Creating Engagement - The Health and Social Care Digital Service

Yesterday the HSCIC started the first steps in another interesting procurement – the Health and Social Care Digital Service (name, fortunately, not final!). Building on NHS Choices, a hugely successful site in its own right, with 30m visitors a month – 50% on mobile – the new site aims to improve the experience even further for patients, plus add feedback and transactional functionality. With 80,000 articles on the current site this is no trivial website refresh!

Timescales are to finalise the design approach by November, begin procurement in early 2014, with final contracts by April.

John Couthard outlined his vision for the platform. He considers this a vital part of helping deal with the £29 billion shortfall the NHS is staring at right now. The case for digital is compelling; 85% of UK adults have been online at least once, and in the last year there has been a 34% increase in internet use amount the elderly*. Conversely, in some London boroughs only 20% of people are registered with a GP practice. In reality, this leads to reliance on emergency services like A&E. It’s clear that clear, well signposted online resources can have a part to play in easing this pressure and reducing inappropriate attendances – whether to A&E or indeed to GP’s.

At the moment, however, a startlingly small 13% of the UK population are ‘engaged’ in their own care. This compares to 26% in France and higher in the Nordic countries. Clearly, we have a long way to go. For analogy, internet banking, which is oft citied as a corollary to online health care took 12 years to mature in the UK market. This is not going to happen overnight.

John set out four steps to achieving higherparticipation – Inform (which the current Choices does exceptionally well), Feedback, Transact and Participate. While this is correct, we see the stages as part of a cycle, rather than four discreet steps. Patients may go through the cycle several times, learning from their previous engagements or notes left by others. The real challenge, however, is getting the cycle started.

Much like internet banking, there are trust and familiarity issues to overcome. To start that journey users (note: I deliberately refer to users, not patients here; the two are not quite synonymous) must be offered what they want - an easier, quicker, less frustrating way to interact with their care. It is not possible to force a change in habits. There must be a base reason to use digital services. Online must earn its place by simply being the best option.

Once that is normal, comfortable, then, and only then, can the innovative leaps that will change the way services are delivered begin. It is this which will keep the NHS free at the point of care in the face of great pressure. But we cannot cut corners. This is a journey, and simple, safe, transactional services are the first step.

*Elderly is a poorly defined term but without the original source I'm afraid will have to do!