PAGB's Digital Self-care Audit 2023 findings

Digital tools including NHS website and 111 key to self-care but Government must better promote trustworthy information online

New research carried out by PAGB has revealed shifts in the public’s use of apps and other digital interventions in managing self-treatable health conditions.

Three years on from our first audit in 2020, PAGB’s latest digital self-care audit analysed a range of NHS digital tools, which are free for the public to use to access health and self-care information, between February and May 2023. Tools reviewed as part of the audit included NHS 111 (online and telephone), the NHS app, NHS website and websites from England’s 42 Integrated Care Systems (ISCs). In addition, the audit also looked at NHS England (NHSE) datasets and parliamentary and UK Government documents.[i]

The audit found that, for the NHS website and App:

• Despite UK Government committing to improving the functionality of the NHS App and website[ii], funding for digital services has been reduced[iii].
• However, NHS website use has increased, with 1.2 billion visits between October 2021 and September 2022[iv]. This is a huge increase from 2019 during which the website recorded an average of 40 million visits a month (approximately 480 million a year), indicating increased public willingness to use this channel to access healthcare information.
• PAGB’s 2020 self-care audit recommended the inclusion of a central hub for self-care within the NHS App. Three years on, this still hasn’t happened, with users having to navigate through a lengthy alphabetised list of conditions and treatments to find relevant information on self-care or use the link to the NHS 111 online triaging service to find self-care recommendations.

The audit found that, for NHS 111:

• NHS 111 telephone service saw calls received increase from 17.7 million in 2019 to 20.7 million in 2020[v] – likely due to efforts by Government agencies to reduce pressure on in-person primary care services during the pandemic. This trend has continued with calls reaching 22 million in 2022[vi], suggesting increased public willingness to use this channel to access information and healthcare.
• Use of NHS 111 online service increased from 1.9 million in 2019 to 12 million in 2020[vii] – however unlike the phone service, online sessions have since decreased in the years that followed to 6.4 million (2021) and 7.2 million sessions (2022)^vii. Nonetheless, far more sessions have been recorded in 2021 and 2022 than in 2019, suggesting online symptom checkers use has become more common following the pandemic.
• NHS 111 online sessions resulting in a recommendation to self-care in England showed a 17% increase between 2019 to 2020 (from 8% to 25%), however this decreased to 10% in 2021 and fell again to 7% in 2022, their lowest point in 4 years^vii.

The audit recommends NHS England and UK Government maximise opportunities for better supporting self-care using existing digital tools.

These recommendations include:

• Development of a self-care hub accessible via the NHS App and website. This hub should include a library of publicly available tools to help people self-care, list self-treatable conditions, consolidated information on self-care and accessing appropriate over-the-counter medications. It should also include a library of accredited and trustworthy self-care apps.
• The majority of Integrated Care Systems (ICSs) currently include information on self-care on their websites, however the depth of information is not consistent across the country. NHS England should seek to provide support and national guidance on information to include on these pages. Pages should cover how to: self-care for self-treatable conditions; seek self-care advice and information via NHS digital services, including NHS 111; and seek advice and information from pharmacy services, where appropriate.
• NHS England to maximise opportunities to provide self-care advice and information via NHS 111 (online and phone) by:
  • Reviewing the NHS 111 pathway and algorithm to make sure self-care advice is delivered at all appropriate stages of triage
  • Regularly publishing data on the number and proportion of users provided with self-care information or advice for specific conditions
  • Better promoting NHS 111 services and increasing public awareness about the types of health conditions for which users can receive information and support

Responding to the findings of the self-care audit, Michelle Riddalls, PAGB, CEO, said:

“Digital apps and interventions are vital in helping empower the public to learn more about and manage self-treatable conditions at home, without placing extra pressure on our already-stretched NHS services, including GPs and A&E. According to our audit, use of NHS website and NHS 111 phone service is increasing year on year, but people often feel overwhelmed by the amount of content available online and don’t always know which sources are trustworthy. We also found a postcode lottery when it came to self-care information available at a local level, with ICB websites differing in level of detail provided. Being able to access quality health information shouldn’t depend on where you live.

“We need to see the UK Government put in place the recommendations outlined in our audit, including reinstating a library of trusted health apps, so people can be reassured that they are accessing reliable, accurate and useful information. With winter approaching and more industrial action planned, it’s never been more important to give the public the tools they need to self-care for common treatable conditions such as coughs and colds.”

The audit is accompanied by best practice case studies leading the way in digital health interventions:

• ORCHA Health App Infrastructure (Assessment, Library and Formulary) ensures health apps are centrally continuously assessed against standards and regulations in clinical and professional assurance, data and privacy, and usability and accessibility. It allows care providers to build an online self-serve Health App Library of consumer-friendly over-the-counter apps, and a Formulary for staff to digitally recommend over the counter and more complex apps, with the governance needed.
• The Smart Symptom Checker from Healthily is a Class 1 Medical Device that utilises artificial intelligence (AI) to help users identify possible causes for their reported symptoms and suggest probable next steps to support users in adopting decisions about the necessity to see a health professional.

Liz Ashall-Payne, CEO, ORCHA, said:

“Health apps can help take significant pressure off the NHS, helping people to better self-care; and 68% of the public want the NHS to recommend them[viii]. But whilst there are great, clinically effective apps, 80% in app stores do not meet standards[ix]. The infrastructure to connect the right app, with the right person, at the right time, can transform how we look after our own health and the health of our NHS system.”

Matteo Berlucchi, CEO and Co-founder at Healthily commented:

“Finding the right information online is incredibly difficult for people who are wondering if they need to speak to a doctor or if self-care is appropriate. While AI can’t and shouldn’t replace a doctor, symptom checkers can be incredibly effective at recommending the most probable next steps thus lowering the burden on the overstretched healthcare service.”

Research:

• Access PAGB’s 2023 digital health audit
• Access PAGB’s 2020 digital health audit

References

[i] NHSE data sets: NHS 111 Integrated Urgent Care Aggregated Data Collection (IUC ADC), NHS 111 Minimum Data Set and NHS 111 online usage data (not publicly available, obtained via a written parliament question accessible on the UK Parliament Hansard website). Government and parliamentary documents: Department for Health and Social Care (2022) A plan for digital health and social care and House of Commons Health and Social Care Committee Expert Panel (2023) Evaluation of government commitments made on the digitisation of the NHS

[ii] Health and Social Care Committee (2023) Evaluation of Government commitments made on the digitisation of the NHS – Fourth special report of session 2022-2023, accessed 5 September 2023.

[iii] Department of Health and Social Care (2022) A plan for digital health and social care, UK Government, accessed 5 September 2023

^iv NHS Digital (2022) 1.2 billion visits to the NHS website in the last 12 months, accessed 5 September 2023

v NHS England (2021) NHS 111 Minimum Data Set time series to March 2021, accessed 5 September 2023

^vi NHS England (2023) Integrated Urgent Care Aggregate Data Collection (IUCADC including NHS 111) Data and KPI Time series to March 2023, accessed 5 September 2023

_[vii] Jolly J. (2023) NHS 111, UK Parliament: Written question, 23 March, UIN HL6796, accessed 5 September 2023

[viii] Lydon C. (2023) Majority of public want digital health apps to be used in NHS, accessed 7 September 2023 via Digital Health

[ix] ORCHA, 2023, Digital Health in the UK – National attitudes and behaviour research 2023, accessed 7 September 2023