2014 marked ten years of Choose & Book, the online appointment service for NHS patients. Although it has been criticised by commentators and users, the tenth anniversary highlights a worrying gulf in technology innovation between the public and state sectors.
In this article, Peter Connor argues that the independent sector has not kept pace with a sea-change in consumer behaviour in the last decade. People are increasingly choosing to access services, including essential medical treatment, in a way which is most convenient for them – private sector providers ignore this trend at their peril.
From initial suspicion, many of us have adopted online shopping with wholehearted enthusiasm. It has taken longer for the web to become a mainstream channel for buying services – some still prefer the human touch – but there can be few people who haven’t tried internet banking, booking a holiday or flight, buying a cinema ticket or reserving a table in a restaurant. And more recently, on-demand mobile app-based services such as Uber (an app for ordering taxis) have allowed consumers to access amenities via their smartphone.
On demand apps are even spreading to the world of healthcare. In the US, a service called Medicast allows users in Florida and California to request a visit via their smartphone from a private doctor to their home, office or hotel room. Meanwhile, in the UK, the Babylon healthcare app was launched in April 2014, giving patients online access to a health professional, including consultants, who can suggest a diagnosis; advise them to see their GP or a specialist; or send a prescription to a pharmacy in the patient’s neighbourhood. The service is even registered with the Care Quality Commission.
There is currently a real buzz surrounding the potential uses of technology in the health sector. In September 2014, The Kings Fund, a leading UK health think tank, attracted over 500 delegates to its fourth International Digital Health and Care Congress and looked at the latest ideas and innovations, from Apple’s new smartwatch (which records the wearer’s daily activity and heart rate) to robotic surgery!
Access in the NHS
But access to specialist healthcare is an area where technology has already made a real difference. NHS Choose and Book was the public sector’s first attempt at creating a central appointments service back in 2004. It enables patients to make an appointment at a time and hospital which suited them and to compare providers quickly and easily (via a link to NHS Choices which provides ratings and patient feedback). According to Beverley Bryant, Director of Strategic Systems and Technology for NHS England up to 40,000 patient referrals are made through Choose and Book every day and over 40 million bookings have been made through the system to date.
Of course, Choose and Book is far from perfect (paper referrals are still being used) and it will soon be replaced with a new NHS e-Referral Service (scheduled for Spring 2015) which is intended to increase functionality and improve users’ experience.
It will be interesting to see how the new service is received but from the perspective of the independent providers, this should be a wake-up call.
To put it another way, there is something missing in this picture of progress. Access to treatment in the private healthcare sector is still arranged for the convenience of consultants and hospitals rather than patients. Indeed, from the time they are referred by their GP, the private patient is obliged to take on all the legwork and phone calls (with help from their PMI if they have one), from researching the hospitals and consultants, to making an initial appointment and potentially arranging follow up appointments for tests and treatment.
According to the CMA’s final report, the top reasons for people to purchase private healthcare are
- Reduced waiting times,
- Greater availability of appointments,
- Quality of accommodation
- Access to a named consultant
However, if we cannot offer patients an equivalent appointment booking experience to their NHS counterparts, we risk undermining our traditional selling points – flexibility and convenience.
The private healthcare sector is a competitive market which means centralised services such as appointment booking do pose a greater challenge than the centralised public sector but the latter has demonstrated that the technology exists and I think it’s achievable if we focus on the needs of our consumers.
Healthcode has produced a roadmap which sets out the different types of information that should be available to potential patients. The essential components include:
- A basic directory of services, who does what, where and for whom… and when;
- A common language or terminology – a consistent way of describing the services available in a way the consumer can understand;
- Reliable, understandable Quality and Outcomes information, that’s easily comparable to alternative options, both independent and NHS;
- Feedback from other patients;
- Information about charges for consultations and treatment (and whether this is covered under their policy).
In fact, the groundwork is already underway, even before the CMA published its information remedies, thanks to the work of the Private Healthcare Information Network (PHIN) which publishes hospital episode statistics (using Healthcode’s data processing power), enabling patients to search for a hospital by location and procedure. As the newly appointed Information Organisation, I’m confident that PHIN can effectively echo the work of the Health and Social Care Information Centre (HSCIC) in the NHS which sets data standards, collects information and helps healthcare organisations improve the quality of the data they collect and send.
What is needed now is a concerted effort by healthcare providers and PMIs to raise the status of IT within the sector. For example, I would like to see planning and investment in information technology receive the same priority as investment in accommodation, equipment and staff; and for industry leaders to become stakeholders in their organisation’s IT development and ambassadors for change. Most importantly, IT development strategies must focus on improving patients’ experience, as well as organisational networks and hardware.
For our part, Healthcode is ready to work with providers to drive forward the technology at their disposal in the interests of patient choice and accessibility. This includes helping to coordinate and develop a central appointment booking service which offers the same functionality and convenience as the next generation NHS version.
The way ahead
The internet did not transform our lives immediately. We all remember the interminable wait for a page to load when the World Wide Web was in its infancy. The trouble is, that the independent health sector’s IT sometimes appear to be progressing at the same glacial pace.
We need to adjust to the patient as a consumer who has become accustomed to convenient, online services. It is not too late for us to catch up with this new normal but if we don’t show we are focused on meeting the expectations of our patients, there is a risk that they will vote with their feet.