Dr Brian Gaffney - The return on investment of delivering health services online - an NHS Direct Case Study
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Delivering health services online through NHS Direct can provide significant returns on investment. Digital services increase access to care for the 51 million internet users in the UK and allow the NHS to meet growing demand at a lower cost than traditional face-to-face methods. Online symptom checkers and advice can effectively manage up to 1/3 of GP appointments by directing patients to the most appropriate care. This reduction in face-to-face consultations could save the NHS £200 million annually. NHS Direct's digital services saved £57 million in healthcare costs in 2010-2011 alone.
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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 ”
- 4. So, why be digital?
- 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
- 11. How to create value
- 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
- 20. A future vision?
- 21. A future vision?
- 22. A future vision?
- 23. A future vision?
- 24. Other uses? Online medicines Webcam review Self care follow up advice Digital healthcare GP-Patient- Pre-attendance Consultant questionnaire conference Webchat questions
- 25. How we distribute our content
- 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
- 28. Netdoctor
- 29. Channel 4
- 31. Conclusions
- 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?
- 34. Conclusion Digital is transforming healthcare With or without you.
- 35. Thank you for listening Any questions? Visit Eduserv at stand 159
Editor's Notes
- 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.