SUPPORT-SYSTEMS (55) The Lancet: The politics of universal health coverage (2)

27 May, 2022

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Our progress with the technical, cultural and clinical change of doctors sharing digital records with patients supports the statement - "These windows of opportunity are created in various ways. For example, sudden, attention-grabbing events can draw attention to the need for government action and create an exogenous opportunity for actors to mobilise and push through health reform..." Here are two examples

1. Harold Shipman - Wikipedia Harold Frederick Shipman (14 January 1946 - 13 January 2004), known to acquaintances as Fred Shipman, was an English general practitioner who is considered the most prolific serial killer in modern history with an estimated 250 victims. On 31 January 2000, Shipman was found guilty of the murder of fifteen patients under his care. He was sentenced to life imprisonment with the recommendation that he never be released.

Solution - The National Patient Safety Agency and the UK General Medical Council supported the practice of patients - and eventually families and friends through proxy access - accessing contemporary family doctor medical recvords after Dr Harold Shipman was convicted of murdering 250 patients and altering their records afterwards to collaborate his fake diagnoses of the cause of death.

2. Covid19 pandemic

Solution - The NHS App and its central role in the fight against COVID-19 - NHS Digital

“The NHS App launched in 2019 became a crucial tool in the fight against covid, and has changed the way million of adults in England now access healthcare services."


Barry Cassels, Head of Product, NHS App

Date: 1 March 2022

“The NHS App launched in 2019 became a crucial tool in the fight against covid, and has changed the way million of adults in England now access healthcare services.

“Many of NHS Digital’s programmes were in the pipeline before COVID-19 struck, but the pandemic and an uptake of digital services forced their development to be accelerated � and the NHS App was no exception.>

“The NHS App turns 3 with 22 million users (at the recent digital government at Westminster, London, I believe we were told that now 40 mllion use the NHS App.)

“Launched in January 2019, the app was already in place when the coronavirus pandemic took hold in the UK in early 2020. Today, it has more than 22 million users and was named the most downloaded free app by UK iPhone users in 2021.

“Since its launch, people have been benefiting from easier access to NHS services. The app provides a simple and secure way for the public to access healthcare services from their smartphone or tablet, enabling people to manage their care at a time, and from a place, most convenient to them. To date, more than 10.4 million repeat prescriptions have been ordered and more than 1.1 million GP appointments have been booked via the app, saving valuable time for patients and clinicians.

“Additionally, more than 316,000 people have used the NHS App to manage their organ donation decision, with over 151,000 preferences recorded over the last 6 months. Registering a preference helps NHS specialist nurses to quickly understand what people want to happen to their organs and enables them to discuss the patient’s wishes directly with their family.

“The NHS COVID Pass is used for sharing COVID-19 vaccination records or test results when travelling abroad or attending certain events and venues domestically (although this is now voluntary). The addition of the COVID Pass led to a rapid increase in registrations for the app. There were over 18 million registrations for the NHS App following the addition of the COVID Pass on 17 May 2021. More than 140 million COVID Passes have also been generated through the NHS App and NHS website since the service was added last May.”

“Messaging services in the NHS App

“Another benefit of the NHS App is the use of messaging services for health and care providers which is giving users more choice in how they receive messages and interact with healthcare professionals. Messages are delivered almost instantaneously and are free for senders.

“Test and Trace and the COVID-19 vaccination programme have also seen increased digital uptake, and our research tells us that users now expect to receive digital communications from the services they use, and to use digital channels to manage their health. In user research we conducted with the Digital Transformation of Screening programme, we found that 79% of users were likely or extremely likely to move to a digital communication channel if it was possible.

"Messaging services in the app have been used during the pandemic to encourage blood plasma donations and to alert users to new services. Our user research shows that patients trust the app as a channel and act on the messages they receive through it.

When we sent a message encouraging eligible patients in one area to sign up to their personal health record account, the sign-up rate for the following 10 days nearly doubled, with an increase of 88% on the 10-day period before the message.

"Senders will be able easily to integrate NHS App notifications and messaging into their services. We can provide message status analytics and reporting to understand, for example, how many users have opened the message, allowing for back-up messages to be sent by other methods if needed. The NHS App can currently support the sending of 3.4 million in-app messages and associated push notifications each day, within a 16-hour window. Over the coming months we will be developing our notification and messaging capability further.

HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT