Today I published my letter to Jeremy Hunt about how I would like to see digital inclusion at the heart of the NHS.

It was a great privilege to be asked to think about how to help put digital access and engagement centre stage. I think the UK could be a world leader in how we approach our healthcare and the internet. For me, its not just about creating a global, commercial health business but it is about making sure the universality and care is put at the core of how services are designed.

Here is my letter :

I am delighted to provide my recommendations to the National Information Board on how to increase people’s take-up of new digital innovations in health and social care.

One of the founding principles of the National Health Service was to ensure that everybody —irrespective of means, age, sex, or occupation—should have equal opportunity to benefit from the best and most up to date medical and allied services available. Principles of universality, equity and quality remain at its core.

These principles are also the foundation of my recommendations. In the network age, universality, equity and quality must be at the very centre of how we build, adopt and scale new technologies in health. 

No-one must be left behind. 

Internet enabled technologies can radically transform health care services to improve experiences. Far from removing face to face contact, they can and should focus on improving people’s outcomes and experience of health and social care always starting with what they need and want. With the network age come great opportunities to place more power in people’s own hands in relation to their health care destinies.

I have developed these recommendations with The public purpose of Doteveryone, is to advance understanding and use of internet enabled technologies to deliver prosperity and social well-being.

I founded Doteveryone because I believe we must champion and show how the UK could leapfrog into the future to the advantage of all citizens. Now is the time to build on and support the incredible work of health care and social care workers across the country to enable the NHS to leapfrog into the future for the benefit of all citizens. 

The unshakeable commitment to the principle of universality means that it is critical that we reach the furthest first. If we focus on inclusion we can improve health inequalities rather than exaggerate them.

Infrastructure barriers to digital take up need to be tackled; digital skills within the NHS workforce need to be cultivated; opportunities for people to engage with their health online need to be maximised; and a focus on building and scaling digital health and new technologies that put people’s needs at the centre and reach the most excluded first are all critical.

As such, I recommend the following as a set of preliminary priority actions:-

GOAL: A national health and social care system that leads the world in driving universality, equity and quality through its digital health and new technological services

1. Free wifi for all across the NHS and social care estate by [2018]

I recommend that free wifi is made available across the NHS and social care estate by [2018]s. This will be a powerful and impactful step to improve people’s take up of digital health and new technologies. It could open the doors to new digital tools and technologies which could transform health and social care services. 

Enabling free access to WIFI across the NHS estate could significantly increase take up of digital health and new technologies. Free wifi is a public amenity and should be available in health and social care settings. It should be simple to access and freely available according to what users want. It could transform the experiences and outcomes of people using health care services as well as those working in health care. Critically, it would provide an access point for people to discover and use health digital tools, resources and information when their health is likely a central focus on their mind – supporting a greater take up in digital tools including those focussed on self care and self management. 

For those staying in hospital, it will enable continued contact with social networks which can support recovery and promote well-being. Importantly, it will also enable the more rapid introduction into health care settings of innovative digital health and new technologies which could transform health care services to improve people’s experience and outcomes.

It would have the added benefit of reducing the administrative burden on the health care workforce, freeing up more time for patient care. Some estimates suggest that administrative duties can take up to 70% of a junior doctor’s day. As Professor Sir Bruce Keogh, NHS England’s national medical director has said “I recently asked a bunch of junior doctors what single change in hospitals would make their jobs easier. I didn’t expect the answer: Wi-Fi. But it makes sense”. 

While I recognise there are significant challenges to providing free wifi in health and social care settings, we know it can be done. As digital health tools and new technologies transform the way health and social care is provided, excellent internet connectivity is likely to become a critical factor in improving care. Evidence needs to be built on how the availability of free wifi is impacting on people’s experience and outcomes as we move forward. The internet is a utility service and should be available for all to use, including in health and social care settings.

2. By 2017, the NHS workforce must be digitally confident, mature and skilled to lead the NHS into the network age.

I recommend that the assessment, training, support and mentorship programme is developed and rolled out locally, regionally and nationally that builds the digital maturity of the health care workforce, including the leadership. This cannot be a one off initiative but an ongoing process which keeps people’s skills and confidence at pace with technological developments for the benefit of all citizens.

Building the digital skills and maturity within the health workforce could radically improve the take up and adoption of new digital tools and technology. Digital health literacy, confidence and maturity amongst the NHS workforce is critical to realising the great potential the network age brings. It would provide two major benefits. Firstly, it would enable health care workers to support people to engage with digital tools and new technologies to promote take up and engagement. Secondly it would support health care worker’s own professional development and engagement with new ways of working as the digital revolution progresses and work patterns change. We know that changing technologies demand constant updating of expertise.

The National Information Board has already recognised the need to support health care professionals to make the best use of technology and data in ‘Personalised health and social care 2020’ but action needs to be taken as a matter of urgency. In a report focussed on ‘Digital Capabilities in Social Care’, it was found that the majority of managers felt that lack of staff capability inhibits the use of digital technologies, and that the pace of technological change presents a challenge to maintaining staff skill.

Good work is already being done in many areas in relation to skills and maturity development including work done by NHS England Widening Participation Programme. This work should be built upon not only to increase skills but also about motivation and understanding of the benefits of digital health and new technologies which is critical.

3. Reach the furthest first and do not leave anyone behind

I recommend that NHS England work collaboratively with partners across sectors to actually show, and provide the evidence, for how digital health and new technologies can help the NHS and partners reach the furthest first. Together we can drive digital transformation from the inside out: turning larger strategic problems into simple, tangible solutions that deliver. As a starting point, I recommend a cross-sector focussed project working with older people with life-limiting or terminal illness facing the end of life to give them more control over their health care destinies. I also recommend that digital inclusion programmes are mainstreamed across all areas of NHS work nationally and locally including in commissioning. Reaching the furthest first should be a critical principle of everyone’s work.
I would like to see a massive transformation using digital health and new technologies, focussing on those who are traditionally digitally excluded. Through digital innovation and inclusion, we can show that if you focus on what people need and want, you can see significant take-up, improved experiences and outcomes, as well as cost benefit to the system. Digital health and new technologies must be designed around people’s needs. Older people are a traditionally digitally excluded group with high health and social care needs. We want to show how if you focus on user needs and wants, as opposed to provider needs and wants, you can increase take up and experiences amongst those who are traditionally seen as digitally excluded.
We know that those with the most health and social care needs are often the most digitally excluded. That is why we must start with the furthest first and inclusion must be mainstreamed. There are fantastic examples of how digital health and new technologies are beginning to transform health care services for traditionally excluded groups including those with mental health conditions and the homeless but much more needs to be done. There cannot just be isolated, localised examples of excellent practice. There must be a commitment to inclusion as a starting point and where digital health services are working, they must be scaled.

4. Support GPs to increase patient registration for online services by 10% each year

I recommend that the role of primary care providers in providing information, signposting and supporting engagement with digital health tools and new technologies is recognised as a key entry point to increasing people’s take up. We should aim for an ambitious target of a 10% increase per year in patient registration for online digital services at the primary care level, opening up more opportunities for digital engagement with their healthcare. I also recommend an assessment should be undertaken to get a true picture of the barriers which may currently be preventing primary care providers from marketing and promoting digital health and new technologies that improve care and experiences. These barriers must be addressed as a priority.

There are many online tools which support and empower people to engage with their own health care, monitor and manage their own health conditions. These include the ability to manage appointments, order repeat prescriptions and many apps and websites which focus on specific conditions or population groups and have been shown to be extremely effective in enabling people to engage with their own health journeys.

The promotion, marketing and support of digital health and new technologies is critical to their increased take up and seems to be a significant barrier. As a key touch point within the health and social care system, primary care providers can play a central role in this. However, to date limited understanding of the evidence around the effectiveness of digital health and new technology and a lack of understanding about what is out there are likely to have been key barriers to the extent to which this has been done. In addition, digital maturity of the workforce and limited staff may impact on the ability or motivation to promote digital services.

I am very pleased that the NIB is developing an accreditation process for new apps and hope that a thorough review of what prevents the promotion and marketing of digital health and new technologies can support the challenges to scale up and promotion of existing digital health tools within primary care providers to be addressed.

In summary

The National Health Service is an outstanding institution with principles that are absolutely central to everything I believe – universality, equity and quality. The amazing opportunity and potential that digital health and new technologies can bring must be totally focussed on these three principles to ensure benefit for all citizens. No-one must be left behind.

One thought on “Putting digital inclusion at the heart of the NHS

  1. In terms of health innovation, check out
    This is a new online treatment service for minor illnesses offering instant access and free assessments. It has the potential treat millions of patients every year for less than one third of the cost of seeing a GP.

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