rolled out nationally.
The announcement followed a series of recent studies that have overturned the widely held view that type 2 diabetes is incurable and must be managed with medication.
Large population-based studies in China, Finland and the USA have recently demonstrated the feasibility of preventing, or delaying, the onset of diabetes in overweight subjects with mild glucose intolerance (IGT). With these studies leading to the conclusion that even moderate reduction in weight and only half an hour of brisk walking each day reduces the incidence of diabetes by more than fifty percent.
The objectives for the DPP are:
To support more people at high risk of developing diabetes to receive lifestyle
interventions to help them lower that risk.
To slow down the increase in the incidence of type 2 diabetes compared with current predictions.
To reduce the incidence of heart disease, strokes, kidney, eye and foot problems (and associated
mortality) related to diabetes compared with current predictions.
The benefits include not only saving the NHS money by alleviating the demand diabetes puts on numerous services within the sector, but the money and resources will then be reallocated and reinvested into providing more essential frontline care.
Chris Askew, the Chief Executive of Diabetes UK states:
“Plans to double the size of the NHS Diabetes Prevention Programme is excellent news. The programme is already the largest of its kind globally and shows England to be a world leader in this area. The ambition being shown by the NHS needs to be matched across all government policy — we need stronger action on marketing to children, and clearer nutritional labelling to support people to make healthy choices.”
There are even plans for online versions of the DPP, involving wearable technologies and apps to help those at risk of Type 2 Diabetes better self-manage. These will also be provided to those who find it difficult to attend regular sessions due to work or family commitments.
The aim is to better integrate the available solutions and help patients feel more in control of their treatment. This will hopefully stop the chance of patients withdrawing from their therapy and in feeling more accomplished with short-term goals- by achieving a certain number of steps for instance. This move by the NHS brings us one step closer to achieving a patient-centric health service, a more integrated solution.
Trust is a valuable commodity and in the words of American business magnate, Warren Buffett — “It takes 20 years to build a reputation and five minutes to ruin it.” The greatest issue is not so much the fact that you have been lied to, but that it then becomes so much more difficult to trust.
Trust is especially valuable when it comes to our privacy, and what is more private than our most intimate data — our personal medical records. In May, Sir Alex Ferguson, Britain’s most successful football manager was admitted to Salford Royal hospital after suffering a brain haemorrhage. After emergency treatment and less than a month in the hospital, Sir Alex made a good recovery.
After an audit of the Trust’s computer systems however, it became evident that a number of staff members- Two doctors, a senior consultant, and two nurses allegedly gained unauthorised access to Sir Alex’s private data.
Doctor Chris Brookes, chief medical officer for the Northern Care Alliance NHS Group, which runs Salford Royal, said of the incident- “We can confirm that a number of staff who work at Salford Royal are currently subject to investigation in relation to an information governance breach… All of our patients have the right to expect that their information will be looked after securely and accessed appropriately. We take patient confidentiality extremely seriously.”
Human error is not the issue here, curiosity shouldn’t be a variable in the privacy of our data since ideally, this shouldn’t even be a possibility. The Information Commissioner’s Office (ICO) is the UK’s regulatory body charged with enforcing data protection legislation and bringing regulatory action against those found to have breached data laws. It regularly deals with health-related cases and states that within its figures for Q2 of 2018/19 alone, there were a total of 4,056 data security incident reports within the sector.
What can Hospital Trusts do to earn our trust? Doctor Chris Brookes, chief medical officer at the site responsible for Sir Alex’s breach also stated — “We take patient confidentiality extremely seriously and will take the appropriate action to ensure staff understand the seriousness of unauthorised access.” Does that mean staff were not previously aware of the seriousness of unauthorised access? Does that statement guarantee this won’t happen again?
If hospital sites and CMOs wish to redress the issue they should reconsider their solutions, since trust is built through actions, not words. Successful relationships, including doctor-patient relationships, are built on the foundation of trust. This isn’t automatically awarded to someone due to a title, but earned, and as each Doctor and healthcare professional represents the sector as a whole, their reputation affects the NHS’s reputation.
Advising someone not to be curious is not enough, we should have firm and robust measures to protect patient data. Around the world, companies are considering using blockchain technology to help with privacy and data safety as they have done for the financial sector. it is time to block unwarranted access so that we can rebuild some trust.
The UK’s Department for Health and Social Care has announced this week, that it will be providing £78 million to establish electronic prescribing and medicines administration (ePMA) systems in NHS Trust sites. There will be an initial share distributed to 13 selected NHS trusts, with a total of £16 million funding for 2018/2019 between them.
The reason for this decision is to move away from handwritten prescriptions which cause many issues within the system. Health Minister Stephen Hammond said, “As part of the long-term plan for the NHS, we not only want to harness technology to make it one of the most advanced healthcare systems in the world but crucially to improve patient care… The funding provided for these trusts will help to drive these changes to the patient experience, but will also aid our hard-working and dedicated staff… The introduction of electronic prescribing is not only known to reduce medication errors but also frees up time for staff by moving away from archaic systems.”
The benefits of ePMA systems include:
The reduction in potentially deadly medication errors by up to 50% when compared with the old paper systems.
The creation of a more complete electronic health record.
Dispensers can reduce use of paper, have improved stock control, and provide a more efficient service to patients.
Patients can collect repeat prescriptions from a pharmacy without visiting their GP, and won’t have a paper prescription to lose. In turn, freeing up GP time.
This is a great move to advance the UK’s health system for the benefit of service providers and patients alike.
A research body conducted by university academics from Manchester, Sheffield and York, identified more than 230 million medication errors a year that took place in the NHS. The report also stated that an estimated 712 deaths result from avoidable adverse drug reactions (ADRs). Furthermore, these ADRs could be a contributory factor to between 1,700 and 22,303 deaths a year.
Fiona Campbell, Research Fellow from the University of Sheffield’s School of Health and Related Research, said: “Measuring harm to patients from medication errors is difficult for several reasons, one being that harm can sometimes occur when medicines are used correctly, but now that we have more understanding of the number of errors that occur we have an opportunity to do more to improve NHS systems.”
A personal case in point occurred recently. On a weekend away within the UK, I became aware that I’d forgotten to bring my inhaler with me. Usually, the asthma is not a problem, but there was a lot of heavy walking and a log fire involved which seemed to exacerbate the issue.
Upon attending a local pharmacy I came to an abrupt roadblock as the pharmacist refused to sell me an inhaler over the counter, instead insisting I give her a paper copy of my prescription.
If I didn’t have my inhaler I certainly wasn’t going to have my prescription with me, so I asked if she could make a discretionary judgment as I had no means of providing the prescription and I mentioned the NHS website, which says:
“If you urgently need medication, contact your prescriber immediately to arrange a prescription. If this isn’t possible, you may be able to get medicine from a pharmacist in an emergency, subject to certain conditions.”
This is when she also quoted the NHS website and relayed to me:
“You must have been prescribed the medicine before by a doctor, dentist, nurse independent prescriber, optometrist independent prescriber or other healthcare professional, who is registered in the UK.”
Here was the alleged issue – I had no evidence that I had been prescribed Salbutamol previously, other than knowing what it is and wheezing at her over the counter.
The next step was to call up my home GP and ask them to send evidence of my repeat prescription to the pharmacy. The GP uses a system called EMIS, the Pharmacy I attended used a rival software, TPP. Therefore both could not communicate with each other to verify my need for this inhaler whilst I became more breathless and wheezy as time went on.
The solution to the issue? (although it is perfectly legal for the Pharmacist to make a judgment call on a solitary inhaler to a wheezing patient, they are registered health professionals for a reason you know):
I needed to register with the local medical practice
Meaning I needed to consent to the medical practice obtaining all my previous medical records
To then book an appointment to see the doctor
To then wait another 2 hours to get to see the doctor- taking up her lunch time
To obtain a prescription I already have on repeat
To go back to the pharmacist that turned me away to get an inhaler
The entire process took over 3 hours all the while physically no better off, which proves the point even though anecdotally. The current system is archaic and not in harmony with the times we live. Almost everything is digital – even the local old man I bought wood to build a fence from accepts online purchases and Google Pay.
The utilisation of electronic prescribing will streamline the present health system and save the NHS financially, by limiting cases of litigation as a result of ADRs and wasted appointments at GP practices (inhaler). Patients will benefit by being able to avoid unnecessary trips to their GP and in having quick access to their medication upon a visit to any cooperative pharmacy.
According to the Office for National Statistics (ONS), in 2014, a total of 6,122 suicides were recorded in the UK for people aged 10 and older (10.8 deaths per 100,000 population), with suicide being the leading cause of death among young people aged 20-34 years of age. This equates to approximately one death every two hours, with around 75% of these being male.
Suicide is not a mental illness in itself, but rather a desperate attempt to control the overwhelming symptoms of the underlying mental health disease; making it the ultimate consequence for many mental illnesses. The Adult Psychiatric Morbidity Survey found that young people aged 16–24 were more likely to report suicidal thoughts than any other age group, with females in this age group having the highest levels of suicidal thoughts than any other demographic.
It is easy to rattle off a long list of statistics to prove a point, but there is a greater issue involved here, 72% of people who died from suicide between 2002 and 2012 had not contacted their GP or a healthcare professional about these feelings in the year leading up to the event.
There are a multitude of reasons to why patients are not reaching out for help. Severe depression and anxiety can make simple tasks such as going outside or calling your doctor too difficult. Simple everyday processes become a barrier to accessing help. It may be difficult to get access to a GP or a Doctor they trust, they may lack faith in the system to help them or are poorly informed about the help available, and the general stigma associated with mental health.
Although society and the media is trying very hard to change perceptions of mental health and the stigma associated with it, it remains a part of the problem. Stigma comes from multiple fronts. There is the social stigma inherent in a society, which can be localised due to the demographic disparity. Then there is a self-imposed stigma from the perception of the sufferer, at the possibility of being labelled as perhaps self-absorbed, their symptoms self-inflicted or unimportant. Either way, the fact that stigma exists around mental health compounds the suffering. Sufferers may feel it is a personal weakness or failure on their part, but the reality is that it is a disease that needs treatment and is ultimately not their fault.
If stigma, isolation and lack of availability of help compound the issue, the converse must also be true. People who receive support from caring friends and family, and who have access to mental health services are less likely to act on their impulses, however those impulses manifest.
According to the Care Quality Commission, evidence suggests that the number of children visiting A&E for mental health treatment has more than doubled since 2010. Many services are even failing to meet NHS guidelines for an out-of-hours crisis service.
Dr Nick Waggett, Chief Executive of the Association of Child Psychotherapists commented on the current state of the sector – “We do hear stories of children and young people having to have attempted suicide on a number of occasions actually before they are seen within the service… The problem is that then they’re very ill and it actually becomes increasingly difficult to offer them an effective treatment.”
I started this article to break the ice, stating the worst case scenario, but these points are just facts. Just as it is a fact that mental health is a continuum, the extremes are quite distinct, but the variations in between are gradual. If the number of fatalities represent one extreme, even though so prevalent, there will be so many more who are affected along the scale.
Everyone has mental health and just as everyone has different states of physical fitness, everyone has varying states of mental health. The two should not be thought of as separate since mental health plays a major role in your ability to maintain good physical health. Mental illnesses, such as depression and anxiety for example, affect your ability to participate in healthy behaviors.
Clearly there is a need for mental well-being to have the same prominence as physical well-being. Not to compare mental health disease with physical disease, but to appreciate that they coincide. Clinical depression is an illness that should be treated by a health care professional or a mental health professional, in as much as diabetes, arthritis or hypertension needs treatment.
Since the openness and access to sources of care and support can mitigate the risks associated with mental health issues, especially the prevalence at which these issues affect the young, we should publicise any available resources.
Tom Madders, Director of Communications, Campaigns and Participation at Young Minds, an organisation dedicated to tackling the issues around mental health in youth states- “Most young people spend much of their time online, and it can feel easier for them to communicate through messaging and online services than face-to-face”, this is where services such as Kooth come in. Kooth is a platform which offers online counselling and emotional well-being support for children and young people through a community of peers and a team of experienced counsellors.
It would seem that the use of health apps is an indispensable convenience and even preference which should be more widely adopted by local health organisations, including the greater health and social care system as a whole.
Many services are failing to meet the demands of those in need and the last thing which should happen if they have been able to reach out; is for young people to be rejected from a service they believed could help them. Whether there be a top-down, or bottom-up dissemination of these resources, it doesn’t matter, so long as access is made available. Anyone can download an app.
A helpful summary of available apps to support mental health well-being can be found here:
As the Digital Revolution gave rise to the beginning of the Information Age, the control of data became the defining characteristic in human civilization. Data is everywhere, and informs most of the decisions we make on a daily basis.
This advancement has been progressing at a rapid pace in every aspect of modern day life, except perhaps within the health sector. The need for evidence based technology is so ingrained in NHS culture, that anything new is often viewed with suspicion and cynicism. This leads to a scenario where tradition reigns and innovation effectively plateaus.
Within this sector, medical professionals use data collected from groups of patients to identify issues associated with certain conditions, which is then used to develop more effective treatments and management techniques. Having the right data at the right time (and knowing how to use it), not only improves quality of life, but can save it. It is logical then that barriers are broken down to make way for greater use of data in the health sector.
A step in the right direction is the newly formed ‘HealthTech Advisory Board’. This board is made up of IT experts, clinicians and academics. They will report directly to the Secretary of State for Health and Social Care and its roles will include:
Assisting in policy creation.
Challenging decision making.
Acting as a sounding board for new ideas.
Health Secretary Matt Hancock said: “I want the UK to have the most advanced HealthTech ecosystem in the world. That starts with improving the technology and IT systems in the NHS and creating a culture of innovation so patients can benefit from cutting-edge treatments while reducing the workload of staff… The new future-focused HealthTech Advisory Board will bring together tech experts, clinicians and academics to identify where change needs to happen and be an ideas hub for how we can improve patient outcomes and to make the lives of NHS staff easier.”
Chair of the board Ben Goldacre said: “I am delighted that Matt Hancock has created this board to inject challenge and diverse expertise around better use of data, evidence and technology in healthcare… I hope we can bring positive change for staff and patients, and realise the Tech Vision with a cutting-edge 21st century NHS. Medicine is driven by information: better use of data can revolutionise health care.”
We are unlikely to see an instance of metamorphosis with the NHS becoming a paragon of health and social care given its capacity for change. But we are now in a position to ask the right questions, to evaluate the status quo, and start to break down some of those systematic barriers.
Many will be familiar with the impromptu visit to the local hospital. That anxious rush to arrive at the reception desk to register your arrival with the admin staff on hand, to then need to sit and wait with the other attendees until you are eventually called in for assessment, then after no short while finally on for treatment, transfer or discharge. Or perhaps you have entered the system more subtly, via a referral from your GP to an outpatient appointment.
Either way, this is the most many of us will ever experience of this healthcare juggernaut. To filter through the various departments when the need arises. You will have noticed however the timescales involved between appointments, that oftentimes they seem to take longer than we’d like. This is something we might not appreciate.
A fitting analogy to help us see the overall picture is traffic flow. Each leg of a route can be thought of as an individual ‘process’ in the overall journey. As variations in speed at different legs of a journey can equate to delays, each ‘process’ affects the efficiency of the entire journey as a whole.
Just as the flow of traffic is improved by controlling the variation in the speed of cars and the havoc stop-starting causes in the endless lines of caterpillar-esque traffic, the flow of patients can also be improved by understanding the causes of variations of processes within the healthcare system.
Whole healthcare systems have been analysed: from GP practices, to ambulance services, secondary care, tertiary care, and including social services. This work has shown that improving patient flow across health and social care systems is beneficial to patients and staff alike in many ways, such as: • improving the clinical outcome and experience of patient’s journey. • eliminating waits and delays. • saving time and effort by avoiding duplication of work. • saving money from the cost of overtime, waiting list initiatives, locum and agency fees. • improving the trust of the healthcare organisation.
The need to apply Quality Improvement shouldn’t be viewed as a box ticking exercise either, but rather, as healthcare organisations dedicated to the welfare of the general population and the NHS, they have a responsibility to identify and review these processes with statistical accuracy so improvements can be implemented and audited. That should mean taking into account all the costs related to any process, including the loss of income to a patient attending an appointment and the impact of transport on public health. The inefficiencies of our health system impact on the general health of our society as a whole.
In order to deliver high-quality healthcare, establishments must start to think in terms of value and sustainability; this means the need to identify a balance between cost and outcomes (value) and long-term impacts (sustainability). There is no ‘one-size fits all’ solution to the inefficiencies we encounter in the current healthcare system, but there are innovative solutions to address many of these sticking points; healthcare organisations need to acknowledge these deficiencies honestly and utilise new technologies to advance care for all.
A case in point is whether there is a legitimate need to physically attend a consultation. If there is not, are we not then forcing a one-size fits all solution to a legacy issue without taking advantage of the modern day tools at our disposal?- As Apple’s trademarked slogan goes, “there’s an app for that”.
Outpatient appointments and the sheer number of users flowing through a system may be the bread and butter of many establishments, but the reality is that cost is borne out in more than how taxpayer contributions are expended.