A fully inclusive service is one that can be accessed and successfully completed by all its users. They will be able to interact however they need to, regardless of their personal characteristics, situations, capabilities or access needs.Inclusive design lead, Government Digital Service.
A good service is by default an inclusive service. In healthcare, badly designed services can exclude people and increase existing inequality, while well designed inclusive services can support better health outcomes by making it easier for groups at risk of exclusion to access the support that's needed. The same holds true for digital services.
The challenge for trust leaders is to support the design of inclusive services that include digital, rather than services which are purely digital. Doing this well requires a good understanding of the impact of the whole service on health inequality, and intentionally creating short feedback loops between those running the service and those using it to improve the service early and often. Users will access health services in different ways depending on their needs, so a service is rarely simply a 'digital service'.
In our work with trust leaders through the Digital Boards programme we've found that boards worry about the impact of digital services on existing health inequalities. The concern is that by putting a service or information online, using an app, or implementing a patient portal, users who have accessibility needs, fewer digital skills or less access to the internet will be excluded. This applies to staff as well as patients/service users – they are all users of your digital services.
At the same time, we see great examples of where trusts have used digital as an enabler for building better, more inclusive services: services that are more effective, more convenient, quicker, and safer for users. The pandemic heightened trusts' awareness of digital inclusion as services rapidly adopted digital as a way of continuing to provide care and run large organisations in very unusual circumstances. As a result, the usual perceptions of who uses and benefits from digital services were challenged, from video consultations being a preferred channel for some children and adults with autism and online exercise groups that saw higher attendance and engagement than previous in-person sessions had.
What is digital inclusion?
NHS Digital defines digital inclusion as skills, connectivity and accessibility.
- Digital skill: whether someone can confidently use a device to access a service online.
- Connectivity: whether someone can access the internet easily – either using their own home broadband or data, or for example public WiFi provided by many local authorities.
- Accessibility: whether a digital service has been designed in such a way that it meets all user needs, for example those who use assistive technology such as screen readers.
The Good Things Foundation (whose aim is to fix the digital divide) has useful research on the wider picture of digital inclusion in the UK. For example, limited users of the internet are four times more likely to come from a low-income household, showing that digital inclusion is part of a wider social issue, the impact of which includes poorer health outcomes.
Three questions for boards to ask
As a board, you will be signalling to your organisation how important you think digital inclusion is in your trust. Informed by our work on digital transformation and leadership with over 75 NHS trusts, here are three questions we've found useful for boards to ask in designing good, inclusive services.
How would we know who is being excluded right now and why?
It's likely that your current services, digital or not, are either already excluding some people completely, or making it harder for them to access. Understanding what's happening now in your services and where you can make small but important changes quickly, will help you better understand your users' needs.
How are we designing for inclusion from the start?
The single biggest difference that effective digital organisations achieve is becoming genuinely user-centred. This means they make decisions based on the evidence of what their users need, rather than making high level guesses based on assumptions.
How close are you as a board to your patients' and staff experience? Do your teams spend time with those excluded from your services finding out what their experience is really like?
How could we make this simpler?
A simpler service benefits everybody, especially in a health context where the process can be stressful for patients and loved ones. So make everything in the service as simple as possible. That includes simpler language, fewer digital and non-digital steps to access the service, and doing the hard work now of service redesign and improvement to make the digital service better.
We can help
Through bespoke board developments sessions, briefings and events, the Digital Boards programme can help you and your trust think through how you'll lead the digital inclusion discussion.
Get in touch, we would love to work with you.