The steady advance of digital technology in health care is exciting. There are potentially huge benefits for patient outcomes and NHS cost efficiency, both outlined in the Nuffield Trust’s new report The digital patient: transforming primary care?
But like all digital innovations, not everyone is set to benefit.
The latest estimates suggest there are 12.6 million people in the UK who don’t have basic digital skills, and 5.3 million people who say they have never been online.
This isn’t a marginal issue. It means that 23 per cent of the population are currently unable to benefit from the digital transformation of health and other public services.
And it goes even deeper than this. The digitally excluded are unable to do things that most of us take for granted every day, like going online to stay in touch with family and friends, shop and find basic health information. And because digital continues to change, these people are falling further and further behind.
There is a strong correlation between digital exclusion and other forms of social exclusion. Some 60 per cent of those without basic digital skills have no qualifications. There is also a strong correlation with age (57 per cent are over 65) and disability (49 per cent). On top of this, 82 per cent say that the key reason they are not online is motivation. So engaging the socially excluded, and building their confidence to use technology, are critical in addressing digital exclusion.
The evaluation of digital inclusion programmes shows that becoming digitally confident and skilled drives a wide range of social benefits: reducing social isolation, increasing wellbeing and boosting confidence.
And as well as the social benefits, there are substantial economic benefits. A 2015 report commissioned by Tinder Foundation and Go ON UK from the Centre for Economics and Business Research found that the cost of helping everyone in the UK to gain basic digital skills would be £1.6 billion, but the economic benefit over 10 years would be £14.3 billion: a return of almost £10 per £1 invested.
So addressing digital exclusion is an imperative that no Government, health service or council can afford to ignore.
How does this related to digitally enabled patients, and the new Nuffield Trust report?
From 2013 to 2015, Tinder Foundation ran the Widening Digital Participation programme for NHS England. By connecting GP surgeries with community-based digital inclusion services, the programme helped 380,000 people learn about digital health information, and created over 250,000 digitally enabled patients who could use NHS Choices, GP online booking systems and other services to self-manage their care. As well as driving ‘digital activation’ at scale, evaluation of the programme showed that every £1 invested in digital health literacy would save the NHS £6.40.
We’re also now working with two of the NHS Test Beds to help patients use higher-end health technology including wearables and apps; and helping Clinical Commissioning Groups to think about the best ways to digitally upskill patients and clinicians. These developments are exciting, but there is so much still to be done.
The potential of digital to transform health care is enormous. But we need to find ways to address digital exclusion at scale, and we need to do it alongside the continuing transformation of the NHS.
Ultimately, digital inclusion isn’t about technology. It’s about people: people helping other people to see how the internet can transform their lives. It works when it is local, face to face, friendly and person-centred.
On this basis, there are two things that would help address digital exclusion while creating digitally enabled patients.
Firstly, investment in digital inclusion as part of programmes that address social exclusion in its different forms will help. Funding is at a premium, and support to use digital should be built in, not bolted on. For health care, this means looking at all the ways digital inclusion can be delivered and signposted as part of current and future patient pathways.
Secondly, mobilising people and communities everywhere will help. The UK online centres network comprises of around 5,000 hyper-local organisations across the country, of which around 3,000 offer both access to the internet and support to use it. There are also thousands of volunteer 'digital champions' across the country. These resources can and should be locked into health service delivery, at all levels.
In 2015, Nesta published a report on the NHS in 2030 that included the concept of a ‘social movement for health’. All our experience shows that addressing digital exclusion at scale requires this same type of movement. As well as highlighting the critical role of digital technology in patient care, the NHS Five Year Forward View also carried the intention to “become a better partner with voluntary organisations and local communities”.
By putting people at the centre of digital transformation, and finding ways to scale and embed digitally inclusive practice, we can create a social movement that helps everyone realise the incredible potential of digital for health.
Adam Micklethwaite is Director of Business and Innovation at Tinder Foundation. Please note that views expressed in guest blogs on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.
Micklethwaite A (2016) 'Why the NHS must tackle digital exclusion'. Nuffield Trust comment, 17 November 2016. https://www.nuffieldtrust.org.uk/news-item/why-the-nhs-must-tackle-digital-exclusion