There is a lot of enthusiasm lately about the NHS Health Apps Library.
Whilst probably some of it is well deserved, the NHS Health Apps Library is nothing new in fact.
Remember, this is actually “Version 2” as there was a previous version of the library (Wayback Machine cache 1, Wayback Machine cache 2) which closed circa 2015 due to problems with the assessment process as reported by a study published in BMC Medicine (media articles reporting the issues – Link 1, Link 2)
So work on this updated library has been going on since before 2016 under the guise of NIB. See here re: Workstream 1.2: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/572415/NIB_Annual_Report_NovA.pdf
Whilst I have no objection to the following statement:
The apps library is about defining the standards for health apps in order to raise the standards for those that were already out there and were being used by the public, but that didn’t meet regulatory requirements. Similar to the principle of NHS Choices to provide ‘trusted’ health content because people were looking to search engines to find information.Hazel M Jones, Apps & Wearables Programme Director @ NHS Digital (consultant) until April 2019
I do however question how long it has taken “the system” to get to this point, to build what is a relatively simple, linear assessment process, the total cost of this time onerous effort and a lack of real understanding of what benefit has (or hasn’t) been gained by it by either the UK general public or health system itself.
Programme and System Benefits?
I asked the Health Apps Library programme team recently the following question:
“Could you be so kind as to tell me if you track how individuals find the apps library, if you track hits and also the number of follow through conversations and completions of the individual app programmes? (so as to qualify overall health system benefit as to the usage of these clinically effective interventions).”
The response I received from the team confirmed my fears… that the programme really had no understanding how much system benefit the health apps library has, or hasn’t actually delivered:
“We have an analytics package that tracks a range of measurements including where users have come from, how many visits the apps library receives and how many clickthroughs go on to the Apple or Google Play.
As the apps are downloaded or interacted with outside of the library domain we do not automatically measure completions of the individual app programmes; this would have to happen at developer / app level.”
The lack of detailed reporting around actual app usage and completion of clinically validated interventions means that we don’t actually know who, if anyone is actually getting “fixed”.
Loss of Market Opportunity?
There is a real possibility that the NHS Health Apps Library may now have missed the critical market opportunity to offer this library at the time when none existed.
During the period between 2015 and 2018 when the NHS was working away at developing the new Health Apps Library, a number of private app assessment companies have either commenced trading or substantially solidified their commercial offerings (eg. Our Mobile Health, ORCHA, App Script)
Various commissioning bodies purchased sets of topic specific assessed health apps during this period to satisfy their need for good quality interventions they could recommend to the public when no process existed within the NHS to do so.
Lack of integration?
No integration between the NHS Health Apps Library and primary or secondary care systems have been made because the NHS assumes that members of the general public will find the apps library on www.nhs.uk and make an app selection from here.
Now compare the NHS approach to what EMIS decided to do with their commercially offered App Library, which was to integrate it into their primary care system:
All EMIS primary care users across England can use EMIS App Library by AppScript to find and recommend various high quality apps – many of which are clinically-validated and some of which are commissioned/paid for by various NHS orgs. It’s quite quick to access.Brian Clancy, AppScript
I believe EMIS is used by a large number of GP surgeries here in the UK, perhaps as great as 1/3 – 1/2 (but do get in touch if I have got that number incorrect).
The NHS had a golden opportunity during the period between 2015 and 2018 to influence and / or standardise how apps are assessed and made available direct to clinicians, but have probably now missed that opportunity as the private sector has done this ahead of the NHS health apps assessment process being ready.
I decided to put this section further down the article because I know it’s not always about the money. And also because I feel the items above are much bigger obstacles for the NHS Health Apps Library to overcome regarding its long term sustainability. However…
I put a broad estimate of the total cost of the programme since the closure of Version 1 (circa 2015) at between £1.5m – £3m
I have estimated that as a reasonable total cost for all staff, contractors, consultants, suppliers and purchases based upon my personal experience of working in government on similar size programmes, writing business cases for the Department of Health and Social Care, managing GDS spend approvals and writing investment cases for Cabinet Office.
(nb. if you know of an actual, credible total cost figure that you’d like to provide, I’d be happy to update my article as such)
Scarce resources and a health system unable to help everyone who needs it
At times my personal motivations for writing about the NHS Health Apps Library have been questioned, as if I was somehow a naysayer or someone who couldn’t just “be happy for other people”.
That’s not accurate at all – since I started volunteering with individuals having mental health issues through a charity staffed almost entirely by volunteers, it’s made me question potential system waste now more than ever before.
A lot of my volunteer work is with people who the system CAN’T HANDLE or help given resource constraints.
Is the health apps library actually helping?
I don’t think any of us really know. Even 7 -8 years later after the first NHS App Library was put live.
However it’s not too late to find out.
Putting personal opinions and conjecture aside, shouldn’t we answer the following questions and publish their answers openly once and for all?
- How much has been spent in total on the NHS Health Apps Library from the very beginning (circa 2011) to current?
- How much public and system benefits can realistically be attributed to this spend?
- To what extent does the private sector now fill the original system need for rigorously assessed and well curated lists of topic specific health apps?
- Does the NHS still have a valid role in running and maintaining a central assessment process for mobile health apps?
- Does the NHS still have a valid role in providing a ‘shop front’ on nhs.uk for their own curated health apps?
- Should the app assessment process developed by the NHS now be standardised into something more like a formal ISO Standard which 3rd parties can universally assess and validate against?
Ask any project manager about the key to their success, and they will say that delivering a project is often more like a "dark art" or by chance, than a predictable science.