Reform: Digital by default

Reform | September 2019 | Digital by default

The think-tank Reform has published Inclusive by Default, a new report assesses the causes of digital exclusion and what can be done to make digital public services inclusive by default. 

The communities that could benefit most from digital public services, however, are more likely to be digitally excluded – meaning that they lack the ability to access or utilise digital technologies effectively. The digitally excluded are more likely to be older, less educated, unemployed, disabled and socially isolated (Source: Reform).

Full press release available from Reform

Inclusive by Default

Digital inclusion

This report assesses the causes of digital exclusion and what can be done to make digital public services inclusive by default | Reform

Removing the barriers to digital inclusion and guaranteeing that digital public services work for those who are most dependent upon them is crucial to ensuring that the digitisation of public services does not exclude people.

The communities that could benefit most from digital public services, however, are more likely to be digitally excluded – meaning that they lack the ability to access or utilise digital technologies effectively. The digitally excluded are more likely to be older, less educated, unemployed, disabled and socially isolated.

As more public services are delivered digitally, there is an imperative to tackle the causes of digital exclusion. This report finds a lack of skills, motivation or the right infrastructure are some of the key factors that make digital exclusion more likely.

In addition to providing alternative routes for those unable to access digital public services, it is essential that these barriers are overcome. Designing accessible services, community support and partnerships across sectors are tools that can help to make digital public services inclusive by default.

Full report: Inclusive by default | Reform

Digital tools help improve access to healthcare for patients with hearing and sight loss

NHS Digital | October 2019 | Digital tools help improve access to healthcare for patients with hearing and sight loss

NHS Digital highlight the work of a project that looked at ways in which access to healthcare could be improved for patients with sensory impairments. In West Yorkshire and Harrogate the project – run by Leeds-based mHabitat – was designed to find out more about the challenges faced by people with hearing and sight loss in making and attending GP appointments.


To date 750 patients have benefited from a project designed to support improvements in accessing health and wellbeing services for people with hearing and sight loss. The project was part of a widening participation programme from NHS Digital. Country-wide,  20 digital inclusion pathfinders are being run in partnership with the charity Good Things Foundation to test new ways of helping people access digital tools to improve their health.


Over 50 people with hearing and sight loss discussed their experie nces of using primary care  and a small group also did walk-throughs of visits to a GP practice to show first-hand the barriers they encountered.  This led the project team to evaluate assistive technologies and apps these included:

  • Online appointment booking
  • Communication technology including note takers
  • An app that turns a mobile phone into a hearing aid
  • Apps which use artificial intelligence

This in turn gave rise to a list of apps and technology been created for GPs and other organisations to help them support patients with hearing and sight loss. The project also recruited 44 Digital Champions to share this information, including charities, service users and NHS organisations within the West Yorkshire and Harrogate Health and Care Partnership (Source: NHS Digital).

Read the full details of the project from NHS Digital 

Read the full case study from NHS Digital 

Using Online Consultations In Primary Care

Using Online Consultations In Primary Care: Implementation Toolkit | NHS England

GPs have always led the way in adopting new technology. This guide aims to support those individuals implementing online consultations as part of their role – in practices, within PCNs, CCGs or other organisations, with the successful adoption and seamless  integration of online consultations alongside face to face and other services.

This online consultation toolkit is an interactive document that provides a range of ideas and options for different professionals, including clinicians, at different points in their implementation journey.

Text message reminders increase attendance at NHS health checks

NIHR | September 2019| Text message reminders increase attendance at NHS health checks

An RCT assessed the impact of patients receiving a text message reminder as a means of increasing attendance at NHS health checks.  Currently, NHS health checks are offered to adults aged 40 to 74 years. Identification and management of cardiovascular risk factors has been shown to save lives. Yet only half of adults attend a check when it is offered.


This trial was conducted across 28 general practices in South London assessed the effect of sending pre- and post-invitation text messages, along with different forms of invitation letter.  Patients were first assigned to receive either a pre-notification text or not. They were then assigned to receive one of 4 types of invitation letter:

  • standard control letter, detailing the health check in several paragraphs
  • open-ended letter, briefly saying their check was due and asking them to call and book
  • time-limited letter, as open-ended letter but asking them to attend in a limited time period, such as ‘your check is due in March’
  • social-norm letter, as open-ended letter but adding testimonials from patients saying how the health check helped them.

Finally, they were assigned to receive a reminder text or not.

The reminder text appeared to be the most effective addition. For all three intervention letters (open-ended, time-limited and social-norm) fewer people attended a health check when a reminder text was not sent. Although the time-limited letter with both texts was most effective, there was not enough evidence to support the value of the pre-notification text.

Amongst invited patients, 24% attended health checks. This ranged from 18% of those sent the standard control letter with neither text pre-notification nor reminder, to 30% of those sent the time-limited letter with both text pre-notification and reminder. Comparatively, this latter group had almost doubled odds of attending (Source: NIHR).

Sallis, A., et al |2019| Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial| BMC public health| 19|1|P.  1-12.


Background: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.

Methods: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS – yes or no) x 4 (letter – national template control, open-ended, time-limited, social norm) x 2 (reminder SMS – yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC.

Results: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder; 10 percentage points for the open-ended letter with reminder and a 9 percentage point increase using the time-limited letter with reminder. The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect.

Conclusions: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance.

Full article available from BMC Public Health 

Manchester study: Smartphones could transform patient care

University of Manchester | August 2019 |Smartphones could transform patient care, finds study 

A smartphone app used remotely to provide information on parents with arthritis could have the potential to transform the care of patients with long-term conditions reports a study now published in the journal Rheumatology.

Remote Monitoring of Rheumatoid Arthritis (REMORA) study designed and tested a system to support clinical care and research, enabling people living with RA to report daily symptoms using a smartphone app with data integrated into the electronic health record (EHR). The study  evaluated the system’s acceptability and feasibility including exploration of participants’ views and experiences of remote monitoring, with specific focus on how integration of smartphone data into the EHR in graphical format influenced consultation


A sample of 20 patients’ data from the app was uniquely integrated into their EHR at their hospital, with the data summarised as a graph visible at their outpatient visit.

The app, jointly designed by patients, clinicians and researchers, allowed patients to input what symptoms they were experiencing each day and the impact it had on their lives.

Their doctors used the data generated by the app when carrying out face to face consultations.

The system provided a “bigger picture” than doctors would otherwise get, capturing “symptoms that would otherwise have been missed”.

And the graphs generated by the app made it easier for patients to participate in consultations and treatment, enabling a shared discussion between the patient and their doctor (Source: University of Manchester).

The authors’ report that:

  • Daily remote monitoring using a smartphone app was viewed positively by patients and completed regularly.
  • Graphs of patients’ daily data identified changes in disease that would otherwise have been missed.
  • Patients valued consultations being focused around their own data, supporting person-centred care.

Read the full news story from University of Manchester



To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA.


The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically.


Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients’ RA more visible by providing the ‘bigger picture’, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.


Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

The full article can be read at Rheumatology

Alternatively, download a copy here 


Hundreds of lives saved through new tech to spot sepsis

NHS England | August 2019 | Hundreds of lives saved through new tech to spot sepsis

An innovation that uses algorithms to to read patients’ vital signs, alerts medics to worsening conditions that are a warning sign of sepsis, has saved hundreds of people from sepsis.  The new ‘alert and action’ technology is already being used in three leading hospitals,  and is now part of a f a major nationwide push to tackle the condition including a one hour identification and treatment option.


In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year.

In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature.

In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.

The schemes are part of a national effort to push best practice and new technology across the NHS, to help hospitals learn from the success of others and spread use of the best technology further, faster (Source: NHS England).

Read the full press release from NHS England 

Hundreds of lives saved through new tech to spot sepsis