NHS England’s recent framework outlines the importance of digital inclusion throughout the NHS and provides guidance on effective and inclusive health and social care services to help address disparities and discrimination faced by digitally excluded groups.
It emphasises the need for strong leadership commitment, geared towards addressing digital inequalities and creating parallel accessible services online and in-person.
Collaboration with cross-sector partners within health and social care is also highlighted as important, especially with local and national initiatives that have unmatched access to excluded groups.
The framework suggests there will be long-term financial savings from its implementation.
While the framework provides clear, actionable starting points for staff across the NHS and beyond, there are implementation challenges around workforce, resources and funding that the framework does not address.
Inclusive Digital Healthcare: A Framework for NHS Action on Digital Inclusion addresses the need for enhancing access to and proficiency in digital health services. Acknowledging the risks of digital exclusion on health outcomes, the framework aims to ensure that individuals facing barriers of any kind can still access quality healthcare and be active in the digital world. The framework recognises the potential for digital to enhance both patient and staff experiences, while mitigating barriers like physical ability, childcare and transport.
The framework outlines strategic actions across key areas:
- Access to devices and connectivity: Targeting populations and communities in need, highlighting tools like the Digital Exclusion Risk Index and establishing sustainable approaches for connectivity.
- Accessibility and ease of technology use: Encouraging compliance with accessibility standards, ensuring public information is accessible and addressing the needs of individuals with diverse physical, communicative or cognitive impairments.
- Skills and capability development: Advocating for skills development for both the public and for NHS staff, aligning with workforce capability considerations and emphasising partnerships with the voluntary, community and social enterprise (VCSE) sector, local government and the private sector.
- Beliefs and trust: Promoting relatable digital services, trust-building through trusted messengers, and prioritising lower-risk, transactional services like booking appointments and seeing test results.
- Leadership and partnerships: Focusing on strategic considerations such as equality and health inequalities impact assessments, data collection for assessing inequalities in digital healthcare, and fostering partnerships at different organisational levels.
The framework highlights more areas for further strategic action, including national efforts to improve access to data and connectivity, supporting accessible services through inclusive design and championing better research and evaluation for digital inclusion.
NHS England has also released A National Framework for NHS: Action on Inclusion Health, to help our members plan, develop and improve health services to meet the needs of people in inclusion health groups.
While use of digital healthcare is certainly widespread, there remains over 11 million people in the UK who lack the basic skills to use the internet effectively, and around 5 million never go online at all. Without measures to include these people, their health outcomes are at risk. As a core tenet of the Hewitt review, members have spoken to us at great length about how they would like to see more digital inclusion in healthcare. Their suggestions included greater strategic action on the following areas.
Equity and access
To avoid creating inequalities or disadvantages for patients, one of the top things our members said policy should consider was equity and access. This includes providing access to up-to-date, easy-to-use equipment and connectivity for people unable to access digital services for reasons including cost or complexity. We are pleased to see a large number of hard and soft actions for a variety of actors throughout the sector to increase access and accessibility.
Similarly, members have called for a consistent and quality offering of face-to-face alternatives for those unable to access digital services to ensure equity of access, as they recognise that a reduced in-person offer could increase loneliness and isolation, especially across older patients with limited digital access. The framework maintains this ask and recognises the pitfalls of an overtly digital health service. However, there are no hard actions to determine the equity of access.
Our members also highlighted the need for infrastructure improvements, particularly the exploration of digital access points in community spaces. This was not explicitly stated as an action. The framework instead encourages VCSE partnership to fill this gap, to which our members have suggested should also be a policy consideration by building on existing programmes and community touchpoints. Overall, the shift to digital health demands a coordinated approach across the NHS, councils and VCSE to increase access, which the framework acknowledges though lacks specific coordination strategies.
The digitally excluded cannot become literate in digital services if the healthcare staff themselves are not fully trained. This was listed to us by our members as a key challenge for their organisation as they develop and deliver digital care and a key consideration for digital policy. The framework provides a good focus on training and support, especially for staff, and encourages partnerships with integrated care partnerships (ICPs) and the VCSE to encourage digital literacy in the community. With this there is a large focus on securing trust, such as using trusted community members to champion digital literacy. Of course, problems persist surrounding vacancy rates for digital and data roles in the NHS, however the framework suggests meaningful actions to encourage digital literacy.
Implementing digitally inclusive services within the NHS presents several challenges to our members that demand careful consideration. As detailed by our members, there exists a significant variation in patients’ understanding of digital resources to hand, with the framework suggesting measures to improve awareness, particularly in underserved communities. Skills development poses a challenge, especially as patients may only interact with digital systems in acute settings in limited amounts, making it difficult to enhance capabilities and build trust.
Language and cultural barriers remain significant, requiring resource-intensive and culturally sensitive initiatives, potentially alleviated through collaboration with VCSE organisations. Our members understand the shift to digital health demands a coordinated approach across the NHS, councils and VCSE, which the framework acknowledges but is unclear on long-term support. With the current environment of large amounts of short-term funding for digital care pilots and inclusion projects, and without a dedicated mention here of funding continuity, our members may still feel the challenge to provide digitally inclusive services.
Overall, while the framework provides clear, actionable starting points for staff across the NHS and beyond, as well as case studies that demonstrate progress and best practice, there are implementation challenges around workforce, resources and funding that the framework does not address.
Key actions for members
- Use tools such as the Spotlight tool and the Digital Exclusion Risk Index to identify key communities in your population who are the most digitally excluded and who are likely to face the most discrimination from services.
- Provide comprehensive training for staff of all levels to equip them with skills in compassionate care, cultural competency and digital literacy. Ensure this training helps staff effectively engage with the digitally excluded.
- Review existing partnership arrangements with integrated care partnerships, local authorities and the VCSE sector. Consider how these partnerships can enhance your inclusive agenda.
- Appoint named clinical and senior leads committed to addressing digital inclusion.
How we are supporting members
We currently run two programmes for digital leads across ICSs that create a space to shape and share digital inclusion strategies:
- Digital Leaders’ Forum – Digital leads meet quarterly to discuss strategy and share best practice.
- Digital ICS Programme – Run with NHS Providers and Public Digital, this programme provides personalised sessions with boards to discuss and analyse their digital agenda and empower them to harness their digital potential.
For more information on digital support contact Lucy Knight.
We also provide numerous support offers for members in progressing their health inequality work:
- Health Inequalities Reference Group – Brings together system chairs, non-executive directors and chief executives to help drive our health inequalities work.
- ICS Public Health Forum – Collaborates with the Local Government Association and Association of Directors of Public Health to improve system performance on public health.
- Cost of Living Hub – Provides insight and initiatives helping to mitigate the ongoing health effects of the cost-of-living crisis.
For more information on health inequalities work, contact Hashum Mahmood.