Digital health: the changing landscape of healthcare.

Healthwatch hear from people all over England about their healthcare experiences. Each month, Healthwatch England look at a snapshot of what they have to say about different areas of healthcare. This gives a window into how the public feels about how the system is working for them – and it can give an important indication of where it might need improving.

This month, Healthwatch looked at the stories people have shared about digital healthcare.

Digital innovations, such as technology to monitor medical conditions at home, the NHS App, and virtual appointments, are increasingly impacting healthcare delivery. 

In 2022, the Department of Health and Social Care laid out its plan for digital transformation. NHS England aims for most health and social care services to have digital foundations, such as electronic records, in place by March 2025. Right now, only 20% of NHS organisations are digitally mature.

This will transform the way people receive healthcare. It has the potential to lead to better tailored services, more targeted care, and fewer unnecessary interventions.

But for both the NHS and its patients to get the benefits of digital healthcare, it has to work well. 

What's needed?

Our work on digital healthcare shows digital tools work best when:

• The people who’ll use the technology have input into designing it, ensuring the tools work for people with different communication needs.
• Tools are tested to ensure they work as intended.
• Patients get information about the reason behind the new way of working, and specific instructions on how to operate new tools. 
• Tools are interactive and support two-way communication between patients and professionals.
• Safeguards are in place to ensure patients get alerts if the technology they’re using malfunctions and know who to contact for further support. 

Monitoring devices should also be free on the NHS or available to buy at low cost.

“It’s convenient and easy to use. It was inexpensive to buy. [My blood pressure] readings are more reliable as they tend to be higher when taken in GP surgery.” — Story shared by Healthwatch Hampshire

Over the last month, Healthwatch heard where improvements might be needed.

Technology can be hard, confusing, or time-consuming to use

We heard stories of online submissions taking a long time to process. It could be tedious to find the right information, according to one story, because documents and letters didn’t have titles. And multiple people struggled with uploading test results, such as their blood pressure readings.

“On the NHS app, not all documents have a title – it’s ridiculous, I have to go into each document/letter and read it, which wastes a lot of my time.” — Story shared with Healthwatch Surrey

Online booking caused issues, with someone sharing confusion because the online booking tool they needed was only available for a short window during the day. And Healthwatch Lewisham shared that they’d had multiple complaints about booking systems that didn’t work properly.

“Getting an appointment is becoming more difficult. I called recently and was told because my condition was ongoing and not urgent I needed to go to their website (not the NHS app which would be set up to make appointments). I did fill out the online form which isn't particularly user-friendly. I received a text with a phone appointment for 2 days later. 

It feels like another barrier has been added to get an appointment and I'm concerned for users who aren’t tech-savvy or have internet access!” — Story shared with Healthwatch Leicestershire

And despite the NHS’s hope that digital innovations could lead to a smoother, more joined-up system, this doesn’t always work. 

One person shared a positive experience of using 111 Online – the system directed them to their pharmacist, who was able to diagnose their child with impetigo. But the pharmacist couldn’t prescribe the cream needed to treat the condition. This meant the person had to go back through 111 to be directed to the local injuries unit instead.

While digital healthcare could keep people informed, it’s not always doing that

We heard stories about missing or incomplete information, such as that the NHS App, a cornerstone of the shift towards digitising healthcare, would show a referral to treatment, but didn’t explain what this was for. People also talked about vaccine dates not showing.

The missing information could mean people can’t benefit from the convenience of digital tools – like the person who mentioned that the NHS App didn’t have enough appointments available in the time frame they needed. This meant they had to ring for an appointment anyway.

Another person shared that they could order their prescription digitally, but the tool they used didn’t let them know when it was ready to collect.

Worse still, the information recorded isn’t always accurate

One person was getting notifications that their COVID vaccination is due as they have a compromised immune system – even though they don’t.

“They have me down incorrectly as having a weakened immune system. There is no easy way for me to correct this, no doubt there are thousands of others in a similar position so significant resources are being wasted.” — Story shared with Healthwatch Gloucestershire 

Even more seriously, another person found that their NHS App incorrectly showed a ‘Do Not Resuscitate’ flag on their medical records. Their GP surgery was unsure who placed it there, and couldn’t remove it. There were also other reports of people feeling that digital tools didn’t adequately or accurately capture their views and experiences.

And sometimes, digital options don’t suit people’s needs

Even when digital tools are available, people don’t always want to use them. Multiple people shared that they prefer to phone their healthcare providers, rather than using online tools. But in one person’s case, they were repeatedly directed to the online tool anyway – even though the GP surgery knew and agreed that they should be able to keep ordering over the phone.

And while apps could potentially provide helpful minor healthcare interventions, people shared that they weren’t happy with app-based support for areas like their physiotherapy or mental health.

This doesn’t mean it’s all bad news

Just as the NHS hopes is possible, we did hear from people who used digital tools like the NHS App to find the information they needed quickly. Others found it easy to use an online prescription system to order their repeat prescriptions.

And we heard positive comments from people whose GP surgeries used WhatsApp as a means for people to book appointments, allowing them to do so more easily – especially when there was good availability of appointments.

“I put an online medical concern in this morning on e-consult. Received a phone call about an hour later, appointment made to see a GP in the next 30 minutes, referral would be sent and all done and dusted. I have never had any concerns with my surgery, always felt they put the patient at the core and appointments provided in a timely manner.  Fabulous service.” — Story shared with Healthwatch Lincolnshire