Summary:
The recent shift in attitudes to the role the state should play in preserving people’s health is an opportunity that can be seized. We propose transforming the NHS COVID-19 app, with its 20m-strong user base, into a wider public health tool to make society healthier, as well as to reduce pressure on the NHS and the public finances. The pandemic-induced changes in attitude allows the app to be developed in ways that would otherwise have encountered strong resistance, or at least would have led to low uptake and engagement. The app could be developed to serve a number of related and mutually reinforcing objectives, including:
1. Nudging people towards healthier lifestyle choices based on their data;
2. Testing public health interventions;
3. Supporting detection and monitoring of infectious diseases;
4. Improving access to patient records and NHS services;
5. Providing personalised health advice and facilitating early identification and treatment of illnesses.
Detail:
When the intense pressure on health services recedes after the pandemic, the NHS – and the public finances – will continue to face sustained and growing pressure from an ageing population and a rise in chronic illness.
One of the most important strategies to address this – and indeed, one of the best ways we can prepare against future waves of COVID-19 or new pandemics – is to improve the underlying health of the UK population. As part of that drive, the NHS COVID-19 app could be expanded to serve a broader range of health policy objectives. These include:
1. Encouraging healthier lifestyles, with a view to tackling preventable and costly conditions such as obesity and hypertension (a key objective of the NHS Long Term Plan). The app could inform people about their risk, based on the data they input (about, for instance, their age, lifestyle and exercise habits) and coax them towards healthier behaviour. There might also be scope for “gamifying” health activity, taking inspiration from the mobile gaming industry, which has perfected the art of sustaining people’s attention through, for example, carefully designed “reward” systems.
2. Testing the effectiveness of public health interventions. The app could also be a perfect ‘sandbox’ to gain behavioural insights and improve the effectiveness of government messaging and nudges. For example, before launching a wider obesity campaign, the app might test different messages and notifications on different users to see which ones have the greatest impact on behaviour.
3. Supporting detection and surveillance of infectious diseases. During epidemics (including winter flu seasons), the app could ask users about symptoms they are experiencing, to generate intelligence on the prevalence and spread of infectious diseases. This would simply be a generalisation of the app’s existing function to collect information on COVID-19 symptoms (though without the information being used to support Test and Trace).
4. Improving access to patient records and NHS services. To encourage the largest number of people to retain and use the app, it might be wise to develop functionality that delivers clear and practical benefits to users, such as an effective booking system for NHS appointments. This could be done by combining it with another NHS app that is already set up to do that, but whose reach and take-up (both within the NHS and by patients) is far more limited. To make the app even more useful, users could be given a right to request access to their records on the app, with a concurrent obligation on NHS bodies to make those records available there if patients request it.
5. Providing personalised health advice and facilitating early identification and treatment of illnesses. Gradually, other existing NHS apps such as ‘Ask NHS – Virtual assistant’ (a symptom check app similar to 111) could also be rolled into the “master” app, since linking functionalities and data will improve all of the services offered by the app. For example:
• The symptom checking function could be made much more powerful and accurate by enabling it to pull data from your patient records.
• Improve the extent to which people act on advice received through the app: for example, if a user received advice to see a GP, they could be taken straight to a booking page for an appointment.
• The data could also enable predictive screening based on machine learning algorithms.
Crucially, the app would ensure patients retain control over what functionalities they want to use; the data they wish to share with the app; and the uses to which that data is put.
919-11