The ‘Wonkavator’ is key to digital health and care services | Alexis Farrow

Alexis Farrow

We live in an age driven by digital. The landscape is significantly different to 71 years ago at the conception of the NHS, and is one which the health services has struggled to embrace and utilise over the last few decades. So why is this?  Alexis Farrow, head of strategy and transformation at Connect Nottinghamshire, has some ideas.   
There is an expectation in 2019 that services are available at the click of a button any time day or night. Nine out of ten households have internet access via computers or smart devices, and 99 per cent of all 18-34 year olds use the internet to interact with others, for entertainment, as well as transactions and 87 per cent of all purchases being made online.
The NHS is a complex beast and is often thought about as a single entity. This aside, the availability of online health and care services is limited and sporadic, and users have limited confidence in where to find accurate and up-to-date information regarding health and care. We are not exploiting how our population interacts with health and care professionals through the use of digital tools,- out of cost, fear or political red tape.
Pete Nuckley, of the Good Things Foundation, once used an analogy, one which really resonated with me (one which I steal with pride often). There is a great quote from the 1971 film, Charlie and the Chocolate Factory:
“It looks like an elevator to me.” —Grandpa Joe
“Yes but elevators only go up. The Wonkavator can go sideways, and slantways, and longways, and backways… and squareways, and frontways and any other ways you can think of. It can take you to any room in the factory just by pressing one of these buttons.” — Willy Wonka

So why is this so powerful? As health and care professionals, whether that is digital, clinical or other, we often view digital transformation as an elevator rather than a “wonkavator”; we have a problem, we fix it; we have another problem, we fix that rather than planning for the future based on user needs, future organisational needs and an understanding the art of the possible.

How are we working to improve this in Nottinghamshire?   

We are thinking more ‘Wonkavator’…
We started at the beginning and did something fairly unusual: we took a step back and took some time (18 months in fact) to research what the user might want. Not the techies, not the clinicians or other professionals, but the population. 
We went to places our population went and asked them what they would get the most use out of, what are the challenges, what are their fears. Some of the findings surprised us, others did not.  
Some of the key things people said was: 

  • it was too confusing navigating the information and applications (some people had lots of different apps, too many, to enable them to manage their health)
  • they wanted a single place to go (a trusted place)
  • what is currently available doesn’t add any benefit to their life
  • there is too much information which is often out of date
  • services aren’t easily accessible.

So, when we developed our Public Facing Digital Services Strategy we did so not only to fulfil our contractual obligations but to also transform and ‘add benefit’ to the lives of our population. 
This led to our vision in Nottinghamshire to transform the way people experience access to health and care services, by providing digital health and care services that connect them to the information and services they need, when they need them in one place. We want to enable people to have access to health and care in a convenient and coordinated way, promoting independence through the digital tools we are all familiar with in other aspects of our daily lives.

What have we learnt? 

Digital inclusion is key
When developing our public-facing digital services strategy, it quickly became apparent that it isn’t good enough just to provide our population with an app and expect them to be able to change the way they interact with health and care services, particularly as the people that could benefit from the use of digital services are those people that are most likely to be digitally and socially excluded. 
While overall Nottinghamshire has a low to medium likelihood of digital exclusion, those at medium to high likelihood of exclusion predominantly live in more deprived areas and face socio-economic challenges and are more likely to live in poverty and ill health, and have lower education as well as housing issues.
We used research available to us, as well as the digital inclusion guidance developed by Bob Gann and NHS Digital, which has since become our bible, developing support models to enable us to understand what issues our population faced in order to target our approach. We learnt that we had to engage with those people who were hard to reach and, most importantly, that we couldn’t expect those people to come to us; we had to engage and work with them in their surroundings, in places which they already accessed and felt comfortable in going to.
While providing our population with the digital tools to help them manage their health and care is a huge step forward – is this enough? Often the focus with digital transformation programmes is in the technology, which is only a really small piece of the jigsaw. User needs, change management and process re-design is all too often left as an afterthought and made to fit the technology rather than the technology acting as an enabler to the change. 
Think more ‘Wonkavator’
Alexis Farrow is head of strategy and transformation at Connected Nottinghamshire. Follow them on Twitter @Connectnotts

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