UK's digital hospital plan meets analog reality check

Experts ask: Where will staff come from, and what about gran's flip phone?

The government has announced a new "digital hospital" service in England that will provide online appointments with consultants as an alternative to visiting a National Health Service (NHS) hospital.

However, some have questioned how it will find staff and whether it will exclude patients not able to use digital services.

Patients in England needing some types of specialist care will be able to book online appointments with consultants working for NHS Online through the NHS app. If they need a scan, test or procedure they will receive these at local community diagnostic centres.

The NHS is notorious for waiting times for non-urgent hospital care. An analysis of NHS England data by doctors' trade union the British Medical Association (BMA) found that 6.25 million individuals were waiting for such treatment in July, with around 2.78 million waiting more than 18 weeks and 191,600 for more than a year.

NHS England said its new service will initially focus on "a small number of planned treatment areas with the longest waits" and will be expanded over time to other areas which are clinically safe to deliver remotely. NHS Online will provide up to 8.5 million appointments and assessments in its first three years from 2027, the government hopes.

According to healthcare charity the King's Fund, NHS hospitals in England provided 141 million patient episodes in 2022/23, suggesting the new service could provide around 2 percent of this capacity over its first three years.

Health secretary Wes Streeting said some NHS services, including those in Southampton for inflammatory bowel disease and several provided by London's Moorfields Eye Hospital, have successfully introduced online consultations and he wants to expand this nationally.

"If you have a condition where it is both safe and effective to be seen online through the new NHS Online service, you will get faster access to the right care in the right place at the right time," he told BBC Radio 4's Today program.

The service will be run by a publicly owned NHS organization and could be established as an NHS trust, which run hospitals and secondary healthcare services in England. A budget has yet to be published.

"Bringing digital care approaches together through a new 'online hospital' is an interesting experiment," wrote Dr Becks Fisher, director of research and policy at health think tank the Nuffield Trust.

"But there are some difficult questions looming about how this new service will be implemented: will doctors and nurses for this service be able to take on this work without it impacting on existing face-to-face work? And how will they pass patients who need care from digital to physical services?"

Fisher said there is a risk the service will be used only by relatively healthy and digitally literate patients. "This will be an interesting initiative and helpful for some. But it is not a transformative shift for most NHS patients, who will still want and need treatment in person," she added.

The BMA raised further questions. "We are told that there will be dedicated doctors assigned to this service," said Dr Tom Dolphin, chair of the BMA Council. "We're keen to find out where this extra staffing is going to be sourced from. Doctors are already flat out across the NHS and there is little spare capacity to go around."

He added that the union was concerned over how patients would be guided when using the service as well as its potential to exclude older people, some with disabilities, those without a smartphone or good internet access and those who speak English as a second language.

"We want to be assured that no one will be left behind in this new online hospital," he said. ®