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The One Solution Healthcare Needs to End the Postcode Lottery

It's clear that health inequalities exist within the NHS–the question is, what is being done about it?


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You noticed a mole on your skin a few weeks ago that has been slowly changing, perhaps even growing. Could it be cancer?


The media is filled with horror stories about crippling waiting times in the NHS, and if it really is cancer, you can’t wait. But you also can’t go private.


It’s far too expensive and the nearest clinic is hours away. You’d need to take an entire day off work, cover the cost of petrol, deal with parking wardens that are out to get you, and secure childcare for your kids. You can’t afford any of it. So you push the fear aside and hope the problem will go away.


With conditions such as skin cancer, you can’t gamble with time. Early detection and treatment can make the difference between life and death; some skin cancers can turn life-threatening in as little as six weeks. 


Unfortunately, the reality is that timely, life-saving care is out of reach for many people because they live in socially deprived areas with no accessible healthcare centres. And it is often those who need care the most who are most affected by this postcode lottery, having the least access to it.


There aren’t nearly enough success stories, if any, about how the NHS is tackling this issue. While health inequalities are a key objective in the NHS Long Term Plan, we hear more about how the NHS is adopting cutting-edge technology to address the rising elective backlog or unacceptably long waiting lists for patients with suspected cancer.


A prime example of this is artificial intelligence (AI). We’ve all heard about how AI can transform healthcare; it’s making headlines: “AI technology set to speed up skin cancer diagnosis,” “£21 million to roll out artificial intelligence across the NHS.” But here’s another headline for you: “AI skin cancer diagnoses risk being less accurate for dark skin—study."


Using AI for skin cancer diagnostic support can be inaccurate because of non-diverse datasets. Most image-based algorithms developed to train the AI use images with lighter skin tones. A study found that of 2,436 images, only 10 were from brown-skinned individuals, and just one was recorded as a dark brown or black skin individual. 


We need to stop thinking that introducing technology, especially complex AI, will automatically lead to improvements. If it’s not carefully considered, adopting a digital solution to solve one problem can worsen another or even create new ones.


Don’t get it wrong; technology is the future of healthcare, and AI may well have a role to play. But any technology needs to be implemented well. This is where digital transformation comes in, a concept that’s talked about a lot but rarely executed successfully. When done properly, the results are astounding. 


This isn’t just another lofty idea tossed around without any concrete proof. Here’s a real-world example: three NHS trusts were dealing with very large volumes of patients suspected to have skin cancer, with wait times of over two months, a situation many other trusts currently find themselves in. However, the trusts adopted PathpointⓇ eDerma, a digital solution to optimise their skin cancer services. But that’s not the only problem they had; they were also dealing with high levels of social deprivation. 


Implementing eDerma did not solve one issue and exacerbate another. Instead, it contributed to a 14-day reduction in the time it took from referral to diagnosis, and regardless of where the patients lived, their age, education, or how much they had in their bank accounts, everyone received a diagnosis at the same speed and with the same level of care and precision. In fact, eDerma improved accessibility for those who often suffer the most from health disparities. 


How did eDerma make such a positive impact? Well, it’s less about eDerma and more about the transformation it enabled. You can’t just slap on some technology on outdated processes and call it a day; it requires a deep understanding of the transformation needed and then using tech to make it happen. The tech supplier, Open Medical, and the NHS organisations worked collaboratively because each trust had different available resources, numerous challenges, and specific needs for their community. 


And the conversation didn’t end at the NHS trusts. Patients were a big part of the transformation too. Open Medical's Patient and Public Involvement and Engagement Committee took a hands-on approach, providing unique insights that significantly improved the final design of the patient journey and led to high patient satisfaction. 


Digital transformation is not about technology, it’s about people. It will impact the lives of clinicians and patients, whether it be to improve their experience or even directly save lives. 


We need to shift our mindset away from deploying technology just for the sake of it, but rather think of it as transformation first, digital second. When executed this way, digital transformation can make a real, positive difference in all sectors of healthcare, not just skin cancer care. It can help address health inequalities across all services, ensuring that every patient, regardless of their background or circumstances, receives the care they deserve. Healthcare should not be a privilege but a right, and it most definitely should not depend on your postcode.


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