Digital Exclusion and Transformation

12th September 2024

**Safeera Ahmed, Managing Consultant at NHS TU and NHSE Core20PLUS Ambassador**

12^th September marks the second annual ‘End Digital Poverty Day’, a day of awareness for digital poverty and exclusion initiated and hosted by the Digital Poverty Alliance (DPA). Established in September 2023, the day sees individuals and organisations come together to provide support and solutions to ultimately improve the digital access gap for all communities across the UK.

What is Digital Exclusion?

Over the past decade we have seen a rapid acceleration in the adoption of digital health technologies, such as telehealth and online health services. This was further expedited by the COVID-19 pandemic where meetings and consultations moved online, more information was accessed via online websites and repositories, and the use of health applications became the way we receive and understand our own health information. These technological advancements have been innovative, modernising the provision of our NHS services and particularly allowed services to still operate at a time when contact needed to be limited. However, there is a cost to these digital advancements – digital exclusion.

Digital exclusion refers to the increasing challenges people face when engaging with or accessing digital services and technologies that allows and enables them to participate in an ever-changing online world. The COVID-19 pandemic highlighted and often exacerbated existing digital health inequalities. The rapid shift in 2020 saw a deepening divide between those who had the resources to be digitally independent, and those individuals and communities without reliable internet access or the ability to access the help when they needed it the most.

Millions of people across the UK are impacted by digital exclusion. The DPA predicts that approximately 13-19 million people over the age of 16 are experiencing some form of digital exclusion. Breaking this down in by age and socio-economic circumstances, they estimate that this equates to 1 in 2 older adults and a startling 20% of all children. People who are unemployed are estimated to be 2-3 times more likely to experience some form of challenge, as well as people living in rural areas, people with disabilities and ethnic minorities. For those affected, it isn’t just about seeking information through a different route, it is a very real barrier to accessing the right help, looking for employment, accessing resources, getting timely health advice when needed and even for making or maintaining important social connections.

Why does the NHS need to narrow the gap?

Improving access to digital resources and platforms allows everyone to equally engage with all public services, including health and social care services. As the NHS continues with the improvement and transformation of its services, it is vital that programmes of recovery deliver equitable, fair and accessible outcomes. Achieving true digital inclusion is not solely the responsibility of the NHS, but alongside social care, business, civil society and wider communities – the NHS, Integrated Care Boards (ICB), hospitals, GPs and others all have a part to play in achieving fair access to all the communities they serve.

Having digitally inclusive services leads to improvements in enhanced and timely communication between staff and users, improved health access and outcomes, efficient use of vital resources and ultimately improves the quality and experience of care. If services are not designed with the end users in mind or without consideration of the barriers some people may face, communities can be left without access to the right help.

Transformation programmes need to prioritise addressing the barriers to digital inclusion to develop services and solutions that are responsive and accessible for the people who will need and use them. Health systems have a statutory duty to consider how digital solutions will impact their populations, and are also bound by the public sector equality duty to understand and actively reduce barriers and health inequalities.

In September 2023, NHS England published ‘Inclusive Digital Healthcare: a framework for NHS action on digital inclusion’. It aims to help NHS staff enable and encourage greater access to – and improved experience of – healthcare, and increased adoption of digital approaches where appropriate. It supports new requirements under the Health and Care Act 2022 for NHS England and Integrated Care Boards to consider how to reduce inequalities in access to and outcomes from health services.

The framework has five key domains for action:

Access to devices and data so that everyone can access digital healthcare if they choose to and experience the benefits
Accessibility and ease of using technology so that user-centred digital content and products are co-designed and deliver excellent patient outcomes
Skills and capability so that everyone has the skills to use digital approaches and health services respond to the capabilities of all
Beliefs and trust so that people understand and feel confident using digital health approaches
Leadership and partnerships so that digital inclusion efforts are co-ordinated and help to reduce health inequalities.

The framework recognises that digital inclusion is a societal issue and therefore regular, meaningful collaboration is needed with professionals and end users to design services that are accessible, appropriate and equitable. There are great innovative digital opportunities, but digital inclusion needs ongoing focus to promote inclusive and equitable provision. Here at the NHS Transformation Unit, we strongly believe that we all have a duty to ensure that the design of digitally enabled services are inclusive, understood and accessible to everyone.

Below is a suite of resources to support you and your organisation in delivering equitable services: