Why digital inclusion matters to health and social care

Digital inclusion matters to health and social care organisations:

• it’s crucial to achieving priorities
• they have an obligation to reduce inequalities
• there are clear policy commitments
• there’s a strong benefits case 

How digital inclusion can support health and social care priorities

Supporting people to get online and use digital health resources can be crucial to achieving local priorities including:

• physical and mental wellbeing
• prevention
• self care
• shared care and shared decision making
• long term condition management
• appropriate use of urgent and emergency care

In these videos, healthcare and digital leaders talk about the importance of digital to local service transformation, and why digital inclusion is important so that nobody is left behind.

Digital inclusion: improving access - Rob Webster, Chief Executive, South West Yorkshire Partnership NHS Trust talks about how digital inclusion is making a real difference to mental health service users.

Digital inclusion: social prescribing - Sir Sam Everington, GP and Chair of Tower Hamlets Clinical Commissioning Group, talks about social prescribing at the Bromley-by-Bow Centre.

Digital inclusion: long-term conditions - Dr Ruth Chambers, GP and Clinical Telehealth Lead at Stoke-on-Trent Clinical Commissioning Group, talks about how local clinical commissioning groups are taking on board digital inclusion.

Digital inclusion and health inequalities

The NHS long term plan makes a commitment to a more concerted and systematic approach to reducing health inequalities and addressing unwarranted variation in care. In today’s society, digital exclusion can be seen as a form of inequality. There is a close correlation between digital exclusion and social disadvantages including lower income, lower levels of education, and poor housing. Health inequalities should be addressed in the local plans being developed in response to the national Long Term Plan. 

In an increasingly digital world, people who are digitally excluded are at risk of worse access to services and worse health outcomes. People who have characteristics that are protected under the Equality Act 2010 (age, disability, race) are less likely to have access to the internet, and the skills to use it. Health and care organisations should take this into account when carrying out Equality Impact Assessments (EqIAs).

Policy commitments

Important commitments to digital inclusion have been made in recent policies, including:

NHS long term plan

“People will be empowered, and their experience of health and care will be transformed, by the ability to access, manage and contribute to digital tools, information and services. We will ensure these technologies work for everyone, from the most digitally literate to the most technology averse, and reflect the needs of people trying to stay healthy as well as those with complex conditions”.

The future of healthcare

“Different people may need different services and some people will never use digital services themselves directly but will benefit from others using digital services and freeing resources to help them. We must acknowledge that those with the greatest health needs are also the most at risk of being left behind and build digital services with this in mind, ensuring the highest levels of accessibility wherever possible”.

Preparing the healthcare workforce to deliver the digital future (Topol Review)

“The NHS is founded on a commitment to the principles of equal and equitable access to healthcare for all UK citizens. Yet use of digital healthcare technologies could undermine these principles by exacerbating inequalities, unless consideration is given to how they affect equality and equity, including the risk that vulnerable groups might be excluded or exploited”. 

Benefits of digital health

When considering the business case, there is increasing evidence of the benefits of digital health. 

The benefits to patients and carers include:

• improved self-care for minor ailments
• improved self-management of long-term conditions
• improved take-up of digital health tools and services
• time saved through accessing services digitally
• cost saved through accessing services digitally
• reduced loneliness and isolation

And benefits for the health and care system, including:

• lower cost of delivering services digitally
• more appropriate use of services, including primary care and urgent care
• better patient adherence to medicines and treatments

Those who are digitally excluded risk missing out on the benefits to individuals of digital health. And the health and care system will not save money and transform services unless it engages with the one in five of their population who are not online or have digital skills  – and are the heaviest users of health and care. 

Evaluation of Phase One of the NHS Widening Digital Participation programme provides the most detailed analysis of the impact of increasing digital inclusion on health. Of those who were supported by the programme:

• 59% felt more confident in using online health information
• 52% feel less lonely or isolated
• 21% have had less visits to their GP for minor ailments    22% have progressed to booking GP appointments online and 20% to ordering prescriptions online
• 39% have saved time through carrying out health transactions online

This evaluation estimates a return on investment of £6.40 for every £1.00 spent by the NHS on digital inclusion support.

Read the evaluation report in full here.

Increasing digital inclusion has benefits for society as a whole as well as for the NHS. It is important to take these benefits into consideration when considering the impacts for public health.

A 2014 report from BT on valuing digital inclusion calculated the social return on investment (SROI) of digital inclusion for individuals and for workers. For individuals, getting online is worth £1,064 a year due to increased confidence, less social isolation, financial savings and opportunities in employment and leisure. For workers, getting online is worth £3,568 a year due to opportunities for remote working and increased earnings opportunities. 

A 2016 analysis of Scottish data carried out by Ipsos MORI for Carnegie UK Trust illustrates how the wider societal benefits of internet use is associated with better health and wellbeing. Those who use the internet are more likely to have been to a cultural event, visited the outdoors for recreation, taken part in sport or volunteered. Conversely those who are not online are more likely to have visited their doctor once a month or more.

While there are significant benefits, remember that being online can also have downsides. Some people have been scammed or victims of cyber-crime. Others (particularly young people) have been victims of online bullying. There is an abundance of “fake news” in health with poor quality health information online. Increasingly digital skills support is focusing on helping people approach the internet critically so that they can appraise information, and mindfully so they are not overwhelmed by it.

Read more about this in Victoria Betton and James Woollard’s Teen mental health in an online world.