When Michael Seres became the 11th UK person to undergo a small bowel transplant, he started blogging about his experiences. He now uses social media to develop global online communities of patients, and uses WhatsApp, Facebook and Skype to interact with healthcare professionals.
These online tools give him faster access to healthcare staff and test results, as well as more control. “The biggest [benefit] has been much closer relationships with my clinical teams,” he says.
Technology has the potential to improve public services and transform the lives of people like Seres, but UK public services have faced challenges in moving towards more digital systems. So how much progress has been made?
Experts at a recent Guardian roundtable on the subject pointed out many positive examples of digital innovation. For example, Oxford city council has been using chatbot to help answer questions outside of office hours, while Aylesbury Vale district council has improved access to services via webchat and is using AI to provide more consistent, responsive answers to queries.
But Eddie Copeland, director of government innovation at charity Nesta, says it’s been a challenge to create cultural change in UK local government. Technology should enable “fundamentally different ways of working”, not just a “slightly shinier front-face”, he says. One good example is the Good Sam app, which alerts nearby trained first aiders when someone calls an ambulance. The app provides a map which can be accessed by more than 40,000 global responders, so they can help before the ambulance arrives. It’s more than just a new website, Copeland says; this app has provided extra support and created a new approach by tapping into a volunteer network.
Developments have also been made in data analytics. The London fire brigade uses predictive analytics to prevent future fires by providing extra safety advice to homes statistically considered high risk. Elsewhere, Transport for London is using Oyster and contactless card data to work out usage patterns, provide better services, and .send emails to people about routes that affect them.
There have also been many digital development in healthcare, according to Wendy Clark, executive director for product development at NHS Digital. They include the NHS app, which allows people to manage prescriptions electronically, as well as the 111 online service, which allows patients to get urgent healthcare online. “There’s now a whole set of products that are focused on patients being more in control,” she says.
But not all NHS trusts are doing well. “A lot comes down to local leadership,” says Sophie Castle-Clarke, digital programme lead at the Nuffield Trust thinktank. “A chief exec needs to push the agenda forward. Plus you need a digital workforce, such as data analysts and software developers, which are skills in short supply. And we need a reality check about how much all of this will cost.” There has been good progress overall in healthcare, but Castle-Clarke says the picture is still very patchy, with a lot to do to get weaker organisations in line with more digitally mature ones.
Technology has the potential to transform some aspects of social care. The Social Care Digital Innovation Programme, funded by the Local Government Association and NHS Digital, has enabled councils to work on new ideas, such as the biometric wearables being worn by people with autism in Wirral to find out what causes anxiety attacks. The device measures heart rate and body temperature, and the data can be cross-referenced with staff information on when and where an anxious episode occurred.
Digital systems have also made it easier to share information across the sector. The child protection information sharing service (CP-IS), set up by NHS Digital, makes it possible for alerts about vulnerable children to be made between social care workers and health services. Chris Elkington, its programme manager, says this means social care workers can spot when people bring abused children into different A&E departments to try and avoid detection. “In some cases we’ve seen missing 15-year-olds turn up pregnant in another county. By alerting social services we’ve been able to detain the men who exploited them and put the children back into care,” he explains. Clark says between 8,000 and 9,000 alerts are triggered every month.
Despite examples of innovation, there remain barriers to creating better digital public services. In 2018 there were still 5.3 million adults in the UK who were digitally excluded because of a lack of internet access or low levels of digital literacy. An IT skills shortage also threatens the ability to bring in vital digital expertise. Experts at the Guardian’s roundtable event pointed to the need for further cultural change within organisations and for some leaders to take digital more seriously. Digital-by-default systems have also been criticised, most notably with the online process of claiming universal credit causing problems for up to half of all claimants, according to the Department for Work and Pensions’ own figures.
Some people need to interact face-to-face rather than with technology, said Vicki Sellick, executive director at Nesta, at the Guardian event, while others prefer it. This could in part be down to concerns around sharing personal data with the state when private systems, such as Facebook and Amazon, have been questioned over their use of information.
Clark says NHS Digital has been working on programmes that focus on data protection and security, while Seres says that, for him, sharing data with public services is different. “There’s nothing I wouldn’t share to give myself a shot at staying alive longer,” he says. “But I do want to know what’s happening to my data.”
Globally, the Organisation for Economic Cooperation and Development has shown the UK to be behind Korea, France and Japan when it comes to making government data open, useful and reusable. Studies from IT management company Capgemini and IT consultancy company Sopra Steria also suggest the UK may lag behind countries such as Germany, France and Norway when it comes to digitising public services.
Seres, who accesses healthcare in both the UK and America, says he believes the US is more digitally mature. “It’s not that they use better tools, it’s their [mindset],” he says. “They’re more entrepreneurial and we’re more reserved.” But Copeland says it’s not helpful to compare, as every country has a different population size and unique challenges.
When Mike Davies, 53, who lives in Cardiff and has a mild learning disability, kept accidentally missing his doctor’s appointments, social services felt he should move into a supported home with 24-hour care. But then Innovate to Save, a project set up by the Innovate Trust that uses technology to allow people like Davies to live more independently, stepped in. Davies now has a virtual assistant to remind him about appointments and when to take his medicine. “Life’s changed a lot now,” Davies says. “I can stay in my flat.”
There may be a long way to go before we achieve truly digital UK public services that work for everyone. But for people like Davies, who has been able to regain independence, and Seres, who can “engage in life first and foremost” rather than being restricted by his health, the progress so far has been life-changing.