NHS England has launched a new framework for digital inclusion, outlining a set of actions for trusts to take when developing and updating services, to ensure the benefits of digital transformation are accessible to all and that digital approaches do not exacerbate health inequalities. It aims to encourage greater access to and improve experiences of healthcare, alongside increasing the uptake of digital approaches where appropriate.
Digital inclusion covers three broad aspects: the skills and confidence to use online services, connectivity to the internet and access to technology and devices that meet the needs of the user (this may include enhancements, such as screen readers). Digital inclusion supports individuals to engage with online services and digital technologies.
When implemented correctly, there is real potential for digital solutions to increase the accessibility of services and improve the quality of care patients receive. However, the benefits are not evenly distributed – as there is considerable cross-over between deprivation, social exclusion and digital exclusion. Certain groups are more likely to be affected, such as those from more deprived areas, those living in rural locations and elderly populations.
The number of people using the internet to interact with NHS services has been steadily growing over time. NHS England estimate that 1.2 billion people visited NHS websites in 2022 and there have been over 30 million sign ups to the NHS App. More and more communication between patients and providers takes place online, for booking appointments and sharing follow up information.
We are also seeing a move towards virtual wards to provide 'hospital at home' care within communities. Patients with long-term conditions are in some cases encouraged to self-manage their conditions using remote technologies. However, it is important that certain groups of patients are not left behind in this shift to digitisation of healthcare. As NHS trusts move to providing more services online, they will need to consider how these services remain inclusive, considering age, deprivation, ethnicity and other factors.
Although access to technology and connectivity is increasing overall, 7% of households do not have access to the internet. Data show that 79% of individuals not using the internet are aged 65 or above and are more likely to have a disability and/or be unemployed. There is also concern that the current cost of living crisis will further impact individual's ability to access technology, broadband and data, potentially limiting their ability to engage with online health services.
A way to mitigate against these issues is to make the digital offer one part of the service, offered alongside face-to-face support, recognising the need for personalised care. Enabling digital approaches for those who want to embrace them can free up capacity within services to focus on face-to-face care for those who need it most. Inclusive approaches recognise the need to enhance the provision of both.
In our briefing, we encouraged boards to prioritise action in three key areas. Firstly, boards can improve digital literacy by encouraging staff members to complete digital self-assessment tools, providing user-friendly guidelines and appointing digital ambassadors within the trust. Secondly, trusts can design inclusive services by engaging with patients and communities to better understand their needs and by ensuring their digital design teams include diversity of experience. Finally, trusts can improve user access by providing digital outreach services and direct access to technologies, where possible.
We are pleased to see NHS England's new digital inclusion framework highlights similar actions within five key domains. The framework outlines specific actions for senior leaders at the provider level against each of these domains.
- Access to devices and data/ connectivity
- Accessibility and ease of using technology
- Skills and capability
- Beliefs and trust
- Leadership and partnerships
NHS England's framework also highlights existing practice from across the country where services are already embedding effective digital inclusion practices. One example showcased is the Midlands Partnership University NHS Foundation Trust, who have developed a digital strategy for 2021-26 setting out their plans to improve outcomes through digital innovation. They identified specific barriers preventing patients in their community from accessing digital technologies, notably a lack of understanding and lack of connectivity. Working with suppliers, they introduced two new devices, a one-button computer and a camera (both with built-in data connections) to improve access for patients who have restricted physical or psychological needs.
So far, 49 devices have been used within the trust's pre-dementia and learning disability services, which has supported 200 meetings and 110 messages have been sent. The initiative has also contributed to reductions in the trust's elective care backlog. For patients, the devices have combatted social isolation by providing an opportunity to communicate with friends and family.
At NHS Providers, we support trust board leaders to harness the opportunity digital provides, including the design of digitally inclusive services, through our Digital Boards programme. The programme is delivered in partnership with Public Digital and is supported by NHS England as a part of their Digital Academy programme.
Get in touch to learn about how we can help your board build confidence and understanding of the digital agenda and explore our resources on digital inclusion.
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