Wellbeing: Is there really an app for that?

The app-enthusiast Health Secretary wants to ease pressure on the NHS with smartphone technology. What are its limitations?

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In 2018, Matt Hancock became the first member of parliament to launch his own smartphone app. The eponymous “Matt Hancock” – still available on Apple’s App Store and rated 3.5 stars – allowed users to communicate on Facebook-like feeds, and promised to keep them up to date with news from the digital minister and his team. Big Brother Watch, a pro-privacy and civil libertarian campaign group, described the app as “a fascinating comedy of errors”; users had to consent to having their contacts, photos and videos harvested from their devices as they signed up.

Now the Health Secretary, Hancock, who began his career working for his family’s software company, has maintained his technophilia in the Department of Health, promoting tech-based solutions for services creaking after ten years of the chronic underinvestment that has become all too visible during the coronavirus pandemic.

Hancock has called for a combination of “the best of healthcare culture and the best of tech culture” to “drive innovation”. In 2019 he set up NHSX, the NHS’s digital technology and big data unit. “The X stands for user experience,” he told the Royal Society of Medicine when it launched.

One area to see such digital innovation is in mental health therapies. The NHS’s Apps Library – an online list of approved health apps – lists 21 for mental health and wellbeing, most of which are available for free. The apps offer a range of online services, from six-week courses to help with sleep deprivation to the child-friendly animated breathing techniques taught in “Chill Panda”.

The NHS lists all of these apps with a disclaimer: “The app developer is solely responsible for their app’s advertisement, compliance and fitness for purpose. Unless stated otherwise, apps are not supplied by the NHS, and the NHS is not liable for their use.” Nine of the 21 still on the site are currently listed as “under reassessment”. Two are being assessed to check compliance with GDPR rules, but are still listed in the meantime.

Simon Leigh, a health economist who has conducted research into the efficacy of mental health apps, recognises that some are of extremely high quality, and have been proven to be clinically effective. However, in 2015 he published research in the British Medical Journal that concluded that such apps had major shortcomings, stemming from a “frequent lack of an underlying evidence base” and “a lack of scientific credibility and subsequent limited clinical effectiveness”.

Leigh describes an “over-reliance” on apps, as well as problems with “equity in access and increased anxiety resulting from self-diagnosis”. The research concluded that, while apps do have the potential to play a useful auxiliary role in mental health therapies, many do not meet the standards of scientifically credible, peer-reviewed or evidencebased therapies.

Other apps promoted by Matt Hancock have also stirred controversy. Babylon Health’s “GP at Hand”, which offers users an AI-powered chatbot service, stands accused of creating a £26m deficit in Hammersmith and Fulham Clinical Commissioning Group, and creaming young, tech-savvy patients from local GP surgeries, who are left with older, more expensive patient lists. The Health Secretary was criticised for appearing to endorse the app in paid-for advertorial content that appeared in the Evening Standard in 2018.

Some of those promoting the more widespread adoption of apps in the NHS see them as a cost-saving device. In April last year, the Health Secretary wrote the foreword to a TaxPayers’ Alliance (TPA) paper as part of the group’s “Automate the State” research series. The TPA is a right-wing libertarian pressure group, set up by Matthew Elliott, the Vote Leave co-founder. Who Funds You?, the campaign for transparency in the lobbying and public affairs industries, gives the organisation an “E” grade to reflect the fact that it does not disclose its income or the sources of its funding.

“This report from the TaxPayers’ Alliance is a timely and provocative intervention,” Hancock wrote. “Whilst we don’t agree on everything, the TPA has a long history of challenging the status quo. So I welcome the challenge to think even harder about how we can use technology and innovation to save money, time and ultimately lives.” The report states: “One area, in particular, where embracing automation and new technology can make a real difference to patient care is in the field of mental health treatment.”

But apps cannot make up for cuts to front-line care. The 2012 Health and Social Care Act declared that the health service would deliver “parity of esteem” between mental and physical health. In 2018, however, the Royal College of Psychiatrists reported that although mental health funding had risen in absolute terms, once inflation was taken into account mental health trusts actually received £105m less than in 2011-12. In 2013 there was one mental health doctor for every 186 patients. By 2018 this had fallen to one doctor for every 253. In mental health nursing there have been similar reductions. Since 2009 there has been a 30 per cent reduction in the number of beds available in mental health trusts.

Austerity has also affected mental health service provision indirectly. Research by Professor Ian Cumming, former chief executive of Health Education England, concluded that “the response to individuals in crisis”, “the position of the criminal justice system as the default provider of mental health care”, and “the personal toll policies such as the work capability assessment have inflicted” had all contributed to a deterioration of the nation’s mental wellbeing. The links between poverty, financial stress and poor mental health outcomes are well-established.

Lockdown is likely to accentuate mental health problems, and could lead to a surge in demand for therapies. Hancock may be an app enthusiast, but he would do well to remember that smartphone apps are no substitute for well-funded, properly staffed mental health services, or policies that promote financial security and stability.

You can read the full Spotlight Mental Health Supplement here.

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