Tag Archives: transparency

An app a day … how m-health could revolutionise our engagement with the NHS

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It seems like almost every day now we see in the news and read in newspapers about the increasing pressures on our NHS, strains on resources and the daily challenges facing already overworked GP staff.

Mobile health applications (m-health apps) are increasingly being integrated into practice and are now being used to perform some tasks which would have traditionally been performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and signposting to other health and support services.

How m-health is transforming patient interactions with the NHS

In 2015 International Longevity Centre research found some distinct demographic divides on health information seeking behaviour. While 50% of those aged 25-34 preferred to receive health information online, only 15% of those aged 65 and over preferred the internet. The internet remained the favourite source of health information for all age groups younger than 55. And while not specifically referring to apps, the fact that many people in this research expressed a preference to seek health information online indicates that there is potential for wider use of effective, and NHS approved health apps.

A report published in 2019 by Reform highlighted the unique opportunity that m-health offered in the treatment and management of mental health conditions. The report found that in the short to medium-term, much of the potential of apps and m-health lies in relieving the pressure on frontline mental health services by giving practitioners more time to spend on direct patient care and providing new ways to deliver low-intensity, ongoing support. In the long-term, the report suggests, data-driven technologies could lead to more preventative and precise care by allowing for new types of data-collection and analysis to enhance understandings of mental health.

M-health, e-health and telecare are also potentially important tools in the delivery of rural care, particularly to those who are elderly or who live in remote parts of the UK. This enables them to submit relevant readings to a GP or hospital consultant without having to travel to see them in person and allowing them to receive updates, information and advice on their condition without having to travel to consult a doctor or nurse face-to-face. However, some have highlighted that this removal of personal contact could leave some patients feeling isolated, unable to ask questions and impact on the likelihood of carrying out treatment, particularly among older people, if they feel it has been prescribed by a “machine” and not a doctor.

Supporting people to take ownership of their own health

Research has suggested that wearable technologies, not just m-health apps, but across-the-board, including devices like “fitbits”, are acting as incentives to help people self-regulate and promote healthier activities such as more walking or drinking more water. One study found that different tracking and monitoring tools that collect and analyse health and wellness data over time can inform consumers of their baseline activity level, encourage personal engagement in health and wellbeing, and ultimately lead to positive behavioural change. Another report from the International Longevity Centre also highlights the potential impact of apps on preventative healthcare; promoting behaviour change and encouraging people to make healthier choices such as stopping smoking or reducing alcohol intake.

Home testing kits for conditions such as bowel cancer and remote sensors to monitor blood sugar levels in type 1 diabetics are also becoming more commonplace as methods to help people take control of monitoring their own health. Roll-outs of blood pressure and heart rhythm monitors enable doctors to see results through an integrated tablet, monitor a patient’s condition remotely, make suggestions on changes to medication or pass comments on to patients directly through an email or integrated chat system, without the patient having to attend a clinic in person.

Individual test kits from private sector firms, including “Monitor My Health” are now also increasingly available for people to purchase. People purchase and complete the kits, which usually include instructions on home blood testing for conditions like diabetes, high cholesterol and vitamin D deficiency. The collected samples are then returned via post, analysed in a laboratory and the results communicated to the patient via an app, with no information about the test stored on their personal medical records. While the app results will recommend if a trip to see a GP is necessary, there is no obligation on the part of the company involved or the patient to act on the results if they choose not to. The kits are aimed at “time-poor” people over the age of 16, who want to “take control of their own healthcare”, according to the kit’s creator, but some have suggested that instead of improving the patient journey by making testing more convenient, lack of regulation could dilute the quality of testing Removing the “human element”, they warn, particularly from initial diagnosis consultations, could lead to errors.

But what about privacy?

Patient-driven healthcare which is supported and facilitated by the use of e-health technologies and m-health apps is designed to support an increased level of information flow, transparency, customisation, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects for each user. However, it’s not all positive, and concerns are already being raised about the collection and storage of data, its use and the security of potentially very sensitive personal data.

Data theft or loss is one of the major security concerns when it comes to using m-health apps. However, another challenge is the unwitting sharing of data by users, which – despite GDPR requirements – can happen when people accept terms and conditions or cookie notices without fully reading or understanding the consequences for their data. Some apps, for example, collect and anonymise data to feed into further research or analytics about the use of the app or sell it on to third parties for use in advertising.

Final thoughts

The integration of mobile technologies and the internet into medical diagnosis and treatment has significant potential to improve the delivery of health and care across the UK, easing pressure on frontline staff and services and providing more efficient care, particularly for those people who are living with long-term conditions which require monitoring and management.

However, clinicians and researchers have been quick to emphasise that while there are significant benefits to both the doctor and the patient, care must be taken to ensure that the integrity and trust within the doctor-patient relationship is maintained, and that people are not forced into m-health approaches without feeling supported to use the technology properly and manage their conditions effectively. If training, support and confidence of users in the apps is not there, there is the potential for the roll-out of apps to have the opposite effect, and lead to more staff answering questions on using the technology than providing frontline care.

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How AI is transforming local government

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Robot

By Steven McGinty

Last year, Scottish Local Government Chief Digital Officer Martyn Wallace spoke to the CIO UK podcast and highlighted that in 2019 local government must take advantage of artificial intelligence (AI) to deliver better outcomes for citizens. He explained:

“I think in the public sector we have to see AI as a way to deliver better outcomes and what I mean by that is giving the bots the grunt work – as one coworker called it, ‘shuffling spreadsheets’ – and then we can release staff to do the more complex, human-touch things.”

To date, very few councils have felt brave enough to invest in AI. However, the mood is slowly starting to change and there are several examples in the UK and abroad that show artificial intelligence is not just a buzzword, but a genuine enabler of change.

In December, Local Government Minister Rishi Sunak announced the first round of winners from a £7.5million digital innovation fund. The 16 winning projects, from 57 councils working in collaborative teams, were awarded grants of up to £100,000 to explore the use of a variety of digital technologies, from Amazon Alexa style virtual assistants to support people living in care, to the use of data analytics to improve education plans for children with special needs.

These projects are still in their infancy, but there are councils who are further along with artificial intelligence, and have already learned lessons and had measurable successes. For instance, Milton Keynes Council have developed a virtual assistant (or chatbot) to help respond to planning-related queries. Although still at the ‘beta’ stage, trials have shown that the virtual assistant is better able to validate major applications, as these are often based on industry standards, rather than household applications, which tend to be more wide-ranging.

Chief planner, Brett Leahy, suggests that introducing AI will help planners focus more on substantive planning issues, such as community engagement, and let AI “take care of the constant flow of queries and questions”.

In Hackney, the local council has been using AI to identify families that might benefit from additional support. The ‘Early Help Predictive System’ analyses data related to (among others) debt, domestic violence, anti-social behaviour, and school attendance, to build a profile of need for families. By taking this approach, the council believes they can intervene early and prevent the need for high cost support services. Steve Liddicott, head of service for children and young people at Hackney council, reports that the new system is identifying 10 or 20 families a month that might be of future concern. As a result, early intervention measures have already been introduced.

In the US, the University of Chicago’s initiative ‘Data Science for Social Good’ has been using machine learning (a form of AI) to help a variety of social-purpose organisations. This has included helping the City of Rotterdam to understand their rooftop usage – a key step in their goal to address challenges with water storage, green spaces and energy generation. In addition, they’ve also helped the City of Memphis to map properties in need of repair, enabling the city to create more effective economic development initiatives.

Yet, like most new technologies, there has been some resistance to AI. In December 2017, plans by Ofsted to use machine learning tools to identify poorly performing schools were heavily criticised by the National Association of Head Teachers. In their view, Ofsted should move away from a data-led approach to inspection and argued that it was important that the “whole process is transparent and that schools can understand and learn from any assessment.”

Further, hyperbole-filled media reports have led to a general unease that introducing AI could lead to a reduction in the workforce. For example, PwC’s 2018 ‘UK Economic Outlook’ suggests that 18% of public administration jobs could be lost over the next two decades. Although its likely many jobs will be automated, no one really knows how the job market will respond to greater AI, and whether the creation of new jobs will outnumber those lost.

Should local government investment in AI?

In the next few years, it’s important that local government not only considers the clear benefits of AI, but also addresses the public concerns. Many citizens will be in favour of seeing their taxes go further and improvements in local services – but not if this infringes on their privacy or reduces transparency. Pilot projects, therefore, which provide the opportunity to test the latest technologies, work through common concerns, and raise awareness among the public, are the best starting point for local councils looking to move forward with this potentially transformative technology.

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General Data Protection Regulation (GDPR): 10 things business needs to know

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European Union flag with a padlock in the centre.

By Steven McGinty

On 25 May 2018, the data protection landscape will experience its biggest change in over 20 years.  This is because the European Union’s (EU) General Data Protection Regulation (GDPR) will come into effect for all member states. The regulation, which has been described as ‘ambitious’ and ‘wide-ranging’, introduces a number of new concepts, including the high profile ‘right to be forgotten’ – a principle established in a case involving technology giant Google.

Below we’ve highlighted ten of the most important points for business.

Directly effective

The GDPR is ‘directly effective’, which means that the regulation becomes law without the need for additional domestic legislation (replacing the Data Protection Act 1998). However, member states have also been given scope to introduce their own legislation on matters such as the processing of personal data. This may result in some EU states having more stringent rules than others.

Sharing data and monitoring

It also seeks to increase the reach of EU data protection law. Not only will EU-based data controllers and processors fall under the scope of the GDPR, but its authority will also extend to any business which either processes personal data or monitors the behaviour of individuals within the EU.

This will impact businesses who transfer data outside the European Economic Area (EEA). It will be their responsibility to ensure that the country the data is being transferred to has adequate levels of data protection. The most prominent example of this issue was the US Safe Harbour scheme, which was intended to protect European individuals whose personal data is transferred between the EEA and the USA. In 2015, the European Court of Justice ruled that this scheme had ceased to provide a valid legal basis for EEA-US transfers of all types of personal data. It has now been replaced by the Privacy Shield.

Transparency and consent

Greater obligations have been placed on business with regard both to seeking consent for use of personal data and providing detailed information to individuals on how their personal data is being used. The GDPR requires that consent notices are ‘unambiguous’ – not assumed from a person’s failure to respond – and that consent is sought for different processing activities. Law firm, Allen and Overy recommends that businesses review their notices to ensure they are fit for purpose.

Personal data/ sensitive data

Article 4(1) of the GDPR includes a broader definition of ‘personal data’ than previous legislation. It states that any information relating to an individual which can be directly or indirectly used to identify them is personal data. Specifically, it refers to ‘online identifiers’, which suggests that IP addresses and cookies may be considered personal data if they can be easily linked back to the person.

Enhanced rights

New rights and the enhancement of existing rights will require some businesses to improve the way their data is stored and managed. These rights include:

  • Data portability – Business must ensure that individuals can have easy access to their personal data in case they want to transfer their data to other systems.
  • Strengthening subject access rights – Individuals can now request access to their data for no cost and it must be responded to within 30 days (this is a change from the current legislation which requires a £10 fee and there is 40 days to respond).
  • Right to be forgotten – Individuals can request that an organisation delete all the information they hold on them (although this would not apply if there was a valid reason to hold that data).
  • Right to object to processing – Individuals have the right to object to the way an organisation is processing their data.
  • Right to restrict processing – Individuals have the right to request that the processing of personal data is temporarily stopped. This may be invoked whilst a right to object request is being investigated.

Personal data breach

Businesses have an obligation to report breaches to their national regulator, such as the Information Commissioners Office (ICO) in England.  The GDPR requires that notice must be provided “without undue delay and, where feasible, not later than 72 hours after having become aware of it.” This may be challenging for some businesses, particularly if the incident is discovered at the end of the working week.

Failure to comply with GDPR

The regulation introduces two levels of fines. Less serious offences under the regulation will be liable for a fine of up to €10,000,000 or 2% of global turnover – depending on which is highest. However, for more serious breaches, such as a breach of an individual’s rights or a breach during international transfers, a business may be held liable for up to €20,000,000 or 4% of global turnover.

In addition, individuals are also given the right of redress, and those who have had their rights violated may seek to receive compensation. This has led digital marketers to suggest that GDPR could be the next PPI – a practice where insurance was mis-sold to customers, which resulted in a large number of successful claims against financial institutions.

Privacy by design

Technology businesses should also consider data protection at the initial design stage of product development. This could involve adopting technical measures such as pseudonymisation – the technique of processing personal data in such a way that it can no longer identify a particular person. Additional measures, such as policies and programmes, would also show a national regulator’s commitment to compliance with the GDPR.

European Data Protection Board (EDPB)

A new body has been created to issue opinions and to arbitrate between disputes that arise with national regulators.  The board will be made up of heads of national regulatory bodies (or their representatives) and the European Data Protection Supervisor (EDPS), who govern the data processing activities of EU institutions. The opinions expressed by this board may have important implications for data protection legislation.

Impact of Brexit

Evidence suggests some businesses may be delaying taking action until they see the results of the Brexit negotiations. This possibly explains the research by cloud security firm, Netskope, which found that 63% of UK workers have never heard of the GDPR. Similarly, research by Veritas Technologies, a leading information management firm, has found that 54% of organisations have not ensured they will comply with the new GDPR.

However, it would be very surprising if the UK did not ‘mirror’ the protections offered by the regulation, particularly considering the UK’s significant input to the new legislation. Digital minister Matt Hancock has also confirmed that the UK government intends to fully implement the GDPR.

Final thoughts

If businesses already have policy and procedures in place to meet the requirements of the Data Protection Act, then they should have a solid foundation to comply with the GDPR. In many ways, the new regulation simply provides a clear framework for delivering good practice in data protection.

However, all businesses will need to take action to ensure compliance with the GDPR. Otherwise, the financial penalties (as well as reputational damage) of a breach could have serious consequences for their business. And this is not just an IT issue. The whole organisation, starting from board level, must show a willingness to understand the legislation and implement procedures that protect the fundamental rights of individuals.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other data-related articles. 

Supercouncils: questions raised about new powers for England’s combined authorities

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Image: James Carson

Just over a year ago, Manchester began blazing a trail for devolution in England. Ten local authorities in the Greater Manchester Combined Authority (GMCA) signed a deal with George Osborne, the Chancellor of the Exchequer, for the transfer of powers in areas such as transport and skills from central to local government.

Since then, the English devolution bandwagon has picked up speed. After the general election in May, the newly-elected Conservative government introduced a Cities and Devolution Bill , creating a framework for the transfer of powers to the regions, and making provision for directly elected mayors.

During the summer, the Chancellor invited cities, towns and communities across the UK to submit their own devolution proposals, and by September 38 submissions had been received (including a number from Scotland and Wales).

Meanwhile, further deals have been announced, giving greater autonomy to local authorities in Sheffield, Cornwall, the North East of England and the Tees Valley. In November, two further deals were announced for the West Midlands and Liverpool.

As its momentum gathers pace, questions have arisen over the nature and implications of devolution for England’s cities and regions.

The devolution time frame

In October, a survey for Local Government Chronicle (LGC) highlighted concerns about the devolution timetable. 69% of the 45 chief executives and deputies responding to the survey indicated that the seven-week timeframe given to put a proposal together had been too tight. Of those councils which had not submitted a bid, 38% said they could not arrange a partnership with another authority, while 8% said they could not convince politicians in their area to agree.  However, the survey also indicated that 15% of councils were holding back on bids to see how other authorities fared first.

Accountability, transparency, public involvement

Some of the key governance issues surrounding devolution were considered in a report by the Centre for Public Scrutiny.

The report was critical of the secrecy of the deal-making process, noting that details were only being released when agreements had been reached:

“Local people – anyone, indeed, not involved in the negotiations – need to understand what devolution priorities are being arrived at and agreed on. Increased public exposure in this process will lead to a more informed local debate. At the very least, the broad shape and principles of a bid for more devolved powers should be opened up to the public eye.”

The report argued that governance arrangements for the work that combined authority areas will be doing in future need to satisfy three conditions:

  • Accountability: decision-makers must clearly take responsibility, and engage with those seeking to hold them to account (non-executives, the public, and others)
  • Transparency: it must be clear (to professionals, elected councillors and the public) who is making decisions, on what, when, why and how
  • Involvement: a commitment to public involvement should be seen as central to good governance.

Directly elected mayors

In 2012, plans to replace local council cabinets with directly elected mayors were rejected by voters in nine English cities, including Manchester, Newcastle, Sheffield and Leeds.

However, the government has insisted that devolving powers to English regions is now conditional on the inclusion of directly elected mayors. In May the chancellor explained why he thought this was so important:

“It’s right people have a single point of accountability; someone they elect, who takes the decisions and carries the can. So with these new powers for cities must come new city-wide elected mayors who work with local councils. I will not impose this model on anyone. But nor will I settle for less.”

George Jones, Emeritus Professor of Government at the London School of Economics, has asserted that the concentration of power in one person is undesirable:

“…the advantage of collective leadership is it enables exploration of policy from different perspectives. Colleagues can consider possible impacts of policy in a variety of contexts, spotting pitfalls ahead and the consequences for different people and groups. A single person is unlikely to represent the diverse complexities of a large urban, metropolitan or county region area better than can collective leadership.”

The journey to greater autonomy for England’s regions has only just begun, but it’s already clear that the path to devolution will not be straightforward.

Read more about English devolution in our previous blogs:

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