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NHS England - Transformation Directorate

Tackling physical health inequalities through data

Professor Robert Stewart is a psychiatrist and researcher at King’s College London

"When I began as a doctor, all our information was on paper and there was very little way to use that information to improve health care. Now that everything is electronic, there’s a transformative opportunity for the healthcare system to learn from itself and from its experiences of people receiving routine care. We can harness that information and create much more targeted services.

"Through looking at mental health data, we’ve been able to understand many new things, particularly in the area of physical health inequalities faced by people with mental health conditions, where they’re not receiving physical health care as well as they should. We also understand a lot more about medications, their side effects and how well they work, through being able to look at them at scale, over large numbers of people, so we can provide more targeted treatment.

"For example, if a patient is diagnosed with dementia, they’re often on a lot of different medicines, which may cause problems further down the line. With data from other patients, we’re able to look at the effects of those medicines and improve prescribing at an early stage. 

"Access to data can always be improved - every time we’ve opened it up, a lot of knowledge becomes available that we wouldn't previously have been able to access. An important aspect of healthcare data, which currently doesn’t work well, is the patient voice. I think record systems will soon be able to capture more routinely what patients have to say for themselves, rather than what doctors and nurses write about them, which I think will be transformative in understanding people's experiences. 

"As well as tools to access data, we need to use them in a better way. One recent advance in the field of mental health is natural language processing, which has allowed us to use data gained from text sources (instead of tick boxes, as previously) such as case notes and letters to GPs. For example, this has allowed us to better understand and respond to patients’ personal experiences of stressors such as violence, which we know have an enormous impact on mental health. That information is routinely recorded, but only available in text form, so it would have been invisible to research before this advance in data processing. 

"Since medicine began, it has advanced by learning from itself, so it’s enormously important that we use the information we have from people’s experiences to take steps forward in that respect. This is particularly important in mental health - the more information we can collect, and the better quality the information, the more we can improve services. Someone's mental health record focuses specifically on their mental health, but it misses other areas of experience, such as their physical health, which we know is impacted. By being able to access other records, such as from a GP or hospital, we can work to highlight and address inequalities experienced in other aspects of care, in order to improve health and wellbeing."