Can mobile health save the NHS?

With the election over and the coalition government announcing that it will ring-fence health spending, everyone is beginning to wonder what that means. There’s no indication that demand for health services will stop rising – all of the demographic data indicates exactly the opposite. And it’s unlikely that ring-fencing will mean expansion, rather than limiting the current spend.
   
This means that despite warm words from politicians, the NHS is going to need to tighten its belt and find more efficient ways to spend its money. That’s where mobile health comes in. The mobile industry has been quietly introducing a range of innovative products and services which help health professionals make better use of their time.
  
Mobile health applications face immediate challenges. The current consultations on Liberating the NHS by devolving commissioning to GPs will provide an opportunity to roll-out many new services. But that’s still a few years away. In the interim, there is a danger of stagnation as both PCTs and GPs wait to see how their respective budgets and responsibilities will change.  
   
Whilst they do that, I thought it might be interesting to make an optimistic forecast of how mobile health applications can deliver savings and efficiencies, based on reports and initiatives that have been suggested over the years. This is intended to demonstrate the breadth of savings potential. In the next issue, I’ll explore the applications already deployed within the NHS, along with new ones that may help in the transition to GP commissioning.

SIMPLE APPLICATIONS
The first important thing to realise about mHealth is that it doesn’t need to be complex. Although it keeps on getting rebranded by the industry to look new (it’s also been called telehealth, eHealth and wireless health), it’s been around for over ten years. High-tech James Bond stuff that grabs most of the headlines, with upmarket mobile ECGs detecting pending heart attacks, but most of what can be achieved is delivered through better management of resources and improved prevention.  
   
Public awareness of simple applications began back in 2005 when The Sunday Telegraph reported that missed appointments cost the NHS £575 million every year. For those that like measuring in non-SI units, that’s enough to pay for another 27,000 nurses or 8,000 doctors. The obvious solution is to send reminders to patient’s phones. Back in 2005, a large percentage of patients didn’t have mobile phones. In the intervening five years that’s changed and companies like iPlato have been successfully rolling out a wide range of SMS based services.  
   
The appointment numbers come from research that reappeared in more detail the following year, when Vodafone published a report it had commissioned from the Tanaka Business School. Titled ‘The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare’ it is still well worth reading. One of its interesting findings is the difference in the use of mobile and fixed line phones for calling NHS direct services. The research was done back in 2004, when mobile ownership and usage was nowhere near as widespread (or cheap) as it is today. In the age group 16-44, a group with one of the lowest levels of GP consultations, significantly more calls were made to NHS Direct using mobile phones.
   
The report makes interesting points about the additional access to NHS Direct that a mobile phone gives, particularly during the working week. This suggests that mobile access could be making a major difference in this age group accessing the NHS, which may have a positive knock-on effect on their health in later life. It raises fascinating questions about the way mobile usage of services is changing the patient/GP relationship.

IMPROVING THE LIFE OF PATIENTS
As well as looking at these simple services, the report also provides an indication of the how SMS reminders, coupled with cognitive behaviour programmes could improve the outcomes and quality of life for patients with asthma, TB and diabetes. Here the savings are more difficult to quantify, however, the suggestion is that better management of diabetes could substantially reduce hospital days. It puts the current cost of diabetes to the NHS at around nine per cent of the overall budget, and suggests that this could be cut by a couple of per cent with better SMS based management (and presumably connected measurement and reporting devices), equating to savings of up to two billion pounds.  
   
Thankfully TB incidence in the UK is low, at less than 10,000 people. Similar SMS compliance techniques are shown to be beneficial, having the ability to save around £10 million and 2,000 lives.
   
There are fewer apparent savings to the NHS from their asthma studies, but a significant potential for improving patient’s lives. That means a win for the economy, as asthma costs around £1.2 billion a year in lost working days. The report suggests that as few as 30 per cent of asthmatics are believed to be fully compliant with their medication, which costs the NHS £1 billion per year. Hence improving compliance could reduce the number of deaths from asthma, cut 20 per cent of the NHS medication bill and support the economy.
   
Another way to reduce NHS costs is to persuade people to bypass it for non-critical conditions. According to Lloyds Pharmacies, a new generation of internet savvy and iPhone toting mothers are dispensing with doctors altogether, diagnosing their children themselves and dosing them up at the local pharmacy.  In doing so, they’re allegedly saving the NHS £825 million a year in prescription costs. Taking that to the extreme, a recent episode of Channel Five’s Gadget Show compared self diagnosis using health monitors available on the high street, with their television GP, finding self-diagnosis to be just as effective. So Lloyd’s vision may not be so fanciful.
   
NESTA, the National Endowment for Science, Technology and the Arts, has gone even further and thinks that mums and doctors ought to get together to redesign healthcare. It’s a harbinger of the current NHS consultation on Liberating the NHS at a local level. Their report on ‘Patient Designed Services’ states that this could lead to savings of £15 to £20 billion over the next few years. Again, much of this is from simple diagnosis and the use of behavioural techniques to change the way we live. How better to do that than enlist the mobile phone?
   
Whilst doctors are busy at their coffee mornings comparing iPhone apps with parents, it’s worth making sure we take care of the remaining NHS staff who will inevitably end up doing all the work. They’ll be busier than ever in this new regime so it’s important to ensure they’re working at peak efficiency. Last year an independent report by Steve Boorman outlined how NHS organisations could tackle staff health and wellbeing and save up to 3.4 million working days currently lost to sickness within the NHS, equivalent £555 million per year. Once again, a lot of what is suggested can be accomplished through the use of mobile phones, text alerts and a new generation of simple, connected health and fitness devices.
    
STAFF WELLBEING
For a start, they could walk to work. The Ordnance Survey revealed that it had calculated the benefit of walking. By promoting walking, they believe that people could tackle their weight issues, reducing the incidence of early onset diabetes and saving the NHS half a billion pounds a year. There are already hundred of smartphone apps to help them do that, as well as free maps to stop them getting lost along the way.
   
You can still save the NHS money by staying at home. A more recent report, ‘Hospital care at home’ by Healthcare at Home Ltd and Dr Foster, has shown that the free provision of home-based hospital care could save the NHS £1.2bn. Most of these services rely on remote sensors – either in the form of assisted living sensors, or more critical connected personal monitors that use a GPRS data connection. mHealth triumphs again.
   
Having made my own calculations based on all of these savings, if we can use mHealth to achieve all of them, it accounts for almost £13 billion pounds a year – more than the NHS spends on drugs.
   
We have to question how real the savings actually are. At the beginning of this item we looked at the £575 million every year that could be saved from getting patients to turn up for appointments. That’s the equivalent of 27,000 nurses or 8,000 doctors. It’s a good, solid application that is already out there and working, unlike many others which are spoken of.  
   
There’s no denying that the mobile industry can help to increase efficiency and improve patient satisfaction. In the UK, Orange, Vodafone and O2 have all set up specialist mHealth divisions and are actively involved in piloting new devices and applications. If the government makes the major commissioning changes it is promising, GPs will need these more than ever. How they generate savings for the NHS will need careful work by both politicians and NHS staff to ensure they are properly integrated. What they are already doing is making the NHS more accessible to patients and improving their quality of life. In the next issue we’ll look more closely at how this is already happening.