Following a multi-year programme to help ensure people have the digital skills, motivation and means to access health information and services online in the UK, it has been established that the NHS could be saving millions of pounds if it invested in bridging the digital health divide across the population.
Good Things Foundation has been working with NHSX, NHS Digital, NHS England and other local partners since 2013 on the ‘Widening Digital Participation Programme', which was aimed at ensuring more people have the digital skills, motivation and means to access health information and services online.
The programme of work completed in March 2020, just as the UK went into lockdown following the outbreak of COVID-19, and the authors of the report note that the conclusions released today are even more pertinent in the context of a pandemic.
For example, in March 2020 alone, online consultations doubled from approximately 900,000 to over 1.8 million.
In addition to the context of COVID-19, in September 2020 NHS England asked NHS leaders to review and develop digitally-enabled care pathways to increase inclusion, ensure all patients receive the same level of access and care regardless of their digital preferences, and ensure it does not affect health inequalities for others, due to barriers such as access, connectivity, confidence or skills.
In other words, the findings from the programme are incredibly timely.
Phase 1 of the programme took place between 2013 and 2016, and focused on improving digital health literacy in communities. Phase 2 of the programme took place between 2017 and 2020 and used co-design to find points in health and care systems which could be improved with digital and community interventions.
Phase 2 also supported 23 pathfinders, each with a different focus reflecting local needs and partners, from homelessness to self-care of long-term conditions.
Another 5 pathfinders and 22 mini pathfinders evolved a model of community-led local ‘digital health hubs', which the report released today notes are emerging as a "promising way to improve digital health literacy and inclusion".
Nicola Gill, director of the Widening Digital Participation Programme at NHS Digital, said:
The pathfinders were developed around the principle of going to where people are, whether that was a GP surgery, a homeless shelter, a dementia support group or a cancer support network.
Being there, talking to people, drinking tea and learning about their lives allowed us to gain trust and valuable insights into what they really need.
If NHS commissioners, policy makers and designers of digital health services and tools can just do some of the things recommended in this report, then hopefully we can start to narrow the gap of health inequalities, and help people benefit from the choice and convenience they offer.
Phase 2 pathfinders supported 21,178 people. During the programme a further 166.263 people were made aware of digital health resources; and 53,173 people improved their digital health literacy through Good Things Foundation's free online learning tool (Learn My Way).
As an example of how Learn My Way in itself could help the NHS save resources, people who completed the courses were questioned 3 months later, and 33% said they made fewer visits to their GP (average 4.8 visits saved) and 14% said they made fewer visits to A&E (average 3.1 visits saved).
The report states that a return on investment calculation undertaken for Phase 1 alone (which focused on building digital health literacy through community organisations) found potential savings to the NHS of £6 million a year. That's a £6 return on investment for each £1 spend on the programme in its third year.
Conclusions and recommendations
Good Things Foundation has released a number of learnings and recommendations off the back of the work it has been carrying out with the NHS over the last seven years. Across the pathfinders, the Foundation found that there were eight key messages and areas for action:
Recognise digital access, skills and confidence as a social determinant of health. In addition, national data on the links between digital inclusion, health care and outcomes should be improved.
Patients should be able to use what works for them - whether digital, physical or blend. Co-design with patients should be at the heart of a digitally-enabled NHS: it should always include co-design with those who have low digital skills and face barriers to health care.
Improve population digital health literacy, and support safe and healthy internet use. Improve people's understanding of how their health and personal data is used.
Further test and scale digital health hubs as community infrastructure for inclusion. Develop commissioning frameworks which support the role of community sector partners. Establish a national community of practice for digital health hubs.
When commissioning for digital health inclusion, recognise the time needed to build trust. Train and support peers to be digital champions for health and care.
Support people to try out different devices and assistive technologies. Include information about how to improve accessibility when training digital champions.
Build digital confidence and motivation of staff, following Health Education England's lead. Train, support and build a network of digital health champions in a service or locality.
Embed digital inclusion and digital health literacy in local health and wellbeing strategies. Build on community assets and collaboration across health, care and community sectors.
Commenting on the findings, Helen Milner, chief executive of Good Things Foundation, said:
Using digital has become essential in order to reduce health inequalities. This three year project - which has reached over a quarter of a million people - shows that by understanding the barriers to access and taking services to the people, we can engage and support them like never before.
During lockdown, people have felt lonelier than ever and have struggled with their physical and mental health. Digital Health Hubs, piloted and developed during the programme, have been able to tackle this by improving digital health literacy and the use of digital health tools in a safe, trusted space in the community.
We hope that a future network of Digital Health Hubs and Digital Champions will further harness the benefits of digital inclusion. It is vital that digital is at the centre of health, care and wellbeing strategies in the future."