Company of the Month – Written Medicine
Written Medicine, founded in 2012, provides a solution to a seemingly glaring gap in healthcare provision. According to the 2011 Census and Home Office, there are approximately 3 million people in the UK that speak English with a limited proficiency. Yet, despite this, instructions for prescription medicines are given in English only. And, whereas primary and secondary care have access to commissioned interpretation services, community pharmacies do not.
Communications barriers
Ghalib Khan, Co-founder and Director of Written Medicine, explains:
“Pharmacies in diverse areas usually hire staff from the local area, who can speak the languages common in the community. But that is far from reliable. I, for example, can speak Urdu and Hindi but do not know the formal terms and instructions in these languages needed for medical settings.”
Ghalib also points out the cultural barriers associated with giving verbal instructions on, for example, directions for a suppository or pessary, which can make it crucial that patients are given clear, accessible instructions they can understand.
As an ex-pharmacy dispensary manager, Ghalib has experienced these barriers first hand. He also has personal experiences which influenced the focus on accessibility.
“My son has Down Syndrome, my mum speaks English with a limited ability, my grandmother was deaf and mute from birth, and I myself have dyslexia and dyspraxia. I am surrounded by communications barriers all the time, so it’s very much a personal journey for me as well.”
Cloud-based solution
Written Medicine’s product is a cloud-based software, which subscribers either access through an online portal, or have integrated with their existing vendor systems. Healthcare professionals use existing hardware to print and provide personalised accessible medication information, including dispensing labels and A4 summary sheets, in simplified English or in the patient’s preferred language.
The product is available in 12 languages (with 5 more launching soon). The team are also developing pictogram and audio file options to cater for patients with low literacy, special and sensory needs.
Phrases, indications and warnings go through a four-stage language development process, using ISO 17100 accredited experts, including translation, proof-reading, quality checking and testing with a UK–based bilingual pharmacist.
A peer-reviewed academic evaluation by Portsmouth University, funded by NHS Health Education England, found that Written Medicine’s translated pharmacy dispensing labels increased how often patients understood medical instructions from 38% to 89%.
The solution is now being used by London North West University Healthcare NHS Trust, Barts Health NHS Trust, Luton & Dunstable University Hospital NHS Foundation Trust, and East London NHS Foundation Trust. They are also running a pilot with private providers HCA Healthcare UK.
Bottom line benefits
As well as the patient benefits, Ghalib cites cost savings that could be achieved through better understanding of instructions:
“National estimates are that 12% of all unplanned hospital admissions are due to medication safety issues, and 10% of all prescribed medicines are wasted. In East London alone, over £200 million is spent on prescription medicine. When you factor in that 26% of the population there speak English as a second language, and 65% are from a BAME (black and minority ethnic) background, there was a real opportunity there to reduce the financial burden on the NHS.”
NHS England has stated that BAME communities are six times more likely to suffer from chronic conditions and COVID-19 has shone a spotlight on health inequalities in these communities. Ghalib points to a large-scale study in Birmingham, which also found correlation between language barriers and poor adherence to prescribed medicine in some communities. As a minimum, he believes this means that more money is being spent on medication to manage these conditions, which has potential to go to waste due to prescriptions not being taken correctly.
Successfully making the case
After 8 years of working to make the case for Written Medicine’s solution, Ghalib partly credits the recent increased profile of health inequalities with an added interest.
“In the past, sadly, some of the feedback has been that, while commissioners liked the product, they saw it as a ‘nice to have’, and not necessarily a priority. We’ve seen a noticeable shift in attitude recently, as tackling health inequalities has become more of a public priority.”
Overcoming challenges
While the team have a good network of contacts within pharmacy in the UK, they have experienced the challenges of navigating the commissioning structures that will be all too familiar to many. In response, Ghalib and his co-founder Dr Murtada Alsaif have keenly accepted learning opportunities that have come their way. They were part of the first cohort of the Digital Health.London Accelerator, have been involved with the Health Innovation Network South London, and are currently on the Yorkshire and Humber Propel Programme.
Ghalib is also on NHS England’s Clinical Entrepreneur Training Programme (which MedCity has supported and offered mentorship through). Ghalib has found this to be a particularly valuable experience:
“Tony Young, who is spearheading the programme, is a great guy. He’s very passionate about entrepreneurship and innovation and also has a wide network, which has helped with connections and introductions into both private companies and NHS bodies. The programme has provided a really good place to meet like-minded individuals and discuss our entrepreneurial journeys, and it’s helped a lot with developing, not only our business strategy, but also personal growth. I feel it’s helped me learn a lot about myself, and how I come across during business presentations (I’m very passionate about what we’re doing and often wear my heart on my sleeve). There’s been a lot that I’ve been able to take away from the mentorship.”
Ghalib also admits that, with no real competitors to benchmark against, they have often found the pricing and commercial aspects of the business strategy challenging. For this, they have also sought support from MedCity:
“It’s been really useful to work with the Digital Health Lead at MedCity, to go through the commercial aspects and, in particular, pricing. To have that guidance on what other businesses are doing, and to have someone with good commercial knowledge as a sounding board, has been really useful and helps us go into pitches with more confidence.”
Plans for growth
With discussions ongoing with both NHS trusts and private providers, Written Medicine hope to be providing their service across more and more hospital and community pharmacies in the UK. They also have agreements in place for a project in India (delayed by the COVID-19 pandemic, but now due to kick off by the end of next year).
The team continue to grow the core product by adding new language options, and are working on ways to improve integration with other systems, particularly those being used across the NHS.
“Up until now, we’ve been lucky to benefit from a number of grants, such as from the Social Tech Trust, Shell LiveWIRE, UnLtd, Bethnal Green Ventures, and others. We hope that, by the end of next year, we’ll be in a position to look for investment to take the product further,” says Ghalib.
Find out more
writtenmedicine.com – Written Medicine would love for you to get in touch if you know of an area that could benefit from their bilingual solution, or if you would like to be part of their testing network of bilingual pharmacists.