Picking up where others left off, the new health secretary Therese Coffey has vowed to be the champion of the patient and focus the NHS and social care on how best to deliver for them.
As part of her plan for patients, the deputy prime minister has promised to test and scale technologies to support people to live fulfilling, independent lives for longer.
It’s a laudable sentiment and matches consumer expectations for a more digitally accessible health service. But are we at risk of digital transformation turning health services into a postcode lottery?
The short answer to this question is ‘yes’, unless the health tech industry can make sure its services are fully inclusive to everyone in the UK. Anything which excludes people on the grounds of where they live would indeed result in unequal provision and a profound social injustice, especially during a vicious cost of living crisis.
Region by region, the digital divide is stark. In the South East, 28% of the population are limited users of the internet but in the North East, it is 38%. In Wales, 36%; the East, 33%; Scotland and Northern Ireland, 32%.
Based on these numbers, provided by the Good Things Foundation, building digital health services for people who are limited users of the internet clearly risks excluding around a third of the population.
Too often, tech entrepreneurs make the mistake of assuming that everyone has the latest smartphone and is a digital native like themselves. In fact, 8% of UK adults do not own a smartphone, according to Deloitte Digital Consumer Trends 2022. That’s equivalent to 4.7 million people.
Further, 6% of UK adults do not have any access to the internet at home, says Ofcom, and this increases with age, with a fifth of those aged 65 and above not having home internet access, compared to just 1% of 18-34s.
There is a growing backlash against the digital transformation of public services, despite the benefits that come from increased productivity. The Silver Voices campaign group is calling for “safeguards against rampant digitalisation” and legally mandated non-digital alternatives for older people who are being left behind in the so-called march to progress. Witness the fury over the limiting of access to face-to-face GP appointments.
Internet access and digital literacy are “super social determinants of health”, according to a 2021 paper published by Nature. Applications for employment, housing and other state support programmes, each of which influence health outcomes, are increasingly carried out online and sometimes exclusively so, the authors point out.
They warn that greater reliance on digital tools has the potential to increase disparities between those who have skills and access and those who do not.
What’s more, if developers and commissioners don’t take the needs of all social groups into account when creating new digital health services, these disparities could become even more deeply entrenched, according to the Ada Lovelace Institute.
The research body urges a people-centred approach to addressing health inequalities, one that considers all factors at play such as economic deprivation, geographical and place-based inequalities, digital inclusion and skills.
At Inhealthcare, we know the people who are in the greatest need of NHS care are very often the ones who are least likely to have access to the internet and the skills to use digital health services. That’s why we offer people a full choice of communication channels – email, SMS, automated phone call or direct contact from clinical team – in our remote monitoring systems.
This all-inclusive approach is proving effective. An NHS evaluation found that Scotland’s remote health pathway for patients with Covid symptoms actually reduced health inequalities with more than twice as many people from disadvantaged areas using our service.
A separate NHS evaluation in Sussex found our flexible contact methods worked well for patients with learning difficulties, sensory impairment and mental health conditions or those who did not have English as their first language.
Digital inclusion is more than a buzzword. For many people, it means being able to access life-changing services during their time of absolute need. They should not be shut out, just because of where they live. Anyone, anywhere in the UK should be able to benefit from the improved outcomes that can flow from the digital transformation of health services.