The Download: The NHS’ widening digital exclusion gap

Health and social care secretary Matt Hancock said last week that all healthcare consultations should be conducted remotely “unless there’s a compelling clinical reason not to” during a wide-ranging speech to launch the first part of the NHS People Plan.

Six months ago this would have been considered an impossible ask. But the rapid rollout of remote appointment tools across primary and secondary care during lockdown has made it a more realistic ambition. 

In primary care alone online appointment availability increased from 30 per cent of practices nationally in January 2020 to around 90 per cent in June while appointments increased from 30 per cent to 99 per cent.

This increase in digital appointments has, in some areas, revolutionised the lives of both patients and clinicians, saving time and reducing the number of patients setting foot in hospitals and practices.

However, this major expansion of digital services has also alienated people who cannot access healthcare services digitally — and there is currently no clear government plan on how to tackle it. 

NHS England’s planning guidance for the remainder of 2020-21 notes the issue, but without distinct solutions, asking systems to: “Develop digitally enabled care pathways in ways which increase inclusion, including reviewing who is using new primary, outpatient and mental health digitally enabled care pathways by 31 March.”

According to research by digital inclusion charity The Good Things Foundation 11.7 million adults in the UK do not have the necessary digital skills needed for life and work.

In 10 years’ time seven million adults in the UK are expected to be left behind because of digital exclusion. The charity’s chief executive Helen Milner told HSJ that at the beginning of lockdown The GTF’s community centres were inundated with people in desperate need of digital devices and internet connectivity.

As Mr Hancock pointed out “we shouldn’t patronise older people by saying they don’t do tech”. While some elderly people are cut off from technology, digital exclusion covers a wide spectrum of people – including those with learning disabilities, people who do not have English as a first language and people who can’t afford the internet. 

And the rapid pace of change in recent months may have exacerbated the issue further, according to digital lead at the Royal College of Physicians Wajid Hussain. He told HSJ that trusts have sometimes “lost focus” on patients who cannot use the internet, as they pushed forward with getting remote appointment tools up and running. 

He said the key isn’t just giving people internet access, but upskilling them too, as those without the ability to use tech will otherwise risk receiving a lower standard of care.

Dr Hussain told HSJ: “If you have got a system which makes it easy to communicate, you can share data, your team can share data with you. There’s no way you can replicate that in a non-digital way very easily.

“You can send letters, [but] again that has its own issues. Some people might not be very literate; some people might not have English as their first language. The key to this drive is to make sure that inequality is minimised.

“For [the RCP] digital inequalities is something we are very concerned about and we want to make sure everyone considers it every time they implement something.”

However, “even if you are digitally active and enabled, you’re still going to be restricted”, according to the chief executive of Orcha, an organisation which evaluates and advises on healthcare apps. 

Liz Ashall-Payne said the major barrier is that people who are willing to use the technology do not necessarily know it exists or where to find it.

She told HSJ: “Once you become aware of a digital health solution for any condition and you’re digitally active, the next big problem is where do I go to find this solution? And if you go to the app store and type in something like ‘dementia’, you might not find any results, [but] there are in fact thousands of solutions that could help you with dementia, but the app stores are not organised in a way that enables you to access those solutions.”

Research carried out by Orcha found 7 per cent of diabetes sufferers globally use an app to support their condition while just 2 per cent of COPD sufferers use an app to support theirs. And although there are over 327,000 health apps available worldwide to download, 65 per cent haven’t been updated in the last six months.

The key to change is ensuring the NHS does not push forward with a one size fits all approach. 

Ms Ashall-Payne said: “One of the beautiful things of the NHS is it always offered choice and we have to continue to offer choice.  The balance has been on one side, not including digital, [but] now we have swing the other way. We need a better balance.”