Author: Alison Griffiths

 “You book a table in a restaurant these days—or even an appointment at the hairdresser—you’ll get a text message 24 or 48 hours in advance to remind you. Why doesn’t the NHS do this?”

Speaking on the BBS’s Laura Kunessberg show, the Health Minister, Wes Streeting, highlighted SMS text messaging as one element of a new NHS programme which aims to cut waiting lists and increase convenience for patients. Now there is nothing new in the idea of SMS text reminders. As far back as September 2012, our article “Reducing no shows” commented on the way in which some health providers were already sending appointment reminders to patients by text or e-mail. And indeed, the ability to send appointment reminders is one feature of the Clinic Appointments diary management service alongside other features such as onscreen consent signature forms, the ability to manage clinical notes online, and the management of multi-attendance events such as fitness classes or meetings.

But perhaps it is the combination of an expansion in SMS texting with other technologies which the Government hopes will cut down on no-shows and smooth out the patient experience. According to the Government announcement, one of these technologies looks to deploy Artificial Intelligence algorithms in order to identify where appointments are more likely to be missed in order that preventative action can be taken. This might include arranging for patient transport or chaperones, or simply providing reminders in a form which the patient can identify with.

Another plank of the new drive to cut waiting times is the recognition of the part which private health care providers can play in delivering patient care. Two areas specifically targeted in the initial phase are gynaecology with more than 260,000 women waiting more than eighteen weeks for treatment and orthopaedics where more than 40% of patients are waiting longer than the set time period. This drive to partner with independent providers is underpinned by an agreement between the NHS and the independent sector dated 6^th January 2025. The agreement not only covers referral and payment processes, it also looks at aligning NHS and independent sector digital systems, encouraging long term contractual relationships, and working together to develop the elective workforce.

Set alongside community diagnostic centres and surgical hubs the inclusion of private providers aims to both increase choice and speed up the pathway from diagnosis to treatment.  An expansion in the functionality of the existing  NHS App is also expected to enable people to self-refer in some circumstances as well as being able to monitor the progress of their treatment pathway.  As Wes Streeting commented this new approach should help to put people “in control of their own healthcare.” He also commented that: “The NHS should work around patients’ lives, not the other way around. By opening community diagnostic centres on high streets 12 hours a day, seven days a week, patients will now be able to arrange their tests and scans for when they go to do their weekend shopping, rather than being forced to take time out of work.”

Whether looking at quality and outcome, cost-effectiveness, or safety; the value of patient partnerships as a means of healthcare delivery cannot be underestimated. As the Patients Association comments: “In a well-resourced system, patient involvement enhances services and drives them towards excellence.”

Key to that partnership are approaches such as shared decision making, actively seeking patient input, and integrated patient-centric services; all of which can be enhanced by the appropriate use of technology.  And it does seem that scarcely a week passes by without some new announcement on the deployment of new technology within healthcare provision.

At a high level, systems such as the NHS Federated Data Platform are being used to provide an overview of resources, thereby enabling better planning on patient throughput. In the year since its release 87 NHS acute hospital trusts and 28 integrated care boards in England have signed up to the system. Notable successes include one trust reporting a 37% reduction in the number of days patients stayed in hospital, whilst an average increase of 114 inpatient theatre treatments per month have been seen across those trusts which have signed up to the new system. Commenting on the system Ming Tang, Chief Data and Analytics Officer at NHS England, said its many benefits include: “the ability to identify those on waiting lists for longest, highlighting issues that could lead to on the day cancellations of procedures, showing when operating theatres are lying empty and speeding up discharges so patients get home faster.

So technology can help healthcare organisations to provide better and more targeted treatments, thereby potentially positively impacting waiting lists and patient health. But technology can also help on a more patient-centric level. A recent report on the BBC online service looked at whether wearable tech could help the patient-healthcare provider dialogue. This followed on from the current Health Secretary’s announcement of a review into whether wearable smart tech could help patients to track existing health concerns and feed data back to their healthcare providers.

The BBC report concluded that whilst including wearables in the healthcare mix could be of benefit in some instances, there is a danger that relying solely on wearables could result in patients either developing hypochondria or at the other extreme not acting on symptoms which should have resulted in a healthcare visit. Commenting to the BBC Pritesh Mistry, digital technologies fellow at the Kings Fund, said that whilst there is “a good case to be made” for including wearables in the healthcare mix it may be a challenge, “without that underpinning foundation of technology enablement in terms of the infrastructure, and supporting the workforce to have the skills, knowledge, capacity and confidence.”

Amidst all of the discussions about the way in which future technologies could benefit patient-clinician healthcare partnerships, we should not sideline existing technologies which have been benefitting the relationship for years. The deployment of simple online appointment booking services can help both patients and healthcare deliverers; particularly if delivered in tandem with SMS text reminders. Even the ability for healthcare providers to outsource call handling as required to a specialist provider can free valuable clinical time whilst enabling patients to receive a more personal response at a time when they need it most.

Electronic scanners, virtual hospital beds, digitised patient records….: no matter how technological the health solution, every journey towards recovery often starts with a simple phone call. And that’s never more the case than when the call is an emergency.

And yet, there are still far too many instances when that phone call is delayed. Alarmingly a recent analysis of NHS data has revealed that when it comes to strokes, the average time delay between the first onset of symptoms and a 999 call for help was eighty-eight minutes. For a condition in which every minute of delay reduces the chances of recovery, that’s an alarming statistic. Particularly so when you consider that some 100,000 people in the UK experience a stroke each year with 38% going on to lose their lives as a result. 

So what is the problem? Are people so used to making routine health appointments online or via an app that they are reluctant to pick up the phone? Alternatively, are people just not aware enough of the early symptoms of a stroke that they don’t even think of calling for help in the first instance?

Helpfully another new survey might have the answer. Following a number of campaigns there does seem to be a reasonable level of awareness about the FAST (face, arms, speech, time*) mantra for stroke recognition. However, 57% of those surveyed believed that an individual should display two or three signs of a stroke before a call should be made. As a result, despite each one of the face, arms, speech symptoms being enough on their own to signify an emergency, 64% of people for example wouldn’t dial 999 if someone was struggling to smile.

In a bid to overturn this perception, the NHS has commissioned a new advertising campaign which will run across TV and radio. The campaign, which will run until December, illustrates each of the face, arms, speech stroke signs and underlines the importance of acting on just one of these indicators. The campaign launch also features a film which shows stroke survivors listening back to recordings of the calls which saved their lives.

It is hoped that boosting awareness of something as simple as being unable to smile at the TV, not being able to lift a paint brush, or suddenly struggling to read a bedtime story, might trigger an earlier 999 call and thereby improve the chances of a fuller recovery.

Commenting on the campaign Dr David Hargroves, NHS national clinical director for stroke and consultant stroke physician, said: “When someone has a stroke, it’s estimated they may lose around two million brain cells a minute, which is why rapid diagnosis and treatment is critical – the first sign of a stroke might not seem like much, but face or arm or speech, at the first sign it’s time to call 999.”

   *

Face – One side of the face may start to droop, and/or it may become hard to smile

Arms – One or both arms may feel week and it can become hard to lift the arm and hold it aloft

Speech – Words become slurred or confused

Time – The quicker you phone 999 the better

Is a work life balance simply a matter of finding the time or energy to switch away from work and embrace home time? Well not entirely if a new report by the Royal Society for Public Health (RSPH) is anything to go by. The report has spotlighted some of the challenges which an aging workforce will place on health providers.

Over the last forty years, the number of people in England aged over 50 has increased by 47% with those aged over 65 increasing by 52%. Not only does this aging population place a strain on existing public health resources, with the aging demographic also reflecting in the workforce the challenge facing health providers is that of finding ways to ensure that their people can stay as fit and healthy as possible in order to continue to provide a good level of service.

As the RSPH comments “With an ageing workforce comes more workers who require support with long term health conditions, and potentially reduced levels of mobility.” And with over half of workers having a long term health condition by the age of 60 and with a quarter of those aged over 55 considering leaving work due to their health, that challenge is considerable.

One solution proposed by the RSPH is to provide early access to preventative and targeted occupational health services alongside workplace and working pattern adjustments as required. In other words, resetting the work life balance in order to help people to stay in employment for longer.

Interestingly this approach ties in with a new NHS health check initiative which is being rolled out to workplaces across the country. Over sixteen million people are eligible for an NHS health check but just 40% of those eligible actually participate in the programme. The hope is that by rolling the checks out into workplaces, those at risk of cardiovascular and other diseases might be identified earlier. This in turn will enable early interventions which could help people to bring their work life and health balance back on track.

Commenting on this programme Jaguar Land Rover Chief Medical Officer, Dr Steve Iley, said:

“Health checks are a fundamental part of prevention and therefore feature in many of our programmes. Our collaboration with Solihull Metropolitan Borough Council on the workplace cardiovascular disease checks pilot presents a unique opportunity to work together on providing awareness and signposting for our employees.”

Even with programmes such as these, the pressure on health practitioners and health services will continue to grow unless technological patient management and treatment solutions are adopted. One solution for those with mental issues is the integration of digital therapies within mainstream treatment plans. It is estimated that in the 2023/24 year the demand for talking therapies reached an all-time high with 1.82 million referrals. Enabling people to use digital therapies under the supervision of a trained practitioner could save around 6,000 therapist hours per 1,000 people currently receiving talking therapies. Similar results are anticipated for those with depression or PTSD.

Aside from being able to provide a more flexible treatment plan, the saving in therapist hours means that more individuals can be seen and helped in a short time frame; again helping individuals back into the workplace whilst relieving the pressure on health practitioners.

Whether providing consultations or referrals, interventions or ongoing treatment plans; for all health professionals the prime consideration is to act in the best interests of their patients. Those best interests also extend out from the treatment rooms and into the day-to-day practice areas, from reception and administration to the security of patient data.

When carrying out duties such as booking appointments or providing follow-up information, the important part played by health practice administrators was illustrated recently in the 2023 National Cancer Patient Experience Survey. The cancer workforce plan acknowledges the key role played by administrators. And this is reflected in the survey, with 87% of patients commenting that the administration of their care, which the survey defines as “getting letters at the right time, doctors having the right notes/tests results, etc” was either very good or good.

So timely correspondence and the efficiency of patient notes management is important in helping to provide patients with the reassurance which they need when undergoing treatment. And the knowledge that their data is being kept in a secure environment also helps to provide additional reassurance. Particularly so in a time in which the National Crime Agency (NCA) has highlighted high levels of cyber-crime; in particular the danger of ransomware and supply chain attacks alongside compromised social media, business and personal e-mail accounts.

The NCA recommend an initial three step approach which consists of:

• Protect your accounts by using a strong and different password for your email using three random words and by turning on 2-step verification.
• Protect your information when using social media.
• Select online providers and retailers which offer good protection for you and your data/information.

In addition, the NCA recommend that organisations follow the cyber aware advice and framework which can be found on the NCSC Cyber Aware Website. Recognising the importance of data security, on 3 September 2024 the National Data Guardian (NDG) and NHS England announced a plan to change the way in which health organisations assess their data protection and security capability and preparedness. This change will require the gradual phasing out of the current model in favour of the one promoted by the NCSC Cyber Awareness framework (CAF). Initially the change will only affect a few larger organisations but the intention is for all health providers to transition in due course.

According to the announcement, the CAF will benefit organisations in two ways. Firstly, it helps organisations to develop a long-term roadmap of yearly incremental improvements. And secondly, as the CAF focuses on achieving outcomes it enables organisations to apply strong governance and cyber security principles. As a result, health providers are empowered to implement flexible data protection measures which best serve their organisation, patients, and service users. This flexible approach also helps to change their model as new threats arise.

Commenting on the change Dr. Nicola Byrne, the National Data Guardian, said that the transition to the Cyber Awareness Framework: “represents a positive evolution, offering organisations a more current framework for evaluating and improving their data protection and cyber resilience.”

On Wednesday 28th August 2024 the Paralympic Games open in Paris. Since its inception in 1948 as a small event for war veterans, the Paralympics has grown to be a major force in promoting and highlighting disability inclusion. The first competitors only had archery and netball to choose from. In 2024, athletes will compete in 549 events across 22 different sporting disciplines.

In Paris, the ParalympicsGB squad will be made up of more than two hundred athletes, between them aiming to beat the Tokyo total of 124 medals. But the Paralympics represents far more than simply a desire to ‘go for gold.’ ParalympicsGB has three aims: to provide equitable access to sport, to champion disability inclusion, and to transform understanding of disability.

To this end over the last year more than forty thousand young disabled people have been helped to be physically active with over ten thousand people each month being helped to find inclusive sport opportunities near them. Perhaps most importantly ParalympicsGB promotes the Social Model of Disability, which says that “disability is caused by barriers in society, not by a person’s medical condition.”

Removing those barriers requires input and awareness from society as a whole with every aspect from infrastructure to communication potentially having an impact on inclusivity. However, it is also true that helping disabled individuals to optimise their talents can also require a strong input from health professionals and others in related disciplines. And we should also remember that individuals may require a multi-disciplinary approach. For example, those with physical disabilities may also require mental health support; particularly if they are facing inclusivity battles.

The publicity surrounding the Paralympics may also encourage those who would not normally see themselves as disabled but might be struggling with some aspect of their lives to pick up the phone and seek help. Whether that is something as simple as a sprained ankle or something far more complex, the positive impact of seeing those with disabilities competing on the world stage can act as a catalyst for individual change.

Admittedly, in the same way that not all individuals across society can look to participate in the Olympic games, not all disabled individuals will be able to, or want to, take part in Paralympic competitions. But as one South African Paralympic physiotherapist commented in 2021: “The Paralympic Games is an exciting opportunity for rehabilitation professionals to get knowledgeable about different sports in their area and how their patients can get involved. While there are avenues to get classified and participate at a national and international level most people only need help to get past the barriers keeping them from participating locally.”

Research has also shown that the success of Paralympic athletes can have an impact across society. One survey by ComRes revealed that 84% of UK adults saw the achievement of ParalympicsGB athletes as having a positive impact on society with 74% seeing the team as inspirational.

Commenting on this research Nick Webborn, Chair of the British Paralympic Association, said: “This research is the strongest proof yet of the direct link between the success of our talented Paralympic athletes and its wider social benefit.” He went on to say that: “We believe that the success our Paralympic stars achieve on the field of play can be turned into meaningful, long-term action – turning the nation’s cheers into change and those medals into a movement.” ​

We may have passed the longest day of the year but it is only now that the heat of summer is starting to be felt in the UK. On 24^th June the UK Health Security Agency (UKHSA) and the Met Office combined to issue a four day heat health alert. And although no area of the country saw an official heatwave, in which temperatures go above a set threshold for three days in a row, the end of June did deliver the promise at least of a hot summer.

After a cooler than normal spring, the prospect of a few days of warmth is inviting. But there is a difference between warm temperatures and the soaring mercury which can have a serious impact on our ability to function. And for those working in health related areas, that impact cuts across patients and staff alike; increasing workloads at a time when minds feel dull and limbs heavy in the excessive heat.

That’s when even small interventions such as taking regular water breaks and eating small amounts regularly rather than big meals can make a difference. So too can taking steps to shift routine workloads such as phone answering or appointment management to others in order to create time and space to step back and reset mind and body for the work ahead.

Perhaps it is a good thing therefore that people are starting to take more notice of the impact of heat and looking for ways to mitigate it. Certainly, visits to the NHS heat exhaustion advice page more than doubled in the first two days of the heat alert period; with more than twenty-eight thousand visits to the page. And the more publicity this potentially dangerous side-effect of summer receives the better.

According to a Red Cross report ‘Feeling the Heat’ in the summer of 2020 more than two and a half thousand excess deaths occurred due to summer heat in England. That figure is expected to treble by 2050. Babies and young children, the elderly, those who are pregnant or have a range of underlying health conditions are more vulnerable. However, despite the Red Cross report commenting that only 9% of adults believe that they are vulnerable in heatwaves, heat stroke can affect anyone.

Heat exhaustion on its own isn’t necessarily life-threatening. Unless, that is, if individuals fail to treat it swiftly by cooling down and replacing lost fluids. That’s why knowing when to stop and take a step back is so important. Symptoms of heat exhaustion can include tiredness, dizziness, headaches, and feeling sick.

When not treated on time or if there is prolonged exposure, particularly to physical stresses in hot temperatures, heat exhaustion can develop into heat stroke. When this occurs the body’s temperature becomes dangerously high. Other symptoms might include fast breathing or shortness of breath, a fast heartbeat, confusion, a seizure, or loss of consciousness. Without rapid intervention heat stroke can lead to a swelling in the brain or organ damage and can be fatal.

Over the last five years the proportion of people aged over sixteen in England who report long-term back, joint, or arthritis problems has little changed.  Standing at 18.8% in the year ending March 2018, the figure as at the year ending March 2023 had only eased slightly to 18.4%.

That’s one reason why the WorkWell scheme which we covered in our May 2024 article is so important; helping individuals to live and work with long term including musculoskeletal conditions. This new data also helps to illustrate just why those who work in fields such as physiotherapy, osteopathy, and pain management are under constant time pressure as they look to meet the needs of those with ongoing musculoskeletal problems.

Delve beneath the data and some interesting trends emerge. The numbers of emergency hospital admissions for hip fractures in the over 65s and rheumatoid arthritis prevalence in the over 16s are little changed over the time period covered by the data. However, the prevalence of osteoporosis in over 50s has risen from a low of 0.17% in 2014/15 to 0.97% in 2022/23. This echoes an ongoing trend over a longer time period which experts have put down to an increase in worldwide population aging.

According to the International Osteoporosis Foundation, the condition is now being seen as the fourth leading cause of chronic disease morbidity in Europe, behind ischemic heart disease, dementia and lung cancer. And although osteoporosis is primarily a female disease, statistics show that the residual lifetime risk of developing osteoporosis in men aged over 50 is actually higher than the risk of them developing prostate cancer.

The musculoskeletal health data was one element of a suite of new health trends in England data released by the Department of Health and Social Care. The underlying data comes from Fingertips, a large public health data bank. According to the Department of Health and Social Care the data will now be updated and released on a monthly basis.

Other health trends data released as part of the same programme looks at areas such as life expectancy, smoking, obesity, childhood development and anxiety. Here again the underlying data makes interesting reading. Some, such as the graph showing deaths from preventable causes, reveal quite clearly the effect of the Covid Pandemic on mortality rates. Other graphs potentially might indicate the benefit of proactive interventions or improved medical care. For example, stroke prevalence has seen a rise from 1.7% to 1.8% over the past twelve years and yet deaths from strokes in the under 75s has fallen from 15.2 to 12.6 per 100,000. Sadly, some of the statistics provided starkly illustrate a worsening health challenge with diabetes, heart failure, atrial fibrillation and hypertension all revealing upward trends.

Clinic Appointments offers backup services to practitioners primarily working in the health sector. From telephone answering and diary management to the provision of patient records software, Clinic Appointments aims to provide a professional service to clients of health providers, thereby enabling the providers in turn to focus on client treatments.

In the 2023 Spring Budget the Government announced their intention to introduce a Work Well programme. This, it was anticipated, would be designed to Integrate work and health support, thereby helping individuals who might be out of work, or at risk of falling out of work, due to health conditions.

One year on and more information has been issued about the roll-out of pilot WorkWell schemes. Fifteen areas of the country have been designated to run pilot schemes, starting in October 2024. These range from city conurbations such as Birmingham and Solihull, Greater Manchester, and North West London to more rural or mixed population areas such as Cornwall and the Isles of Scilly, or Lancashire and South Cumbria.

Within these fifteen areas the intention is to initially identify some 59,000 individuals who would benefit from integrated health and workplace support. It is envisaged that those identified in the first instance would be in work but suffering from a mental or physical condition which has resulted in their being signed off work on a long-term basis. Individuals will be able to self-refer to the WorkWell service, or they may be referred by their GP, employer, or other local service.

Support on offer by the WorkWell service will start with a personal assessment, following which an agreed support and therapy plan will be put in place. This may include physiotherapy or mental health counselling, but will also include employment advice and referrals to other local resources such as training or support groups. Crucially, the programme appears to understand that individuals may require multiple levels of assistance. For example, the announcement cites an individual whose back pain may be so severe that it also has an effect on their mental wellbeing and that therefore they would require physical and mental health therapies.

As an aside, an interim report from a three-year project on the effectiveness of digital mental health technologies (DMHT) has highlighted the patient perception that DMHTs should be seen as part of a wider treatment package which might include regular therapy sessions and/or medication rather than as a substitute treatment option.

Initiatives such as the WorkWell scheme highlight the important role which counsellors and other health professionals such as physiotherapists can play in supporting people to return to or stay in work. Commenting on this Ash James, director of practice and development at the Chartered Society of Physiotherapy (CSP) said: “Additional support to help people stay in work, or return as quickly as possible, is obviously a good thing and physiotherapists are experts in identifying a person’s needs and putting place a rehab plan, including any adaptations that can be made in the workplace.” However, they also highlighted the pressures being faced by health professionals including staffing.

Meanwhile Matthew Taylor, chief executive of the NHS Confederation, said: “with the right support, people living with poor health and long-term conditions can find that good quality work helps prevent them from becoming more unwell. This helps people to live a fuller life, which in turn reduces pressure on health services.”

There is little doubt about the increasing part which technology such as data, phones or the use of apps has to play in the delivery of health services. Nor is there any doubt about the way in which, properly planned and executed, technology can save time and resources whilst enhancing patient outcomes. To illustrate this we have chosen three stories which were released in March 2024, but we could easily have picked many more.

Our first example comes from the Arthritis and Musculoskeletal Alliance (ARMA) an umbrella organisation which brings together ‘patient organisations and professional bodies representing the breadth of musculoskeletal health.’ Their report into the impact of living with musculoskeletal conditions makes a number of recommendations for professionals including supported self-management, shared ownership of services and moving services into community spaces.

Importantly, the report also highlights the importance of having ‘robust and accessible epidemiological, clinical and outcomes data’ in order to better target the help needed. Not only that, once providers have a better understanding of potential barriers they can draw up programmes and communication methods which will speak more directly to those in need of help.

The second example arises from an initiative to improve telephone contact across GP practices. Trials of a digital system which enabled GP teams to better manage multiple calls resulted in over a thirty percent increase in patients being able to contact their practice. Meanwhile one Warwickshire practice reduced the number of patient-abandoned calls by 90%, simply by analysing call data and ensuring extra staff were on hand during peak times. Of course, not all health practices will be able to provide extra staff in that way but that is where additional phone answering back up such as that provided by Clinic Appointments comes into its own. We can provide as-needed call answering and appointment booking capabilities when health practices are stretched.

Our third technology story also comes from the NHS, this time reporting on a new prescription feature within the NHS App. This enables patients to not only order their prescriptions via the app but also to see when those prescriptions have been issued and sent to a nominated pharmacy. The app also now includes a feature which enables individuals without a nominated pharmacy to use an embedded barcode to collect prescriptions from any pharmacy.

The increasing popularity of the NHS app has resulted in a 79% increase in use from February 2023 to February 2024 with twenty-nine million views in the most recent period. Commenting on the app Dr Vin Diwakar, National Transformation Director, at NHS England said: “We’re delighted to see so many people making use of the NHS App’s new prescription feature. The service is one of many features on the app, which is helping to reduce the administrative burden for general practice as well as making it easier for people to access NHS services.” And of course, the more that people become comfortable with the NHS app the more that they are likely to accept other interactive technologies across health services such as online booking with secure card processing as required.