In this blog, part of a series of comment pieces from NHS Confederation leaders, members and partners, Roz Davies explains that while COVID-19 has brought digitisation of the NHS and its acceptance by service users into its own, our attention must focus on the need for the digitally excluded to be involved when developing digital products and services.
COVID-19 has been a catalyst for fast-tracking the digital transformation of the NHS and many have turned to digital for health information and access to services.
The NHS website, for example, saw a sharp increase to 3.4 million users on 17 March and at mHabitat we saw a 25 per cent increase in the use of our ‘I need help now’ function on our mental health platform, MindWellLeeds. In addition, in one month, our COVID-19 mental health hub page received more than 5,000 views.
The National Audit Office report, Digital Transformation in the NHS and the £8.1 billion Digital Transformation Portfolio noted that it allocated less than 1 per cent to building digital capability in its workforce. What it didn’t say was that there was an absence of any attention or resource paid to the digital inclusion of people who use NHS services. Although there is a section in the emerging NHSX Tech Plan vision on digital inclusion, it seems to have dropped off the national agenda. There is a strong rationale placing it at the heart of digital transformation.
Digital transformation is an enabler to help us provide the best possible NHS. An NHS which ‘belongs to the people’ and, as the first principle of the NHS Constitution says, it should provide a comprehensive service available to all:
'...it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.’
Two years ago, I wrote an NHS Voices blog on the case for a more inclusive approach to digital health, when I was SRO for the national NHS Widening Digital Participation Programme. Last year the Topol Review reiterated this:
‘A range of social determinants affect health outcomes, and digital health technologies should redress not reinforce inequalities, with particular attention given to vulnerable and marginalised groups.’
We now face a complex and difficult triple challenge of health inequalities and digital exclusion compounded by the COVID-19 pandemic.
At mHabitat we have noticed a marked increase in local discussions about digital inclusion. We have been hosting a series of recorded digital inclusion training sessions with 100% Digital Leeds and every session has sold out in days with around 50 per cent of delegates from outside Leeds.
In many ways the argument for digital inclusion in the NHS has been won and there are pockets of good practice across the country, for example 100% Digital Leeds and some tools and resources such as Good Things Foundation’s Learn My Way platform and Refugee Action’s digital inclusion good practice guide. There has been some national NHS digital inclusion programmes, Widening Digital Participation and digital champions and some activity within programmes like the testbeds, such as Care City. COVID-19 has also prompted some vital and collective action around access to devices with the Device Dot Now campaign.
Despite all of this, digital inclusion remains on the margins of the NHS. At mHabitat we work with people who are digitally excluded, together with other stakeholders, to explore the problems, and co-design digital inclusion enhancements into digital products and services using GDS Design Principles and taking into account the NHS Digital inclusion guide.
Drawing on our experience, here are three top tips for NHS leaders and changemakers:
- Co-design and integrate digital inclusion into digital activities from the beginning. People who are digitally excluded are not the problem, they are the solution. Co-design needs to start where people are by exploring life-context factors, digital capability and system factors.
- Digital inclusion is a complex partnership issue to be solved together. At its best inclusive digital transformation strategies mobilise the informal community action semi-formal voluntary sector activity and more formal public sector services.
- It won’t happen without targeted resources and leadership buy-in, but it could be developed at a low cost if it is co-designed in from the beginning of every digitally enabled activity.
Going forward, it is vital that digital inclusion is not lost in digital transformation.
Digital can be transformational for people as well as for the NHS. The last word goes to Marie, an 80-year-old woman who has benefitted from digital inclusion support in Leeds, who says:
“I live alone, I’m a widow. The winters are hard when you live alone...it would be so lovely if there is a way that after coronavirus we could find a way of still keeping together online...I’m not exaggerating to say it’s been a revelation to me.’’