Last Mile Care
The Project
NHS Scotland ⎮ Jan - May 2019
Serving the 5 millions Scottish residents, NHS 24’s mission is to connect people to health information and care 24/7. The organisation is looking to develop further its approach of prevention, aiming at encompassing a more social dimension, eventually relieving A+E and GP congestion and improving self-managed wellbeing. Our final proposal is a new prevention system that turns NHS 24 into a central actor of the last mile care.
The Process
What was unusual for the NHS is this project is that our research pushed the challenges of healthcare far beyond medical considerations. Going beyond the traditional spaces and truisms of healthcare, we questioned what the contemporary meaning of being well has become. We explored the daily elements affecting people’s feeling of being well through desk research, a survey and experts interviews.
We understood that wellness has truly replaced health in the prevention quest, asking for a shift in our vision of care services. Wellbeing happens to be a complex system from which health is just a subset, fundamentally intertwined with other needs : feeling safe, feeling in control and having comforting social interactions.
It is when any of those needs, not only health, is left unsatisfied that people turn to the national health service (when they have no one to share their situation with typically).
To a certain extent, it is the mission of public services to make sure citizens are able to satisfy these important needs. GPs are the touchpoint, in the healthcare system, that are not only the reference for one’s medical situation but who also provide us with a feeling of safety, of control (understanding) of this situation and an opportunity to exchange about it.
With the help of analogies from the worlds of telecommunications and public transportation, we reframed this problem more precisely : just like we can’t all have a subway station on our doorstep to travel more easily, we can’t all have a health practitioner next door to check on us daily.
The healthcare system, like any public transportation system, is subject to the last mile dilemma. Our solution aims then at bridging this last mile gap between the healthcare system and citizens to look after their wellbeing basic needs.
The Design
Our design is based on a digital profile that is fed by touchpoints already ingrained in our daily lives and then made accessible to stakeholders involved in ensuring one’s wellbeing. One’s profile develops into a double sided system enabling both individual scale and national scale prevention.
Each user is able to have its data analysed continuously and to get feedback from it. With a normal analysis, the system stays silent and completely unintrusive ; in case of small risks detected, an educative coaching provides practical recommendations ; in case of substantial risks triage guides towards the most competent practitioner.
On a global scale, all user’s data are aggregated, anonymised and analysed to
provide public services and local governments with insights to improve management.
The system is thus based on the simple and common idea of duplicating GPs digitally. What differentiate our design however, and made it especially interesting is its touchpoints, which gather individual data. These are embedded in one’s life, they are places visited frequently providing professional input (pharmacies typically) but also brief everyday calls (the supermarket, one’s monitoring devices…). Home toilets for example, once equipped with automated sample testing technologies bring data ranging from protein or glucose measures to infection detection, while being completely non-invasive and intuitive.
Another strong differentiating point is the stakeholders that can access the data. Health practitioners involved in one’s care pathway obviously can retrieve data to inform medical decisions. But the key element is that once anonymised, data is gathered in local pools and made available for extended public health partners, such as city councils or schools, which are key actors influencing wellbeing at a community scale. Sharing such information broadly is a sensible
aspect in terms of security, integrity and privacy of datas in which KSI blockchain’s potential plays a key role.
One of the central benefits of the service is that it breaks the health information monopoly, giving citizens the opportunity to understand and get control over their wellbeing without being dependent on a health practitioner, which isn’t possible at the moment in Scotland.
This project was realised with Catriona MacKenzie, Magda Szczepan, Jessie Thompson and Ishika Mukherjee. All illustrations are Eugenie Cartron’s property.