Where do we go next? Discussions on digital innovation and health inequalities at NHS ConfedExpo

The golden thread at NHS ConfedExpo

In her keynote speech, Amanda Pritchard, Chief Executive of NHS England, posed the question ‘Where do we go next?’, noting that the total number of people living with major illness is projected to increase by 2.4 million by 2040. However, we know that with health inequalities as a consideration, this will not be equally felt across the population.

This is a main concern for National Voices, and one we are calling on the next government to recognise. But how do we aid an ageing population experiencing multiple long-term conditions, and tackle the barriers undoubtedly faced to a greater extent by those experiencing health inequalities along the way?

As we heard time and time again at NHS ConfedExpo, AI, digital innovation, and data, have huge potential to support us in this endeavour. National Voices’ Chief Executive, Jacob Lant, was involved in a handful of panels across the two days which supported this belief, but the message was heard loud and clear across several sessions during the two-day event.

Easing the burden on clinicians

One of Jacob’s sessions explored the potential use of Microsoft’s AI Copilot programme, which can generate notes on behalf of clinicians. A concern we frequently hear from patients and members is the lack of compassion felt during interactions in primary care. This isn’t necessarily down to GPs being intentionally uncompassionate, but rather is a result of years of primary care being chronically under resourced and underfunded. Removing the screen and keyboard which signifies the divide between GPs and patients could allow for greater compassion in such appointments.

Similarly, this would ease a burden on GPs during appointments, presenting them with an opportunity to really listen to their patient, lending towards our belief of treating a person as a whole. This holistic approach also featured in Matthew Taylor’s keynote speech as he touched on the need for proactive, person-centred care.

Recognising the impact of wider determinants

Nonetheless, there are challenges which come with this approach. At National Voices, we recognise the effect wider determinants have an individual’s health.

An AI programme may not recognise the way in which an individual travelled to their GP appointment as important qualitative data to include in notes. Yet we know that for those living in rural villages it takes people an average of 71 minutes to reach their nearest hospital by public transport, compared to just 20 minutes for those with access to a car, and that is when public transport is available. Often, people can’t make 9am appointments, evening or weekend slots, as the transport just isn’t there. For those with inflexible employment, or caring responsibilities, that is more than enough to deter them from accessing healthcare services.

Similarly, a man mentioning their husband in an appointment may not be recorded either. But we recognise that the LGBTQIA+ community are more likely to experience discrimination, which resultantly may affect their mental health. It may also be worth hypothetical AI programmes noting an individual’s sexual orientation, with their consent, due to further health inequalities. For example, research also indicates that smoking rates are higher among lesbian, gay, bisexual and transgender people than among their heterosexual peers, due to a number of reasons explored by The National LGB&T Partnership.

Co-producing such programmes with a range of communities and groups is therefore vital to ensuring these essential details are not overlooked. Tech companies now have the opportunity to meaningfully engage with individuals through the Voluntary, Community, and Social Enterprise (VCSE) sector, collaborating with the VCSE sector as a trusted link. Through this approach, tech companies can ensure that their work does not exclude those who need and use healthcare services the most.

Streamlining with data

Looking to data, we are also presented with an opportunity to identify those communities most at risk of facing barriers to health and care, and ensuring health services are accessible, and equitable, for a greater percentage of our population. The founder of National Voices’ member organisation SWAD, who advocate for sexual and reproductive health services access for those with disabilities, experienced a three year wait to receive a cervical screening appointment, being sent to multiple clinic settings, only to find no leg supports, arm supports, hoists, nor reasonable adjustments, were in place to support her screening. By maintaining clear data on which GP practices have accessible screening equipment and adjustments, we could streamline this process and encourage equitable access to cervical screening, and other initiatives, regardless of disabilities.

Effectively identifying inequalities

To an extent, we are already aware of many of the groups and communities experiencing inequality. Yet, with consensual collecting, sharing, and analysing data it becomes screamingly obvious for all colleagues working across the sector, not just those connected to these communities. The use of data also presents an opportunity for services to identify where the groups and communities are, and to what extent changes in policy and healthcare are having a positive impact.  

For this to happen, however, we need to ensure there is a consistency across the board with which characteristics are categorised and recorded, otherwise efforts to address health inequalities may continue to be undermined by incomplete or inaccurate recording. Only by determining characteristic factors and categories to a more thorough extent, and sharing data to establish a larger pool and stronger reliability, can we deepen our understanding of the inequalities communities are facing, and effectively tackle them.

Data hurdles

We do recognise that there are hurdles to gathering such data. Research by Wellcome determined several hurdles, including historical distrust, concerns around cross-sector sharing of data, and technical hurdles such as a lack of time.

Therefore, the process of data gathering and analysis must be transparent with patients involved from the start, surrounding both research, and potential use of AI programmes such as Copilot. It is crucial that the public understands what their data is being collected for, the considerate and positive intentions with which is it used, and the control they have over data stored about them.

Having a relationship with the public accelerates the possible. Change moves at the speed of trust.

Matthew Taylor, Chief Executive of NHS Confederation, in his NHS ConfedExpo keynote speech

Involving patients and communities has never made anything worse

The NHS has been on its knees for too long, and innovative approaches to health and care, as championed by Pritchard, may encourage optimism for a number of roles and departments. Yet to effectively implement such resources without running the risk of widening health inequalities, we must support meaningful co-production from the outset between those designing the services, and those using them.

We recognise that at the very least working with people and communities will confirm whether changes are positive, and give services a solid foundation to proceed with innovation. But more likely, those who use the services will suggest practical suggestions which not only improve such services, but also ensure new initiatives are more likely to succeed first time.

Involving patients and communities has never made anything worse.

Jacob Lant, Chief Executive of National Voices