Digital Inclusion in Healthcare

The Digital inclusion definition refers to the ability of people to be able to use the internet and digital tools, or the availability of resources and services to use them. This can be through apps on digital devices, like smartphones and tablets, or on more traditional computers and laptops. 

With technology constantly improving, it’s vital that people have the opportunity to learn what is available to them, how to use digital devices and tools, and to have access to them else face being detrimentally impacted by modern healthcare. 

In the words of Citizens Online: “Digitally-excluded people can lack skills, confidence and motivation, along with having limited or no access to equipment and connectivity. This can create additional layers of social exclusion and exacerbate social and economic problems. Getting online is usually life-enhancing and it can be life-changing!”.

Modern healthcare is steadily using more and more software on digital devices to interact with patients. This allows clinicians to provide information and tools for the medical services available. People can book GP appointments, order blood tests, read test results, or place repeat prescriptions. 

This approach has been successful in reducing time spent on admin and making it available for actual healthcare, but there is a big challenge in the way of continued success. The UK government website cites digital exclusion statistics, stating: “recent research published by the BBC has found that 21% of Britain’s population lack the basic digital skills and capabilities required to realise the benefits of the internet”. The Fabian Society suggests this figure is more like 29%, with 1.5 million households not connected to the internet. 

Exclusion is thought typically to impact older people; those approaching or past retirement age who were not young when the internet and other digital technologies started to come into the cultural mainstream. It’s important not to forget others who may be impacted though. The King’s Fund’s article on digital inclusion and exclusion highlights that people with disabilities, people with long term illnesses, the homeless, asylum seekers, the traveller community, those living in rural areas, and those from lower socio-economic backgrounds are just as much at risk of missing out.

Barriers to digital inclusion:

NHS Digital has a brief guide to digital inclusion and the barriers facing patients when trying to engage with modern healthcare technology. Their research highlights four factors restricting patients: access, skill, confidence, and motivation. 

This was measured against the digital inclusion scale or digital inclusion benchmark; a tool used by the UK government and latterly the NHS. In the developers own words it was designed “to help service teams see the breadth of diversity in their users and appreciate the range of digital skills and capability users had. It was also intended to identify potential opportunities to help people use government services.”  

According to Ofcom, 89% of the UK population had access to the internet as of 2020 – a statistic that has likely climbed slightly in the three years since. This presents an issue in of itself: a greater percentage of people have access than has the skills to use the internet and related tools competently. 

This can impact the confidence and motivation factors that the NHS has mentioned. A lack of skill and education reduces the willingness to get involved, for fear of making a mistake, getting a computer virus, or being a victim to cyber crime.

Digital exclusion and health inequalities:

The first push to address digital exclusion and the subsequent health inequality caused by it must be to improve skills and lower the difficulty level for onboarding patients, or perhaps both. Once this is done then healthcare providers can move on to tackling issues such as better publicity of services available and further staff development. 

King’s Fund, in their piece ‘Moving from exclusion to inclusion in digital health and care’, then point at the next steps for improving inclusion: the provision of digital devices (like tablets) and the provision of data (e.g., sim cards) to counter the poverty restriction hindering digital inclusion. 

The Good Things Foundation is one of a few organisations currently supporting the data aspect, via the National Data Bank which they run in conjunction with telephony partners O2 and Virgin Media. We also know that NHS virtual wards are providing patients with digital devices, which shows that whilst there is a cost attached to doing so, it can be achieved logistically. 

With these steps taken, then more training – via videos or literature – can be given through digital tools like patient portals and apps, to further hone skills, but all of this research brings us back to an immutable truth: digital exclusion and health inequalities are inextricably connected and resolving these barriers to digital inclusion will have the desired knock-on effect of reducing health inequality.

The mission for the national health service, as stated on the NHS website, is to tackle the main challenges that limit digital inclusion. 

1. Ensuring access to the internet, whether at home or at a public location like a library.
2. Having the skills to know how to use the internet, and how to use it safely.
3. Understanding the benefits of the internet as an information and communication tool.

Statistics provided by both Ofcom and the Office for National Statistics (ONS) show that approximately 11.3 million people in the UK do not have the skills to use the internet for basic tasks, and 4.8 million of these people don’t go online at all.  

There is a clear divide of who does vs who doesn’t use the internet, and social exclusion (those less fortunate in society) very clearly matches up with digital exclusion (those least able to access these digital tools and resources). These groups include: 

• The elderly 
• Low incomes or unemployed
• Disabled people
• Homeless people
• People with low qualifications
• People in social housing
• People living in rural areas
• People whose first language is not English

This NHS mission has been named the Digital Inclusion Strategy. It is an appraisal of existing activities, to make sure impactful projects gets funded and poor performing ones do not, as well as promoting new initiatives within communities for all to benefit from.  

NHS Providers said it best with this quote: “The mistake often made is to ask the question "what is the project for the 20-30 people we think will be excluded", instead of asking "what is the digital inclusion element within all our transformation programmes?". 

This change in approach to digital access and helping people to use the internet or apps is now being driven through existing community groups – in person and online. Action has already been undertaken, with excellent results.

It’s a fact that more and more people are living longer than ever before. This presents a challenge to healthcare systems around the world, like the NHS. Digital tools are helping medical professionals adapt. Clinicians can care for more people whilst managing their own health, but with digital inclusion the public can help care for themselves too.

NHS Digital talks about the benefits for improved self-care, whether that’s minor injuries and ailments or management of longer-term conditions. Time (and stress) is saved by having access to these digital health tools and services. A big part of the personal burden of those in need of care is fear. People don’t like feeling lonely or isolated when in distress. By providing easy-to-use webpages or apps, people feel connected and up-to-date on the best practices they should be adhering to for the benefit of their health.

The NHS has already implemented several instances of digital inclusion. This has been a combination of advertising campaigns for greater awareness online, and digital literacy training. One such case was a scheme in Stoke-on-Trent. The Staffordshire city saw a promotion on Facebook for breast cancer screening, with an immediate increase in the number of people choosing to get screened. 

A report from The Strategy Unit, a statistics-led arm of the NHS, details how this has been enacted. Phase One ran from September 2013 to March 2016 and Phase Two ran from April 2017 to March 2020. The Tinder Foundation analysed survey data from Stoke and other areas across the UK on behalf of The Strategy Unit, with the following findings: 

• 21% of learners made fewer calls or visits to their GP, with 54% of those saving at least three calls in the three months before being surveyed and 40% saving at least three visits over this period.
• 10% of learners made fewer calls to NHS 111, with 42% of those saving at least three calls in the three months before being surveyed.
• 6% of learners made fewer visits to A&E, with 30% of these saving a minimum of three visits in the three months before being surveyed. 3. Improving Digital Health Inclusion
• 29% of learners have gone online to find health services, such as looking for a new GP.
• 22% of learners have progressed to booking GP appointments online and 20% have ordered repeat prescriptions online.
• 17% of learners have gone online to rate or review their GP or another health service they have used. 

These findings show that – from just Phase One – people quickly pick up the skills necessary to use the internet and apps with the right support. Fortunately, other groups are helping to bolster these efforts.  

The National Digital Inclusion Network is organising community skills training, to help people of all ages and abilities to understand the data, devices, and tools that they could be using to benefit their own healthcare and wellbeing.

There are efficiency gains and cost savings to be had through digital inclusion in healthcare. Having a webpage with all the information means there doesn’t physically need to be a member of staff on the other end of a phone or computer to repeat themselves to hundreds or thousands of concerned people. 

A Welsh Government report cites the Department of Health in England, and their figures of £2.9 billion saved through ‘digital deployment’. The document does also point out that these savings cannot be fully achieved until the heavy users of health and care services are included in digital offerings – things like medical records, booking appointments, ordering a prescription. 

The Strategy Unit also refers to the Gann review of 2019, which highlights the cost benefits of delivering services digitally and encouraging more appropriate usage of urgent care, as well as digital inclusion being beneficial for keeping patients on track with their treatment plans. Their insight estimates annual savings of £3.7 million in GP visits and £2.3 million in A&E visits, which works out as £6.40 benefit for every £1 invested into digital inclusion programmes. 

Digital inclusion grants and funds are currently being provided by the Department for Levelling Up, Housing and Communities (DLUHC) in the UK, as well as by charities such as the National Lottery (via their Community Fund) and even in specific cases from the United Nations High Commissioner for Refugee (UNHCR) because of how important addressing digital literacy and equality is for healthcare.

At The Access Group, our products do the support work for digital inclusion. We design our software with customers in mind, taking their feedback and their wishes onboard during the build process. These healthcare tools are made to be both easy to use and intuitive, cutting down on training time and the stress of adapting to what’s new.