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  • 14th Jan 2019

Behavioural insights and the Long Term Plan for the NHS

Last week the UK government published its Long Term Plan for the NHS, an ambitious programme of work to make the health service fit for the future, saving hundreds of thousands of lives, and adding 5 years to life expectancy by 2030.

Of course, the success of healthcare systems in places like Japan is partly down to lifestyle choices, so it is encouraging to see our own Long Term Plan highlighting areas where behavioural change at a population-level is needed to prevent avoidable mortality, morbidity, and ill-health.

Over the last decade we have learned a lot about how to design health services based on the science of human behaviour. As stated by Matt Hancock, Secretary of State for Health and Social Care, we’re excited to bring some of these approaches to the NHS’s Long Term Plan.

Prevention and reducing health inequalities

Behavioural factors, such as smoking, poor diet, and physical inactivity, are the single biggest contributor to premature death. The burden is not shared evenly, with those who are most disadvantaged often suffering disproportionately.

Over the years, we have worked on a range of projects to prevent ill-health, from using personalised feedback to doctors to reduce unnecessary antibiotic prescriptions and speed up cancer diagnosis, to helping shape the UK’s position on e-cigarettes, which now help an additional 22,000 – 57,000 people quit smoking annually. We have seen time and again that small tweaks to the system can have out-sized effects on some of the largest drivers of ill-health while also addressing inequalities.

Our work to redesign the taxation thresholds on sugary beverages, for example, showed that the right incentives can drive industry-wide change, with 15% of the market reformulating to make their drinks healthier. Unlike some nudges related to nutrition, driving reformulation of what is sold on the shelves – whether through consumer demand or regulatory change – does not widen health inequalities; reshaping obesogenic environments normalises healthier options for everyone.

Making the best use of technology

Our experience working with existing technologies within the NHS shows that there is potential within the current digital infrastructure to improve outcomes for patients at scale. For example, making wait times more salient on screens used for specialist referrals results in 40,000 people being put on on shorter wait lists each month, and tweaking messages sent out using existing texting capabilities can reduce missed appointments by 20%.

While incremental tweaks to existing tech can make a difference, new technology will be transformative, enabling clinical staff to do their jobs more effectively than ever before and making better use of NHS resources. Better tech means better data, which enables smarter targeting of resources.

In social care, for example, we have found that case-level data, including information captured in the notes made by social workers, can be used to predict which cases will cycle back into the system and require serious intervention. Similar approaches also allowed us to identify 95% of inadequate GP practices by inspecting only 20% of all practices, saving huge amounts of resource relative to older ways of determining inspection order.

Telemedicine too – a key element of the NHS Long Term Plan, with virtual GP appointments to be universally available in the next five years – can have enormous positive effects on health. Next week we will be publishing our annual report, including a result that shows virtual interactions can almost double medical adherence rates. Whatever the application, as the working relationship between humans and computers blurs, understanding the relative advantages of each will be critical to unleashing the full potential of technology and those who use it.

Technological developments in the last decade mean that we can learn what works faster and target messages with increasing precision. The private sector does this as a matter of course and increasingly-personalised targeting is something all of us are exposed to by marketers every day. Social media pervades society – 89% of adults are now online and three quarters of them have at least one social media account – and its advertising options were designed to enable testing and targeting to get maximum impact. By using information routinely stored in our online fingerprints, we can put these tools to work for us, identifying who smokes or uses tanning beds, whose mental health is at risk from problem gambling, and who would like to eat better or exercise more, as well as how to appeal to them.

The Secretary of State’s commitment to using Facebook and other platforms to change behaviours makes excellent sense as an investment and is something we are particularly excited to be a part of.

Workforce development

Work in the health and care sector is rewarding and challenging in equal measure. Building professional environments that minimise stress and allow for continued development is critical to ensure we can attract and retain the best people, and understanding what drives motivation can help.

We know that simple techniques, such as encouraging people to talk to their nearest and dearest about stress and progress can have large effects. In further education colleges in the UK, students asked to nominate two “study supporters” to receive texts throughout the year on how to support them passed their exams 27% more often than those whose loved ones were not contacted. Similar approaches could help those in the health sector. In the past year, we found that a series of emails designed to build a sense of shared professional experience reduced staff burnout and improved retention for emergency call-handlers, an approach we are intending to build on for others who work in health and care.

We have also had success helping to build more representative workforces and appealing to candidates attracted to the hardest parts of front-line public service roles. For instance, we found that job adverts emphasising the “challenge” of a role tripled applications to the police and was even more effective for women and those from underrepresented ethnic groups. We have also used place-based targeting via adverts on social media to address geographical gaps, recruiting more African American police officers in Los Angeles, for example.

We are delighted to be bringing a behavioural lens to the implementation of the NHS Long Term Plan and look forward to partnering on initiatives that will improve life for all of us.

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