The pandemic has wrought substantial changes in our daily lives. For many of us digital technology has become front and centre in almost everything we do, from buying groceries to seeing family members. In health and care the pandemic has seen an increasing reliance on digital tools ranging from digital triage to video consultations and even endoscopy in the home. And so, it’s changed how services are delivered, how people interact with services, and how data is used and shared. During the pandemic digital has been the default approach. Post-pandemic, it is likely that a mixture of physical and digital services will be used, depending upon complexity, risk and patient preference, but we still expect digital to play a big part in how care is delivered – much bigger than prior to the pandemic. However, there are understandably concerns that an increasing use of digital technologies could create and exacerbate health inequalities through inequalities of access, experience and outcomes.
Digital does have some inherent properties that lend itself to being more accessible for some. For example, remote consultations allow visual contact with no need to physically travel to the appointment, making it easier for those who are frail and vulnerable. Remote consultations can also mean avoiding noisy environments, which could be more accessible for some patients who are autistic. While phone and video consultations offer real-time conversation, messaging services where the patient and staff respond over longer time periods can make it easier to access care for lower priority needs. And some interventions, such as rehabilitation can be provided on-demand, becoming accessible when the patient can fit it in, which can improve adherence. Given the potential to improve access, experience, outcomes and the quality of the care received, it is essential that as many people as possible have the ability and confidence to access digital health and care.
There are multiple reasons people may be digitally excluded, including having no (or old) devices, limited data, low digital skills, misinformation, low trust and poorly designed services. Access to devices and data are difficult problems to solve but solutions are emerging, such as lending schemes that give out devices including data. Skills, misinformation, trust and service design are deeper problems that require ongoing attention. Without the proper resources and community involvement it will not be possible to create services that meet the needs of communities that are less digitally able and willing.
'Without the proper resources and community involvement it will not be possible to create services that meet the needs of communities.'
Ways to improve digital inclusion and digital service design may be emerging through the Covid-19 vaccine rollout. Vaccines cannot be delivered digitally, but there is still transferrable and related learning from the programme that can contribute to creating a digitally inclusive health and care system.
The vaccination programme outstripped initial expectations, with NHS staff and systems (e.g. primary care networks and Trusts) playing a key role in delivering the vaccines. However, misinformation and concerns around side effects have contributed to hesitancy towards getting vaccinated, with polling information suggesting that ethnicity and deprivation are important predictors for vaccine hesitancy.
In order to counter vaccine hesitancy, novel approaches have been taken which started with community engagement to understand why people felt hesitant. The local listening led to new ways for health and care staff to engage with and forge stronger links and trust between health services and communities. Pop-up vaccination sites have been set up in Mosques, with people from voluntary organisation and trusted community leaders, a bus has been repurposed to deliver vaccines within communities, and the supermarket Asda now also provides a space for instore vaccination, all of which increase accessibility by providing vaccinations in non-clinical community settings. Local Healthwatch and voluntary organisations are distributing GP access cards to those not registered with a GP practice, so they can easily access GP services to obtain their vaccination. These community-based initiatives have used their understanding of what will work best for people in that area and addressed the concerns that had been identified by working with trusted community individuals, providing a service that meets people in a familiar non-health care setting.
'The vaccine rollout legacy presents a unique chance to engage at local levels and co-create an inclusive digitally enabled health and care system.'
This legacy from the vaccine rollout is an unmissable opportunity to bring health and care into community settings. Instead of being a temporary requirement for the vaccination programme, this deep community engagement should be seen as the first step in developing inclusive health care services, with these new ways of reaching and talking to patients and the public about digitally enabled services. Local approaches should be evaluated for their effectiveness at reaching previously hesitant or excluded people, with successful examples shared across an integrated care system and further refined to reach more people. These legacy initiatives become ideal forums for a new phase of community engagement, this time focused on understanding how digitally enabled services can address the needs of community members at highest risk of digital exclusion. And so continued health and care presence in community settings could help to address digital skills, mitigate misinformation and build trust. In doing so it offers a way to co-develop services that are truly inclusive and accessible.
Successfully implemented digital health and care is less about the tech and more about the people in our community and their willingness to use it. There’s been much discussion on the digital transformation of the health and care system focusing on the tools in the system. But we’ve not, until now, had the opportunity to connect with those who are less engaged and less digitally able. The vaccine rollout legacy presents a unique chance to engage at local levels and co-create an inclusive digitally enabled health and care system – let’s not miss this opportunity.