Written by Solicitor/Senior Litigation Executive, Kate Goodman
For the past few years, we have repeatedly heard about the impact of austerity on the NHS, and the need to prioritise. Despite austerity, the NHS has found a way to invest in new medical technology such as Proton Beam Radiotherapy, and NICE have approved more expensive drugs to treat more complex medical conditions.
Nevertheless, prioritising the medicine (and rightly so) has meant that some areas in the NHS, communication systems, have gone without much needed upgrades for many years.
However, this is about to change.
For example, how doctors communicate with each other, and their patients, is set to undergo one of the biggest modernisations in the history of the NHS.
In October 2018 the Government published a paper on the future of healthcare. This set out the technological vision for medicine in the hope of improving the quality of services, staff experience and to cut costs.
Furthermore, the envisioned goal was to put technology at the forefront of the NHS and for the NHS to “Lead the world on ‘health tech’.
So, where are we now?
Current methods of communication in the NHS
In December 2018, the Department of Health announced that the NHS was to stop purchasing fax machines, and that their use should be phased out by 31st March 2020.
In addition, this announcement intended to force the NHS to invest in new technology.
According to reports, 8,000 fax machines are still in use across the NHS, despite the fact there are several significant risks. The most significant factor in these risks is that a fax is ‘sent’ but not ‘received’.
Subsequently, for the WhatsApp generation, there are no blue ticks to signify if your message has been read.
Then there’s the more practical concern of whether there is enough paper loaded into the fax machine. Unfortunately, we see this time again in medical negligence cases. Often there is a note in GP records saying that a re-referral is required as the referral does not appear to have been received by the hospital, or a GP has not received crucial communication from the hospital.
Secondly, from a risk assessment perspective, patient care can be compromised.
A failure to send or receive an urgent referral could be catastrophic and the safeguards for identifying when referrals are not received are not effective enough.
Furthermore, whilst this may be stating the obvious,
individuals’ data is not well protected by use of a fax machine. The risk of a
piece of paper going AWOL and turning up somewhere it should not, is real.
Under the new GDPR ruling, a higher standard of protection of personal information is necessary, and therefore changes are required to ensure compliance with these regulations.
Following the announcements to phase out fax machines, it was publicised in February 2019 that the NHS was also going to ban the use of pagers for non-emergency communication by the end of 2021, with plans and infrastructure expected to be in place by September 2020.
The announcement comes after it was acknowledged the NHS uses (according to some estimates), 10% of the world’s pagers and they cost the NHS £6.6 million a year. This is due to lack of competition in the sector, with only one provider in the whole of the UK, and as pagers become more obsolete, one can anticipate the costs of replacement and repair increasing further.
The Department for Health has acknowledged that pagers have several
Pagers work when someone calls a number, and the person who receives the page is alerted to a need to either contact a number, or they receive a short text message advising their attendance is required elsewhere.
The difficulty with pagers is that they only allow for communication one way, and therefore either a recipient of a page needs to find a telephone to call the sender back, or they must attend face-to-face.
The amount of information provided, if any, is limited. As the Government stated, “This can interrupt work, waste time, make the prioritisation of tasks difficult and the evidence trail of communications is limited”.
Making every second count
In an NHS that has more demand for services than ever before, every minute is precious.
Considering the limited information communicated through pagers, this does not support the Government’s approach to data sharing which in turn is anticipated to improve patient care. It is therefore envisaged that moving forward, doctors will use mobile phones and apps to replace pagers.
However, you cannot ignore the backlash that there has been to the announcement to remove pagers from active service in the NHS. Advocates of the system have one simple fact on their side: Pagers work! What is more, they have worked for many years, evoking the principle ‘if it is not broke, don’t fix it’.
Doctors are attached to their pagers, and have used these for many years, successfully. The pagers work on their own radio frequency and they have good reception in hospitals, and there is no risk of interference with hospital equipment. Further, they do not rely on networks that can ‘go down’, or on WIFI which can leave any device theoretically open to interference. Pagers are also potentially lifesaving in emergency situations, particularly cardiac bleeps and a move to a potentially less reliable system is a cause for concern.
Time to replace the humble pager?
Some suggest the ideal Pager replacement is the use of mobile phones.
Moreover, it is positive that the government carried out a pilot project using ‘Medic Bleep’ to test this theory.
‘Medic Beep’ works in a similar way to WhatsApp but with additional safeguards. With GDPR in mind, Critics want to improve response times and greater efficiency.
What is more, using secure communications should enhance
communication between doctors, and theoretically improve patient care. However,
we cannot ignore that there will be drawbacks for the use of mobile phones.
Therefore, whether or not the humble pager needs replacing is certainly the subject of intense debate and that debate is set to continue.
Email is certainly a far more reliable method of communication than fax. Consequently, it is already in use in some parts of the NHS and many expect email’s use to grow exponentially in the coming years.
Use of read receipts are a way of confirming an email has been received and understood/actioned. From a practical perspective, this is useful for doctors making referrals and ‘knowing’ they have been received, reducing the amount of time that doctors and their secretaries spend chasing referrals. Encrypted email and use of ‘Drop Box’ or similar, also allows for safer delivery of information.
However, this touches upon an important point. There are risks of data breaches under GDPR when using emails.
If emails are to be the primary method of communication, there need to be safeguards to protect against data breaches, and there are numerous potential causes of a data breach:
- Entering an incorrect email address;
- Hitting ‘send all’
- CC’ing in people, rather than BCC’ing people (a good example is the HIV clinic email in 2016)
- ‘Fake’ email accounts being set up and used to obtain sensitive data
There is also an ever-growing risk of viruses and malware.
The WannaCry hack in 2017 was one of the most significant cyber-attacks globally in
recent years. It is suggested the ransomware spread to 80 hospital trusts, and
603 GP surgeries.
The impact was widespread, resulting in cancelled operations, cancelled appointments, inability to access computerised information about patients and millions of pounds of costs. It is fortunate that no deaths were reported as a result and no patient data was breached, but if there is a next time, the NHS may not be so lucky.
Telephone, Skype and virtual consultations
The use of telephone, Skype and virtual consultations are increasingly being used in the NHS and private sector as a means of communication between doctors and their patients.
Telephone appointments are already used in many nurse-led
clinics, such as Inflammatory Bowel clinics, and by GP surgeries across the
country. These are nothing new. There are some conditions where a face-to-face
appointment is simply not necessary, whether it is discussing test results, or
considering how a treatment or prescribed medication is helping, for example.
Often a physical appointment is simply unnecessary and using
alternative means of communication is time saving for all parties. Also, using
alternative communication can also be more environmentally friendly.
However, not all conditions are amenable to telephone or other forms of communication. There are times when a physical examination must take place and there is currently no way this can happen virtually.
We already see instances where GPs fail to make a diagnosis based on a telephone discussion with a patient. One might reasonably expect that a diagnosis can be made if the patient receives an examination in person.
It is important to remember, a patient has no medical training and does not necessarily know what is wrong, or what symptoms are, or are not, important.
Finally, not everyone has access to the latest technology. Many
elderly patients do not have access to the internet, whilst others do not have
phones that support Apps.
Some disabilities also make using such technology problematic so there would need to be alternative means of communication, such as face-to-face appointments, to avoid making healthcare inaccessible to patients.
Communication in the NHS, where do we go from here?
We’ve established the NHS needs to upgrade its communication systems, but officials need to be mindful of the potential pitfalls and ensure the appropriate infrastructure is in place to enable a smooth transition to any new technology.
For instance, one of the main obstacles preventing a technological upgrade is financial.
With increased patient demand for services and more expensive treatment, cash-strapped hospitals now need to find the money to also update their technology by the Department of Health deadlines.
The money available to health services only stretches so
far, and it would not be acceptable to the public for patient care to be
compromised by the need to update communication systems.
Buy now, impact future funding next year?
Healthcare services already need to put contracts to tender and this is likely to become an area of increasing interest for tech companies and App developers, which may help institutions to acquire the upgrades at a competitive cost.
However, they need to be mindful that what they spend now,
may impact on how much further upgrades cost in the future. Investing in
technology is a long-term commitment.
There also needs to be a degree of consistency across the NHS service. Recent reports say that doctors may need to log into as many as 15 different systems to access the relevant information they need for patients.
At present, there is no uniformity which increases the likelihood of crucial information going missing. If the ultimate plan is for information to be accessible across the NHS, there must be a unified, easy to access system. Currently, each trust, GP surgery and other health service will need to put their own plans in place. To this end, the government has established the Global Digital Exemplar programme, thereby identifying health trusts that have exemplary technology systems to help assist the drive towards excellence in IT.
The hope is good practice will extend to other trusts in the NHS, and therefore work toward a homogenous system. This dream is a long way off at present, but not impossible.