As the impetus to develop a more digitally enabled health and care system grows, are we building an inclusive digital health and care service fit for the 21st century and accessible to the people most likely to need it? Digital health expert Roz Davies shares her view.
I’m with Matt Hancock, Juliet Bauer and other digital leaders on their drive to build a digital health and care service fit for the 21st century. Unleashing the full potential of digital technology to improve health and wellbeing and to drive quality and efficiency makes sense.
But there are some significant digital and social inclusion barriers which I’m not sure everyone involved in the digital health movement has clocked! As digital becomes more embedded into health and care services, health inequalities could be compounded if we don’t deal with these digital and social inclusion barriers.
There are currently 7.8 million people who do not use the internet
, and they are more likely to be older, poorer and living with disabilities.
There are 15 million people in England who currently live with long-term conditions (LTCs), such as diabetes, chronic obstructive pulmonary disease, arthritis and hypertension. King’s Fund research shows that the 15 million people who live with long-term conditions are more likely to be older and poorer. People with LTCs currently account for 50 per cent of GP appointments
, 64 per cent of outpatients appointments, 70 per cent of inpatient bed days and £7 in every £10 of total health and care expenditure.
The Jo Cox Loneliness Commission report highlights that there are 9 million people who are lonely and socially isolated and that while loneliness can affect anyone at some point in their lives, the risk of chronic loneliness increases for some, including those who are living with disabilities, older and who have health conditions.
also states that three out of four GPs say they see between one and five people a day who come in mainly because they are lonely.
When this evidence is brought together, it is clear that there is a group of people who live with long-term conditions, are lonely and isolated and do not use the internet.
If health and care services go digital without social and digital inclusion support for this group, health inequalities will become even more pronounced, with an impact on quality of life and on the cost and use of health and care services. Fortunately, this does not have to be the case.
Good Things Foundation has spent the last five years delivering a national digital inclusion programme, commissioned by NHS Digital and NHS England, called NHS Widening Digital Participation (#NHSWDP), to ensure that digital and healthcare go hand-in-hand.
Building the capacity of skills, confidence and connections of staff and patients and their supporters and carers to use digital, and ensuring that digital services and products are co-designed with the people whom they are intended to benefit, will help to build an inclusive digital health and care service which could have a positive impact on healthy life expectancy inequalities – and on the use and cost of services.
During the first three years (2013-2016), we supported 221,941 to use digital health tools and resources to access services and manage their conditions. Fifty-two per cent said they felt less lonely and socially isolated and 62 per cent said they felt happier as a result of social contact. The programme saved the NHS over £6m in reduced GP appointments and A&E admissions in one year.
In the last 18 months, with our ‘digital health lab’, we have been working with local partners to co-design pathfinders which support people who are ‘furthest away’, such as people who are homeless in Hastings, young carers in Bradford, people with sensory impairments in South West Yorkshire and isolated older people in Sunderland.
We have explored a range of tools to help people manage long-term conditions, developed ways to build the confidence and capacity of staff to support people on their digital health journey and helped to develop new ways for community organisations to connect with primary care and other health and care around digital inclusion. Our journey, learning and ‘how to’ toolkits are all provided for free on the Digital Health Lab website.
Whilst there has been great progress and there are pockets of good practice, digital inclusion still remains on the margins of many local NHS strategic plans and programmes.
The excellent Digital inclusion guide for health and social care
, produced by NHS Digital, concludes: “local digital roadmaps vary considerably in how much attention they give to digital inclusion”, despite there being specific national direction to ‘pay due attention to digital inclusion’.
The case has been made and our programmes have shown it is possible to overcome barriers and reach deep and wide into more digitally and socially excluded communities.
Roz Davies is director of social inclusion at Good Things Foundation. Follow her and the organisation on Twitter @roz_davies @goodthingsfdn
As part of the #BridgingTheDigitalDivide Campaign, the Good Things Foundation identified that the NHS would save at least £14m if 100 per cent of people in the country were supported to go online by 2018. Find out more on the organisation’s website