Flexibility and mobility

We’re just embarking on a new experience within UK politics, with a coalition government that is having to make tough spending decisions. None of these should be more difficult than those affecting healthcare.
    
Today in the UK we spend around 9 per cent of our GDP on healthcare. That’s at the bottom of the international scale. In the US it’s closer to 19 per cent. By 2050 the US figure, if it continues to grow at current projected rates will hit 75 per cent – a figure that is evidently impossible. In the UK a few years ago, the Health Technologies Scenario report anticipated that if we continued to have strong economic growth we might manage to afford 10.3 per cent for healthcare in the UK by 2025. Events since that report suggest that its optimism is misplaced and we’ll struggle to continue to afford our current 9 per cent. Instead, we need to look hard at how to reduce costs.
    
The uncomfortable reality is that healthcare demand (and expectation) is growing inexorably. The consequences are already a known fact – a few years ago at a Continua Health Alliance meeting in London, Margaret Hodge, then Minister of State for Industry and the Regions, stated that the growth in Type 2 diabetes would, by itself, bankrupt the health service by 2017. She was right – something needs to be done. Yet the reaction of the new government is to ring-fence spending on health. It suggests a major reality gap.

A direct approach
There is always a problem in politics when the numbers involved become too large. Instead of forming a basis for a reformulation of policy, there’s a tendency to take the ostrich approach of sticking one’s head in the sand. During the election campaign, all three major parties pushed leaflets through my door saying how they’d spend more on local hospitals and safeguard the future of the health service. None contained a single hard policy proposal, just bland words of reassurance.
    
Of course, during an election campaign, selling cuts, particularly with regards to the NHS is not going to be seen as a vote winner. But after the election, it is worrying that health policy seems to be “more of the same”.
    
Unfortunately, I suspect that the problem is so big that politicians will avoid it for as long as they possibly can. Acknowledging increasing morbidity and the prevalence of long term chronic disease and then linking their rise to personal health culpability is not a vote winner, even when you may have five years to push it through. So healthcare remains too sensitive an area to touch, even when cuts are being made elsewhere.
    
Every bit helps
A few countries, of which Japan is most advanced, are beginning to tackle this by linking health benefits to proof of healthy lifestyle. Most others will have to follow. The further behind we fall, the greater will be the medium term problems and the eventual culture shock. It is unlikely that the NHS or any other Health Authority will be able to tackle it by themselves. It is not just a case of cutting or even containing costs, but of changing expectations and society’s involvement in taking control of their own health.
    
The size of the problem means that the solution is unlikely to be monolithic, but will come from a mixture of many different services that attempt to change different facets of personal behaviour. Mobile and personal web technologies can assist in this evolution. They are by no means a panacea, but healthcare will need to take advantage of all of the help that they can offer.
    
The reason for reiterating the issue in the paragraphs above is to emphasise the enormity and immediacy of the problem. There is a common consensus that mobile health applications will somehow solve the problem. They certainly have the potential to help. However, the bulk of trials of telehealth or eHealth applications generally have fewer than ten enrolled patients.
    
The UK is pushing ahead in starting some larger scale trials, with the current Large Scale Demonstrator of 3,000 patients. The Assisted Living Innovation Platform is now funding around a dozen projects, building up to a deployment that aims to enrol upwards of 10,000 patients. However, by the time either of these delivers any significant results, we will be halfway to bankruptcy. Mobile technology is a valuable part of the answer, but it is going to need to develop and be deployed alongside current strategies and initiatives if it is going to provide any timely changes.

The basics
The simplest role that mobile technology can perform is in helping the smooth running of a health service. At the most basic level that’s reminding patients of their appointments. For GP appointments the cost associated with missed appointments has been estimated to be £180 million per year. For the NHS as a whole, it’s approaching £800 million. Surprisingly, the largest group missing appointments is the 16-35 year olds, either because they forget or get better and don’t cancel. A number of companies have developed appointment systems based on mobile phones. The advantage over traditional appointment letters is that this most culpable group is the one most likely to use their phone. Text messaging is simple, cheap and gives the opportunity for the customer to reply. It has the added benefit of guaranteed delivery in the 24-48 hour period before the appointment, when the patient is most likely to respond as well as freeing them from the struggle of getting through to the GP reception. A number of companies offer simple appointment reminder systems that link into appointment software, automating the task.
    
As well as managing the patient, mobile technology is increasingly being used to track assets within hospitals, whether that’s equipment or staff. Wireless LAN technology is being employed in the form of small tags to log where equipment is located. The benefits are twofold – it’s a powerful tool to prevent theft, as an alarm can be generated if equipment is moved outside its expected location – a technique called “geofencing”. It’s equally valuable to track down the closest piece of equipment in an emergency, which can include a member of the medical staff. These monitoring tags are typically small, battery powered units the size of a box of matches that run for several years between recharging.
    
Locating staff can also be important when they’re working out in the community. That’s where lone worker alarms come into play. An extension of a mobile phone, a lone worker alarm typically includes a GPS (Sat Nav) system and mobile network connection that can alert a control centre when the worker pushes a panic button. It’s essentially a more mobile version of the fall alarms that are used by over a million people in their homes in the UK (which accounts for over 60 per cent of all fall alarms deployed worldwide – a figure to be proud of).

Assisted living
As the population ages (by 2025, 20 per cent of the UK population will be aged over 65), more needs to be done to allow them to remain living safely in their own homes. Wireless technology can help that by providing a monitored environment that will warn of any issues. A key component to this is a new low power version of Bluetooth wireless technology, know as Low Energy Bluetooth, which will start to appear later this year. It’s designed to connect a wide range of simple home sensors that can connect to the internet. These will allow monitoring services, which may be run by local authorities, independent companies, or even relatives, to ensure that the elderly are living safely.
    
Other monitors, which include basic medical monitors in clothing, can perform the same job using a mobile phone as a link, providing personal monitoring without institutionalising someone within their home. The longer a person can remain in their own, familiar environment, the better. Once they are admitted to care or hospital the cost of treatment escalates.

Health 2.0
The web will have an increasing effect on how we treat health information, and who we trust with our own health information. NHS Direct has been one of the pioneering sites for providing trusted information to patients. The web is now seeing the arrival of more interactive sites, often referred to as Health 2.0 sites, which invite a patient to enter their information to allow them to track their health or the course of a disease. Amongst these, the most prominent are www.revolutionhealth.com and www.google.com/health
    
These sites will grow as consumer devices for measuring blood pressure, heart rate and weight become available which can connect directly to the web. As well as recording data, these websites are likely to evolve to provide feedback about your condition. The business models behind these will vary. What they will do is to generate an increased amount of medical data, which is located outside the preserve of current healthcare suppliers. This dissemination of patient information will present a major challenge for today’s healthcare providers, as it breaks the structure that has been built up by the medical profession over the past few centuries. As such it will be disruptive – it has the potential to repeat the effect that MP3 and Napster had on music – and could change the whole landscape of healthcare and its ownership.

Conclusions
Changing demographics mean that the status quo of healthcare needs to evolve. New ideas from small companies, new technology, mobile networks and web businesses will offer a range of products and services that stand to complement or disrupt what we know and use today. The challenge for the NHS and others is to embrace what is useful and to engage in directing its development. There is a massive problem to be solved. The best route to that solution will be to combine the best of all worlds without indulging in bouts of “not invented here” syndrome. And to persuade our political masters to bite the bullet and change the way we interact with the NHS.

About the author
Nick Hunn is an executive director of the Mobile Data Association, where he promotes the development of eHealth. He is also involved in developing eHealth standards within the Continua Alliance and the Bluetooth SIG and advises on wireless connectivity and eHealth through his company – WiFore.