Build inclusion into all your care models. Ensure that everyone can access your care, be that digitally or otherwise.
I am asking you to focus on inclusion and access because that is what we at National Voices – a coalition of 170 health and social care charities working together to further humanise and democratise health and care – know is important for our members. That is what they have been told by the people they support up and down the country living with long-term conditions and disabilities. In effect, that is what millions of people are saying across England.
What does inclusion mean in practice? Three things:
First, it means creating the infrastructure in digital healthcare – as in all healthcare – to make sure people can share their experiences and needs, and that these influence the design and delivery of services. That requires putting in place serious forums for co-designing and co-producing digital health services together.
Second, it means recognising that while digital healthcare has many positive benefits, some things need urgent improvement. We know from our rapid research study - The Dr Will Zoom You Now – which we did with Healthwatch England, that people appreciate a lot about digital delivery: the convenience, the improvement in access for some of those with physical disabilities, and avoiding germ-filled waiting rooms, for example. Remote consultations can also give clinicians helpful insights into people’s living environments, and help rethink approaches to communicating.
Clearly, then, technology can be a real enabler of better engagement and inclusion. But we also know that some things in digital healthcare are really not working for people: a lack of information and support in advance, and a lack of choice about whether the consultation will be via telephone or an app or in person, chief amongst them. As you design digital services, keep these concerns front and centre. Ensure a reasonable time window for appointments, prepare people to get the best from their appointment, utilise the digital platform to share patient records and enable patients to record sessions.
Most crucially, give people choice – not just between audio and video, but more importantly between remote and face-to-face care. Some conditions and conversations need to be done in person - when bad news is given, when a condition requires a physical examination or when someone's level of digital literacy requires it.
My third ask is that system leaders confront digital exclusion head-on. A significant proportion of the population is digitally excluded. Income, language, literacy, confidence – all play a role. But digital exclusion isn’t equally distributed - those on low incomes, older people, people with disabilities, and specific communities, many of whom are already at particular risk of poor health, are all much more likely to face digital exclusion. They also face the double digital health inequality of not being able to access other essentials online - food, employment, education, social support.
There are lots of things you could do as health system leaders: work with voluntary sector organisations to build people’s digital skills and confidence. Distribute refurbished devices, stripped back to the essentials, and training in how to use them. Provide call-back services or freephone numbers. Prioritise face-to-face alternatives for people who are digitally excluded. Use good old-fashioned methods like the post to provide accessible information.
Most crucially though – join us and fellow voluntary sector organisations in calling on the government to recognise internet access as a basic need. Digital connectivity is now a core element of citizenship. To realise everyone’s citizenship, to make sure all of us can lead healthy lives, we need to put the wider exclusionary effects of digital on the national agenda. That’s right in principle – but our hunch is that ultimately it will also reduce costs to the NHS.
Finally, let’s remember that the same principles apply in digital care as in all health and care. Listen to people and act on what they say. Respect people’s decisions and rights. Give people information that is relevant to them in a way they understand. Support people to understand risks and uncertainties in their lives. Make sure people know how to talk to the person in charge of their care when they need to. Tell people what to expect and that they are safe when they have treatment or care. Keep people informed and supported while they wait for care. Ensure people know they are not forgotten. These are the things is what people told us is important to them right now, and we then distilled into a set of first-person I Statements. They express basic and reasonable expectations, and we would be delighted to work with you to make sure they are realised in digital as everywhere else across the health system.