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From the frontline: What do the people want?
Connected Nottinghamshire won Health Tech Team of the Year at the HTN Awards 2020. Alexis Farrow, Head of Strategy and Transformation for the programme, explains how her team set out to understand what digital solution would best support the wide spectrum of health and care needs for the people in Nottinghamshire. She found that solution in the NHS App.

Our team at Connected Nottinghamshire wanted to ensure we understood what mattered to our population, what challenges they faced and what tools they needed to support them to better manage their own health and care.

Rosie Atkin from the Connected Nottinghamshire is sat on the right of a local resident, showing her how to navigate the NHS App on a phone.

A resident learns how to navigate the NHS App on her smartphone.

The team undertook an 18-month long public engagement programme – reaching out to people in a variety of settings and events to gather views that reflected the local demographics.

We did this by taking health and care to our people, rather than expecting them to come to us.

We began with the obvious starting point, talking to patients’ groups in health and care settings, sitting down in GP waiting rooms and holding stalls in hospital corridors to talk to people. However, we soon realised we needed to reach out to other sectors of the population that wouldn’t normally engage with us.

Visiting events such as beer festivals and hosting roadshows that attracted people from all walks of life was pivotal in our engagement mission.

In addition to this, reaching out to young people was also a must. We went to talk to students at Nottingham College in order to understand their wants, needs and preferences from digital health and care services.

The clear message from the public was:

  • people wanted one single place to access their health records and GP services
  • they wanted a site that offered trusted and up-to-date information
  • they wanted to know that their data was being used in an ethical and secure way

This public engagement output, combined with our strategic vision, national policy and contractual requirement, enabled us to identify four key pillars required to provide effective public facing digital services to our population:

  1.  Different types of consultation - We needed to offer different channels for consultation, not just telephone and video, but also secure messaging for instance.
  2.  Information - Needed to be accessible, understandable and up to date and also be better targeted towards different patient groups and conditions.  Digital access to information that people could store in one place and refer back to was key, and it needed to be from a trusted source.
  3.  Community signposting - Signposting to on-the-doorstep community services was essential.
  4.  Self-care and management - Self care and management of one’s own health needed to be actively promoted and made available. Providing access to key information such as test results, care plans and prescriptions, as well as the tools to enable them to input into their own health and care record. This included tracking and monitoring their own symptoms and conditions and connecting Technology Enabled Care devices.

After understanding what mattered to our population, the NHS App appeared to be the perfect ‘front door’ for public facing digital services; it provided patients with the ability to access their records, make GP appointments and order repeat prescriptions. 

On top of this, the NHS App uses NHS login which provides a secure and re-usable way for people to access multiple health and social care services with a single login. NHS login can be used by the public to securely access their health and care information wherever they see the NHS login button.

Whilst this gave our population an easy method of interacting with their GP practice, to fully achieve our vision of integrating local services within the NHS App, we procured a personal health record solution through Patients Know Best to extend the functionality provided for primary care by the NHS App for all health and care organisations outside of primary care.

 

How the integration went

Connected Nottinghamshire worked in partnership with Patients Know Best, NHS Digital and NHSX to enable the first NHS App and Personal Health Record integration nationally.

The integration of Patients Know Best into the NHS App went better than anyone could have expected. The enhanced functionality appears completely seamless to the user. This now means if you are a resident in Nottingham or Nottinghamshire, you will see all the usual features of the NHS App, but also additional features which mean you can access hospital appointments, remote monitoring templates or care plans you might have on your personal record, for instance.

Whilst the NHS App and Patients Know Best integration offered all the functionality identified through our public engagement and research, there was another key element the public raised with us – that although they would like to use digital health and care services, some said they would struggle to because they didn’t have the skills, access or confidence to use technology. So we couldn’t offer this solution to the public and expect it to work just like that. We had to consider and engage with those people who were digitally and socially excluded.


The work continues

We undertook research to understand local exclusion levels using a great toolkit produced by Bob Gann and NHS Digital. From this we found those predominantly living in former mining villages and rural areas were less technologically equipped and skilled.

However, there was still pockets of digitally excluded residents in the city centre population. We discovered from a snapshot survey that the main obstacles preventing people from using the internet were that they were worried about internet safety, they didn’t have access to the technology and software and when they did, they found it difficult and too expensive for them to use.

Nottingham is ranked the 11th most deprived district in the country out of 317 districts according to the Indices of Deprivation 2019.

We also have a very diverse population with 7.8% of the 126,100 households having no members speaking English as a main language.

So language problems and low incomes were two major factors in preventing people from becoming part of the digital revolution.

So far we have introduced digital support hubs on the high street, where we would support visitors on something they really wanted to learn, like online shopping.

We’re continuing to talk to people from Black Asian and Minority Ethnic communities and groups such as Belong Nottingham and the BME cancer communities. We will be creating surveys available in different languages through our health literacy work with the Patient Information Forum to find out what challenges and barriers they continue to face and how we can overcome them.

So far we have introduced digital support hubs on the high street, where we would support visitors on something they really wanted to learn, like online shopping. It didn’t matter that it wasn’t about digital health and care as we needed to support them with things that mattered to them in order to give them the confidence or skills to join the digital age.

In order to make significant change, we needed to support the up-skilling of our workforce so we established a Digital Champions Network and trained 50 digital ambassadors across a wide range of organisations, from both clinical and non-clinical backgrounds. All champions are passionate about promoting digital tools and support us in championing the NHS App to other members of staff and to patients.

As a result, we're also working with the community and voluntary sector to provide further support directly to communities that's scalable and more sustainable.

As part of our digital inclusion project, we funded a tablet lending scheme through our own digital and social inclusion budget that helped people who simply couldn’t afford their own. However, people had to have broadband to make use of them, so that was quite limiting. We also found it took a lot of time to teach people the basic skills of navigating the internet and using the tablet.

As a result, we’re also working with the community and voluntary sector to provide further support directly to communities that is scalable and more sustainable. We offer grants to the Council for Voluntary Service organisations who want to support their own local communities by improving their digital skills.

The work on gaining access to technology and broadband for the digitally excluded continues.


The impact of lockdown

During March 2020, the coronavirus pandemic hit the UK which of course locked everything down and as a lot of patients were now shielding, we had to adapt to the changing landscape as it was more important than ever that people were not isolated. Our top priority was organising digital how-to sessions to teach people new digital skills.

We moved face-to-face interviews to digital platforms, offered one-to-one telephone calls for NHS App registration support, and loaned out tablets to enable people to participate in community support group Zoom meetings or access health and care services remotely.  

Whilst COVID-19 has caused many challenges to how we work, it has also motivated us to accelerate promotion of the NHS App. We now place the focus on digital communication and promotion methods such as radio adverts and social media, as opposed to traditional outside advertising.

We also used local vaccination hubs to display important messages on wipeable pull-up banners and recorded holding messages on the vaccination phone lines.


The key to success

The real key to successfully gaining support for the NHS App was enlisting the help of the community and voluntary sector, building networks with organisations that people trusted and we could rely on.

One example is with Ashfield Voluntary Action group which took advantage of the free training resources offered by the Good Things Foundation, a UK charity that works to make technology accessible to everyone.

The voluntary sector is keen on promoting the NHS App as they can see how easy it is to use and how beneficial it can be for local community residents.

And we are succeeding. In Nottinghamshire over 65,000 people have downloaded the NHS App and are using it in their everyday lives.

Connected Nottinghamshire’s ambition now is for 100,000 patients to be registered with the NHS App by April 2021 which is around 9% of the population.

We are well on target and believe the residents  of Nottinghamshire are beginning to really feel the benefits of being more engaged with their health and wellbeing.

This is the sort of feedback we've had:

"Communications and consultation arranging with my practice are easier through the app.

"Telephone lines can be busy at times and it is much easier to arrange an appointment. There is the added bonus of pre-advising the GP of my symptoms ahead of the consultation which is useful to the GP."

 

"I believe this is a useful tool for patients and NHS services alike and I will use it on a regular basis to keep myself and the medical professionals updated on health issues affecting me."

The impact of lockdown continues and with it, the need to accelerate the use of the app as far as we possibly can.


Related subjects

The NHS App provides a simple and secure way for people to access a range of NHS services on their smartphone or tablet.

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Last edited: 25 June 2021 1:55 pm