National Information Board’s Personalised Health and Care 2020: A framework for action sets out the role of digital technology in transforming outcomes for citizens and communities. Data and technology can lead to improved customer experience, convenience and choice; improved citizen-professional communications and shared decision-making; and realise efficiency savings. The ONS estimate that 82% of adults in Great Britain access the internet almost every day . 81% of the UK population have a smartphone (Deloitte 2016). However, there are also groups who are currently digitally excluded.
Commissioners need to be conscious of this group too so that any development of digital services does not contribute to increasing inequalities. Increased levels of digital access present opportunities to digitally enable frontline professionals and digitally empower patients, and create new ways to connect people and organisations involved in social prescribing (through online directories for example). Digitally enabled support is not for everyone, but there is strong evidence that the majority of the population want choice provided through multiple means of access and personalisation through an online account (NHS England 2015).
A more recent evaluation published by Tinder Foundation and NHS England (Tinder Foundation 2016) of the three-year Widening Digital Participation programme (an initiative set up to avoid inequalities resulting from digital exclusion) provides new evidence that socially excluded people can benefit from digital skills and enable them to take charge of their own health. The programme targeted and trained 221,941 people nationwide who fall into at least one category of social exclusion; people in receipt of benefits; disabled; the unemployed; BAME Groups and people aged 65 and over (see Table Three). This complements NHS England’s conjoint research that presents compelling evidence that the vast majority of people want self-service and access to health services in a variety of ways including digitally. There may also be opportunities to align future pan-London work in this area with the Greater London Authority’s (GLA) strategy for digital inclusion (Mayor of London 2015).
|41% of those surveyed say they have learned to access health information online for the first time (a further 32% have learned to do this more effectively||After learning about using the internet to manage health:
|65% of respondents feel more informed about their health||21% of learners made fewer calls or visit to their GP, with 54% of those saving at least three calls in the three months before being surveyed and 40% saving at least three visits over this period|
|% of respondents feel more confident using online tools to manage their health9||10% of learners made fewer calls to NHS 111, with 42% of those saving at least three calls in the three months before being surveyed|
|% of respondents feel less lonely or isolated and 62% feel happier as a result of more social contact2||6% of learners made fewer visits to A&E, with 30% of these saving a minimum of three visits in the three months before being surveyed.|
Making the most of online directories
Much of the debate surrounding choice centres on how to equip individuals, families, carers, community organisations and professionals with reliable and up-to-date information about the myriad of ‘hyper-local’ care and support options available within our neighbourhoods. In a social prescribing context, online directories have an important role in promoting local support, networks and volunteering opportunities to combat isolation, loneliness and alleviate social problems. Online directories should not replace social prescribing link workers but can provide invaluable assistance in planning and agreeing care plans around individual’s goals.
Across London, mirroring the national picture, many local authorities have invested in local online directories as a means of improving public awareness and access to a range of local care and support options. Healthy London Partnership carried out a rapid review of online directories that revealed considerable variation in terms of investment, public utilisation and local provider buy-in towards the directories available across London. Existing directories range from CarePlace provided across 19 London Boroughs and Shop4Support that provides services across the country to more bespoke local community directories (e.g. Hillingdon) and formal local emarketplaces (e.g. Enfield).
In Harrow, My Community E-Purse utilises the CarePlace platform to support people to manage their own personal care budgets and to make direct payments. Harrow Council introduced My Community E-Purse as a means of increasing the number of local personal ‘care’ budget holders, stimulate new entrants to the market and to realise back-office efficiency savings. Over a four year period, My Community E-Purse has seen take-up of Personal Budgets rise to around 750 local residents. The application is also linked to developing a vibrant local marketplace, through CarePlace, which has seen Harrow move from two block contracts and eight niche providers to 900 plus care and support options available to local people over a 4 year period. Harrow has also made significant savings in the processing and management of their personal budgets. These savings have been realised by replacing manual activities with automated processes. This has resulted in the streamlining of the process, reduced back-office administration costs and reduction in service provider charges. The Healthy London Partnership rapid review made the following conclusions:
- Online directories are widely available across London and have an important role in signposting the public and appropriate professionals to information on wider care and support options available in their communities
- Online directories are underused community assets. More could be done to promote through online directories public information and access to a wider range of ‘hyper-local’ care and support provided by non-statutory voluntary and community sector organisations ‘up my street’.
- A modest amount of investment is required in some areas to make improvements so online directories become more customer friendly and better meet the needs of the public (e.g. predictive keyword search, increased utilisation by voluntary and community sector organisations)
- Further work needs to be carried out to understand how London’s existing online directories can operate in a way to aggregate information, possibly through a meta-database. This could enable the development of a new social prescribing distribution model that allows GP practices to refer, navigators to signpost and the public to access a wider array of support through a holistic and scalable model that provides channel choice but does not replace the option to have face-to-face contact with a link worker. The rollout of Patient Online and the emergence of Babylon Health and Dr Now are examples of online GP services. As public demand for virtual general practice grows then so will the need to develop online methods for carrying out consultations, tailored health advice and referring to social prescriptions in addition to medical prescriptions.
Development to promote awareness of smaller voluntary and community sector
NHS 111 has developed MiDoS which is supporting front-line health and social care professionals with quick and easy access to local service information, which is available in a choice of mobile devices. The aspiration is for this application to be also available to the public and to include voluntary sector provision. MiDoS, similar to all the local online directories, needs to strike a balance when considering clinical, information governance and legal risks in terms of promoting services provided by voluntary sector organisations of various operational size. Commissioners may consider local campaigns to raise awareness of the benefits associated with local directories of services; market position statements or kite mark standards encouraging compliance with locally agreed on quality standards; ‘light touch’ assurance processes to attract the smaller voluntary sector organisations to see the value and sign-up to online directories, and release funding to the voluntary sector organisations to maintain and/ or host local directories to reduce the maintenance burden on the NHS. This may be a natural step as to remain relevant online directories will also need to evolve so they are maintained and monitored by local experts and communities themselves. The London Brokerage Network is an example of a self-maintained online brokerage which is for disabled people to find supporters for self-care (relating to personal budgets). ALISS in Scotland encourages people to upload and maintain their own entries.
Connect Well a online tool for social prescribing which is usually run in partnership with local infrastructure organisations like Councils for Voluntary Service (CVS) and Volunteer Centres. These local community experts work with VC Connect who assist them to run the Connect Well Social prescribing service in their local area. The local partners quality assure local community assets and services. Connect well can also support people into getting involved in their local communities through volunteering. Volunteering has been shown to have a more sustainable impact on well being, see the report produced by the Local Government Association, which puts volunteering at the heart of any social prescribing strategy.
Town Digital Hub is a free interactive website where towns/cities/regions can make their own digital hubs of community assets, which clinicians, link workers, social workers, and other providers then use to help clients make personal wellness plans. A typical wellness plan includes a personal support network, community assets, and public/VCSE providers that together support the client in achieving personal goals. Clients can give all those who support them permission to view their wellness plan, and use simple self-assessment tools to track their own progress using standard outcome measures. Over time, clients need less support, often taking full ownership of their wellness plan. Some clients go on to help others develop wellness plans, a form of volunteering for which they are uniquely suited and which helps boost their own self-esteem.
Elemental Software, a digital social prescription paltform developed by community development workers helps stakeholders in social prescribing to make, manage and report on the impact of social prescription referrals. A new partnership with EMIS Health sees EMIS Web clinicians able to view the status of referrals at different stages within the patient journey, helping them to better measure and monitor the impact that social prescribing activities are having on people’s lives.
- Town Digital Hub is a free interactive website for social prescribing that lets people manage all their life issues in a holistic way, and enables all those who support them to collaborate effectively
- Elemental Software is an easy to use, cloud-based, responsive platform that simplifies and streamlines the process of referring, enrolling and supporting individuals in local lifestyle interventions by enabling GPs in primary care and other stakeholders to refer within clinical systems to non medical support in the community.