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Dr Brian Gaffney - The return on investment of delivering health services online - an NHS Direct Case Study
1. The Return on Investment of delivering health services online
– an NHS Direct Case Study
Dr Brian Gaffney John Simcock
Medical Director and Charity and Health
Director of Public Health Sector Manager
2. The return on investment of
delivering health services online
Dr Brian Gaffney, Medical Director
3. “ Population growth and the aging of that
population is leading to an increased
pressure on the NHS. Traditional face to
face cannot keep pace with future
demand, nor would it be affordable.
Digital services can help bridge this gap
”
5. Access
contains
62 million people
82% are internet users
or 51 million people
Internet World Stats 2010/Neilson Online
6. The market for digital healthcare
of internet users look for
75% health online (38 million)
of users looking at health on
46% the internet are trying to self
diagnose (18 million)
McDaid & Park, 2010
8. Access
91% = 57 million
27% = 14 million
of adults
49% = 2.5 million
of teens
93% = 58 million
Ofcom Communications Market Report 2011
9. Why multichannel for health?
Improve access
allow the public to interact where they want to
Improve the service
deliver something other channels can’t
Create demand
encourage use of the service by making it available in more places
Create cost efficiency
deliver services for a lower cost
10. Is digital appropriate?
Digital healthcare delivery has been shown to:
increase access to care
increase patient empowerment
reduce costs
achieve equal or better quality of care
Nijland et al 2009, Umeford et al 2006, Bodenheimer et al 2002, Kerr et al 2006, Samoocha et al 2010
12. The urgent care environment
Patients are confused by the urgent care environment,
despite national and local campaigns
13. Online health and symptom checkers
Online tools
Quick and easy
to use
Expert driven
assessment
14. Simple to use
Patient is guided through questions, step by step
15. What are the outcomes?
Online symptom checker
Referred
Callback
Self care Web chat to GP,
from
advice Pharmacy with NHS A&E,
NHS
online Direct Dentist or
Direct
999
Decreasing demand on core NHS services
16. The cost of NHS treatment
*
£219 ***
£8-12
£95
*
- or -
**
£0.12 ****
£32
* DH Reference Costs 2009/10 *** Connecting for Health/University of Sheffield, Second Interim Report, Oct 11
** PSSRU Unit Costs for Social Care 2009/10 **** NHS Direct service evaluation 2012
17. GP patient contact time by relevance
A&E case
Minor – does not
require HCP Genuine medical
case for GP
Only 1/3 of GP contact
Practice nurse
relevant case time is spent with
appropriate patients –
Digital could deal with
Social care many of the rest
Worried well
Aviva Health of the Nation Report July 2011
18. What’s the impact?
1% reduction in
face to face consultation
saves the NHS £200m
Department of Health, 2011, Innovation, Health and Wealth
19. Effect on the health economy
£57 million
Saved in the health economy in 2010/11
26. Operational model for content
Our objective is reach and usage, and to
achieve this we adopt a model that is:
Platform agnostic
Destination agnostic
27. Dr Google
Online information dominated by search engines, so high
visibility is key – people may not look for your service, but for
the thing they want to do
32. Conclusions
Digital healthcare delivery has been shown to:
increase access to care
increase patient empowerment
reduce costs
achieve equal or better quality of care
Nijland et al 2009, Umeford et al 2006, Bodenheimer et al 2002, Kerr et al 2006, Samoocha et al 2010
33. What to do about it?
In your service can you:
allow patients to choose digital
instead of face to face?
shift labour intensive tasks online?
make admin tasks like appointment
bookings available on the web?
35. Thank you for listening
Any questions?
Visit Eduserv at stand 159
Notas del editor
Good afternoon [Introductions] For those who aren’t familiar with NHS Direct, we are an NHS trust and we currently run a national health telephone line on 0845 46 47, as well as a digital symptom checker service and a number of other smaller services. Today’s presentation is about “Future Health”. The NHS is going through a time of major change, and NHS Direct is no different. The commissioning structure is changing, and we’re changing as an organization. But for today, we’re taking a bit of a step out from the immediate future, and looking at some of the big drivers for changing healthcare in the future, especially as it relates to digital services.
There has been an explosion in the range of channels which the public use, and of course, brands and organisations have followed them to these channels, providing a much wider range of engagement opportunities to those which were around even 10 years ago. Successful organisations are doing a great job of engaging people through these new channels, and that applies across all sectors, both commercial and public sector. In fact, from a consumer’s point of view, they expect the same high levels of service regardless of who the provider is, whether it is John Lewis or the NHS. The change has been huge, and focused around technology.
The range of channels is now vast, to say nothing of the individual engagement outlets within them. From simple telephones, we’ve moved to mobile, with SMS and MMS marketing now commonplace From there have come smart phones and now tablets, encroaching on the computer market. Specialist devices like e-book readers are now selling in their millions, and more and more niche web connected products are coming on stream, from web connected trainers to internet ready light bulbs. So the logical answer if you’re a provider of any service is surely to be multi-channel?
91% of the population now has a mobile phone, and over a quarter of adults, and nearly half of teenagers - as of the middle of last year - had a smart phone, and I suspect that trend has only been upwards since. Digital TV had a penetration of 93% last year, and that will be near 100% by the end of this year, supplemented by the growth of internet enabled television, and the forthcoming launch of enhanced digital TV services like YouView. You can add to that other channels, like games consoles, which are in 54% of homes, with 22% of their users accessing other rich content like TV catchup or the internet.
There are four key drivers for successful change in healthcare, and especially for the NHS There are to improve access – helping more people access services, or find the information they need. This is especially true if you can target hard to reach groups, which includes quite a range, with your possibly expected segments such as those in deprived areas, and the socially excluded, but also includes young men, who are very hard to engage in healthcare You can also improve the service, making it better for the people who use it. Patient satisfaction is a key measure for NHS organisations, and for all those organisations wishing to provide NHS services. In a multi-channel world, we can think about this in terms of delivering services that wouldn’t be possible through other routes Of course, you might want to create demand for your services. In the NHS, this is sometimes seen as counter-intuitive, as increased demand is increased cost, but of course, here we mean ‘appropriate’ demand – making sure people present at the right time Lastly, a major theme for organisations, regardless of what sector you are in, is striving for cost efficiency. Multi-channel can be very effective in helping deliver this, and we are going to show you how we’ve achieved it.
Speaker long text: Patients are confused by the urgent care environment, and are not always sure where is best to go to deal with their particular problem. In spite of national and local campaigns, notable the ‘Choose Well’ campaign, tens of thousands of patients present to inappropriate points of care every year. Speaker fast points: Confusing urgent care environment National and local campaigns have not cleared up the confusion Additional key points: Choose well campaign does not include all points of care, and misses opportunity to point to signposting services like NHS Direct Additional Detail Urgent care can be served by any of: A&E Minor Injuries Units Walk in Centres GP Surgery Polyclinic Dentist Pharmacy Ambulance Service NHS Direct NHS Choices or other websites self serve Local urgent care helplines District nurse Notes:
If you think back, we talked about all the different options for urgent and emergency care. Now, here are some of the associated costs. We can see that every time you call 999 for an ambulance, it costs £219 If you go to A&E, and are seen by a doctor, without any tests or treatments, it costs £95. Your GP costs around £32 for a 10 minute appointment Compare that to the remote channels – On the telephone, the latest figures on NHS 111 reference price puts it at around 8 – 12 pounds per call, Or better still, a patient treating themselves with digital information can cost as little as five pence We saw a couple of slides ago the millions of contacts per year that we deal with digitally, and that creates a signficant number of people who then do not need to attend one of the traditional routes to healthcare
The end result is that last year, our one digital service saved the NHS 57 million pounds That is money that can be reinvested for further improvements in any of the areas we’ve mentioned.
So here is one future vision of how the NHS could look. Alayah is a 23 year old female. She has recently had her ear pierced, but in the last few days it has become red, sore an inflamed, and she is on holiday away from home. Alayah logs on the NHS symptom checker tool from her laptop
Last year, Professor Sir Bruce Keogh, the NHS Medical Director suggested that online consultations could become the norm for patients. In this case, Alayah could have an online video conference with a clinician, who can see the problem for themselves, and use this, along with other signs and symptoms, to come an appropriate conclusion which keeps the patient out of expensive primary care.
A remote clinician could refer on to a pharmacy for professional advice, and appropriate medication. Maybe in the future, this could extend to online remote prescribing, especially for recurrent problems or repeat prescriptions.