In the first of our Widening Digital Participation blogs, Nicola Gill wrote about how we are working to support people (including NHS staff) who don’t have the confidence and skills to get online and benefit from digital health services, transactions and information.

With our delivery partner, Good Things Foundation, we are working in an agile way with stakeholders in the local pathfinder areas, shaping the pilot work through interactive Design Workshops. The pathfinders are giving us valuable learning on what works best to increase digital inclusion with particular target groups – including homeless people, young people with mental health issues, and people with cardiovascular disease.

We’re excited about the potential but, compared with the scale of the challenge, our resources are limited and scale is inevitably small. There is only so much that can be achieved by a top-down national initiative. If we are going to make a meaningful impact on digital exclusion and digital inequality we need the local health and care system (in particular commissioners) to understand and take ownership of digital inclusion. Fundamentally, we need to build sustainability and move digital inclusion from the margins to the mainstream.

Data driven approach to understanding digital exclusion locally

We want to build a better understanding of the scale and nature of digital exclusion in the local health and care system – and we are committed to using the best available data and evidence to help us do this. We took the Tech Partnership’s Digital Exclusion Heatmap which shows which parts of the country are experiencing the lowest levels of digital access and uptake (because of low digital skills, poor broadband etc). We then overlaid this with health inequalities data to show where there is most likely to be a double-whammy of digital exclusion and poor health status. We have used this to help us identify locations for our Widening Digital Participation pathfinders, focusing our efforts where there is the greatest need and potential for impact.

Is digital inclusion on the NHS agenda?

All over the country, health and care organisations are coming together in local “footprints” to develop their Sustainability and Transformation Plans and their Digital Roadmaps. Guidance on Local Digital Roadmaps says “Local health & care systems should pay due attention to the key enablers of the vision including digital inclusion and the digital literacy of the workforce and of patients and carers”. We wanted to see whether they really are. So we reviewed all 65 Local Digital Roadmaps. Nearly half (30 out of 65) did not mention digital inclusion, digital literacy or digital equality at all. And those 30 include parts of the country where the Heatmap shows digital exclusion is at its highest. It seems surprising that in these Roadmaps lack of digital participation in the local population does not feature as a rate limiting factor for local service transformation.

However, there are great examples where digital inclusion is taken seriously. Most commonly, local footprints commit to digital skills training for patients and citizens. Others look to developing the skills of the health and care workforce as digital champions, while social prescribing and free wi-fi for patients are seen as key enablers.

Creating the best conditions for sustainable digital inclusion

So we are beginning to understand better how far the digital divide is on the agenda of commissioners and how we can help create the best conditions for sustainable support for digital inclusion. Alongside the desk research on the Digital Roadmaps we are now carrying out a series of visits and telephone interviews with representatives from CCGs, STPs and other local health organisations. We want to explore questions such as:

  • To what extent is digital exclusion recognised as a limiting factor in digital health adoption locally?
  • What are the key drivers for digital inclusion (eg Digital Roadmaps, Sustainability & Transformation Plans)?
  • What other agendas have a strong dependency on digital inclusion (eg self care, prevention, long term condition management)?
  • Where does ownership and interest in digital inclusion tend to sit within CCGs?
  • What initiatives, if any, are being commissioned to support digital inclusion & digital literacy locally?
  • What might create the best conditions for sustainable support for digital inclusion (eg. benefits, levers, incentives, best practice)?

Guide to digital inclusion for local NHS

Initial engagement suggests it would be valuable to build on this learning to produce a practical guide to digital inclusion for the local NHS. The guide could include how increasing digital literacy and access can support key local priorities, with examples of good practice and case studies. We want to ensure that the guide is as relevant as possible to the local health and care system and will be using the visits and interviews to shape this.
We intend to produce an initial draft (beta) version of the Digital Inclusion Guide by end of 2017 for comment and feedback. We expect to have the final version ready for online publication by end of March 2018.
If you have views on what the Guide should cover, or suggestions for stakeholders we should be talking to, we’d love to hear from you.

Bob Gann, Digital Inclusion Guide for Commissioners, NHS Digital
Tel: 07858 390042
Email: bob.gann@nhs.net
Twitter:  @Bob_Gann

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