Safe, low cost email
in healthcare

Professor Iain Carpenter
Date: 20th March 2017

Email in health and care

Why don't we offer everyone the opportunity of using email for all communications with their care provider? You can access email from almost anywhere, a letter you can only access at the address to which it was posted. And email is a lot cheaper! The NHS in England would save over £125 million per year for outpatients alone.

Our recent workshop on standards for outpatient letters got me thinking about this issue and how we address it. Given the current financial challenges in health and care can we really justify wasting money on posting letters when emails are fast, cheaper and reach virtually everyone, even older adults?

88% of adults have used the internet recently. That includes virtually everyone between the age of 16 and 44, dropping to 74% of 65-74 yr olds and 39% of the over 75's. Use by the over 75's has more than doubled in the last 5 years. My father in law is constantly on the internet for research, youtube, iplayer, email and even has his own blog (with only a bit of assistance) – he is 86.

There were over 113 million outpatient appointment and 89 million outpatient attendances in England in the year to March 2016. 18% of these attendances were by people aged 75 and over. If half of the outpatient appointments involved posting just one letter before each appointment and one third with posting a letter after each attendance (eg to GPs or patients), that would be a total of 84 million letters. Sending letters by post costs the NHS approximately £2 per letter while an e-mail costs approximately 0.5p. If 75% of the posted outpatient letters were sent by e-mail, that alone would generate a saving of nearly £125 million.

There are many fears and anxieties about using email for sensitive information. Many people worry about data security and information governance; care professionals worry about increased workload and the legal status of emails. In 2014/15 the PRSB carried out a project to coincide with the launch of the new NHS Secure Email Standard. Extensive literature search, workshops and survey consultations found no reports of evidence of harm to individuals as a consequence of the use of email and no evidence to show that doctors' work load was increased

The project published guidance for the public and care professionals on safe effective emailing in health and social care that addresses much of the confusion about email. Specifically it describes what is secure and what is not secure, and how the standard for secure email will greatly help in email communication between all public services. It also includes guidelines for care professionals and patients, so they can use email safely and with confidence. The information standard is in the process of being updated by NHS Digital. PRSB clinical and professional members had the opportunity to feed back to the review in order to ensure the updated standard reflects current practice.

There is no excuse for not offering every patient and care recipient the opportunity to communicate using email. And most importantly, the money saved could be better spent on care and treatment.