Use the NHS App to transform public health data

Policy Idea:

The government should make better use of the NHS App in order to better understand and improve public health. This would help prevent future pandemics and lead to better understanding of public health, therefore helping policymakers make better policy to save and improve lives.

What is the problem?

Currently, medical polling and data-gathering is slow and retrospective, expensive and vulnerable to inaccuracies. It is predominantly conducted through large polling, aggregation of data collected at hospitals and clinics or through special programmes such as the Coronavirus (COVID-19) Infection Survey. These all have their merits, but there remain gaps in the knowledge base of public health.

For instance, Large public polling is slow, expensive and vulnerable to selection bias. It is also vulnerable to misreporting as respondents may misremember facts such as how often they walked in the last week. While quicker and cheaper, aggregation of data collected through NHS front-line services is inherently retrospective and only measures those who have sought treatment rather than the public generally. Finally, special programmes, while impressive, still have a lag and are often focussed on certain diseases and groups, such as the SIREN programme which measures flu amongst healthcare workers.

These issues lead to two main problems. There is a delayed reaction to emerging health crises from unknown variants as they begin to spread, especially in groups who either are not experiencing strong symptoms or are not going for treatment. In addition, there is a lack of understanding about the true state of public health across the nation, leading to worse policy-making. Both of these problems are especially true of younger and poorer groups, who are both less likely to participate in polls or seek treatment. This means that the NHS and other health organisations struggle to respond quickly or with correct solutions to health problems.

What is one possible solution?

The NHS App is a downloadable application that lets patients in England access their medical record, book appointments and order repeat prescriptions. It is a clever way to make using the NHS’s services simpler and safer, as well as make patients feel more in control of their medical experience. It has been downloaded more than 22 million times and is trusted and understood by the public. However, its greatest potential could be to correct the problem of poor and slow public health data. It could serve as source of real-time and reliable data. The NHS App should be used to gather large-scale, anonymised and geographically linked information about public health.

How would this work?

The NHS App would periodically send push notifications to its users to gather public health data. These would appear on the home screen of the device, similar to a text message. Users would be selected at random. These questions would be simple and designed to be answerable with a single click. The response would be recorded instantaneously. Possible questions could include the following:

1) Have you had a cold in the 36 hours?

2) How many hours sleep did you have last night?

3) Did you walk more than 30 minutes yesterday?

In order to minimise concerns over privacy and encourage accurate reporting, data collection would be strictly anonymous with the sole exception of the broad geographical area of respondent. It would be clearly stated that the user does not have to respond and there would be a clear option to opt out of inclusion in future surveys. The content and timings of the message would be selected by NHS England through a panel, with advice from relevant academics and public bodies such as UKHSA. This method of data collection would be very cheap, almost instantaneous and would reach groups not currently accessed.

How would better data make people’s lives better?

This proposal would provide information that would

1) allow government to respond quickly to developing health crises and,

2) allow government to understand the true state of public health.

The use of this policy in practice is demonstrated through two illustrative scenarios below:

Scenario One: It is the winter of 2024. The NHS App is used to send a routine survey asking if users have had a cough in the last three days. The question is simple and is sent to thousands of users, not just reported at GPs. This means the response rate is high and catches symptoms amongst those less likely to go to a GP or participate in a testing programmes but are still carrying a potential new virus. As it is a digital real-time survey, the results can be collected and analysed in less than a day. They show that there are far higher than expected results for Leeds.

As a response, government moves testing resources to Leeds within a second day and begins a testing campaign, not only in hospitals but also in schools and public spaces. Concurrently, the original survey is expanded to check other areas. The tests return a previously unknown variant which then triggers a public health warning. However, since the virus has been spotted before it has reached a critical mass and before it has begun spreading rapidly in the vulnerable population, care homes can take preventive measures and hospitals prepare accordingly. This keeps rates of infection and death down.

Scenario Two: A policy team in the Department for Health and Social Care is trying to implement a campaign to promote more hours of sleep, which has a proven link to overall health. However, they have no current data for the average amount of hours slept in England and are unsure of how to proceed. They then run a survey through the NHS App a series of times, collecting different, diverse and large samples each time, with the question sent in the morning to encourage honest and accurate reporting. The one question – how many hours did you sleep last night – has a very high response rate and costs almost nothing to run.

The results inform the team that the public are not getting the recommended hours of sleep and so they design a policy intervention in the form of increased public health messaging. This could either be targeted within a certain area or nation-wide. In a year’s time, they can run the survey again either in the targeted area or nation-wide and see the results. The aggregated results are put in the public sphere to inform academic research in the long-term. This leads to better policy, for lower cost, leading to better public health.

These are merely two illustrative scenarios but the applications for this tool are much larger.

Possible risks

There are risks to this proposal, but these can be mitigated through well thought-out design.

1) If the App starts to bother users, they will delete it and this risks reducing progress made to digitise the NHS.

Even with very large-scale surveys of 10,000 users, the sheer number of users of the App means that the chances of the same person repeatedly being randomly selected is low. In addition, questions will be designed to be very easy to answer, preferably with a single click. There will always be an option to not respond and opt out of future surveys.

2) There will be concerns over data security and privacy.

These concerns should be taken seriously and can be reduced in a number of ways. Strict data controls should be in place; aggregation and anonymisation of data would be the default. In addition, the questions chosen would typically be noncontroversial. For instance, questions about diet would be chosen instead of sexual history. In any case, the relative blandness of the questions – did you walk more than 20 minutes yesterday – would reassure users that the damage of any data breach would be limited.

Secondly, there would be a strict process for how questions would be chosen. A panel, assembled by NHS England and subject to the public appointments process, would have to be satisfied that the question was useful and not harmful. If respondents are unhappy with the question, there would be a complaints process and the option to complain to the Parliamentary and Health Services Ombudsman, albeit through the local Member of Parliament.