As video consultations continue to be seen as the method of choice for medical appointments, a gap appears to be emerging between those patients who have access to digital skills and those who remain digitally disengaged. This concept of digital poverty is now gaining recognition, prompting many service providers to explore new ways of ensuring digital inclusion for everyone.
As a recent article in The Lancet made clear, any healthcare development that isn’t easily available and accessible to everyone has the unintended but inevitable consequence of fuelling health inequality, and it’s a far bigger problem than many healthcare providers realise. For example, a recent NHS survey revealed that up to 22% of the population do not have the digital skills needed for everyday life in the UK, with further predictions that by the year 2030, 8% of the population will still be digitally disengaged.
The rise of digital poverty
The terms digital deprivation, digital exclusion and digital poverty are relatively new additions to the medical vocabulary. Yet it could be argued that digital exclusion should be taken just as seriously as other forms of inequality, or social disadvantages such as low income or poor housing
Currently, 10% of the adult UK population are classed as ‘internet non-users’ with limited or zero internet skills. Inevitably this means that caution is needed before automatically directing patients to ‘digital-first’ services, as this can leave some patients, particularly those who are elderly or vulnerable, feeling like a door has closed on their ability to access help and support. As a recent report by NHS Wales suggests, the three main components that contribute to digital exclusion are access, ease of use and engagement. Good internet access can be a particular challenge in remote rural areas and some families may feel forced to choose between the costs of purchasing digital technology and other essential costs of living.
Barriers to digital inclusion
As a significant percentage of the UK population is likely to remain without internet access, or without the skills to take advantage of remote video consultations, the question arises of how can medical teams identify and support these patients?
Most reports point to age as the main determinant of digital exclusion, but there are also other significant factors that can preclude access to online medical care, for example:
· Low levels of digital literacy
· Learning disabilities
· Ethnic origin
· Culture and language barriers
· Remote locations with poor broadband coverage
For patients on low incomes, motivation to embrace change can also be a barrier to adapting to new modes of service delivery and some patients may experience more than one obstacle at a time, making it difficult to access optimal care.
If digital health initiatives, such as the provision of remote video consultations are to be a success, these inequalities need to be addressed and creative solutions sought to make care easier to access and inclusive for everyone.
Supporting digital equity
Bearing all these factors in mind, many health authorities are now creating task forces to explore how the effects of digital poverty can be mitigated. For example, NHS Wales, suggests that support and training for people in the use of
online technology along with co-design of service delivery are both areas that would benefit from more robust evaluation.
The provision of digital healthcare is an area where further research is clearly needed. That said, recent projects involving skills training and building up capabilities within local communities seem to be yielding promising results, often with the additional benefits of creating more streamlined, effective services, that are designed specifically to be digitally inclusive. In the short term, care providers may need to actively seek creative solutions, for example, placing video consultation booths, in public places such as community centres, or libraries. It’s early days but the long-term payoffs of ‘thinking out of the box’ would seem to be substantial. In addition to the cost-saving benefits and convivence of remote consultations, many secondary benefits are emerging. For example, the relative ease of delivering health coaching services, encouraging self-care, supporting health promotion and preventative care as well as easing the pathway to the long-term management of many chronic health conditions.
The three pillars of digital inclusion
Making digital inclusion a practical reality means bringing together the three key components of successful online consultations:
· The ability to use digital devices such as a smartphone or computer.
· Good connectivity to the internet through broadband, wi-fi and mobile.
· Accessibility to private secure online technology.
Guiding these innovations in digital technology is the NHS Long Term Plan which is committed to reducing all forms of health inequality. Local plans which place the patient at the centre of the modernisation process are already well underway in many health authorities, with the explicit goal of ensuring that digital technologies work for everyone. From the most digitally literate to the most technology averse, the aim is that everyone has an equal opportunity to stay healthy and access expert care whenever it is needed.
A peek into the future of healthcare
Technology supported consulting is already delivering a partial but practical solution to the challenging task of providing effective, accessible healthcare for everyone, regardless of age, ethnicity, or geographical location. It’s an enormous task that poses many logistical challenges, but one that also offers huge benefits that could see traditional in-person GP and outpatient consultations become obsolete.
Some people may never use digital services directly, but they may still benefit from the general move towards online consulting which will, in turn, free up in-person resources that they can continue to access.
Non-digital access to healthcare will always remain available for those patients, who cannot access online services or who lack the confidence to embrace new technology. There are many others, however, who fall into the category of being unsure, or who need a little practical help and support to overcome any apprehension about online engagement. For these patients, support, and encouragement, blended with basic education in digital skills may make all the difference. Being digitally confident holds many benefits for patients and carers alike and the concept of digital equity looks set to remain high on the healthcare agenda for many years to come.