Addressing diversity and health inequalities alongside tech innovation

Part of the morning agenda, on a busy day two of HETT Reset, was a detailed panel discussion on how to address diversity and health inequalities alongside health tech innovation.

The panel included, and was hosted by, Shera Chok, Co-Founder of the Shuri Network, Deputy Chief Medical Officer at NHS Digital and National Clinical Advisor on System Transformation with NHS England and Improvement.

The rest of the team included:

  • Lord Kalmesh Patel, Baron of Bradford and Chair of Breaking Barriers Innovations
  • Tara Donnelly, Chief Digital Officer at NHSX
  • Richard Stubbs, CEO at Yorkshire and Humber Academic and Health Sciences Network (AHSN)
  • Harpreet Sood, Former Associate Chief Clinical Information Officer for NHS England and Improvement, Non Exec Director at Health Education England.

Shera began by introducing some of the context on health tech inequalities, particularly in the current climate. She said: “We know that over the last 12 months, technology has played a critical role…but equally we’ve seen a harsh spotlight shone on the significant health inequalities and the digital divide that continues to exist in our society today.

“For example, we know that seven million people in the UK still don’t have internet access at home. We also know that one in five people don’t have the digital skills in order to access information online.

“And this includes information on their health, about housing, about benefits…looking forward, what can and must be done to reduce health inequalities and the digital divide?”

In the first round of discussions, Lord Patel brought “co-production” to the forefront, explaining: “The organisation I work with, a lot of the time I’ve spent is on co-production within communities.

“It’s a phrase that’s bandied about quite a lot. I did a huge co-production project way back in the 90s. [I] spent decades connecting with communities on very taboo subjects; you know, drugs misuse, mental health, domestic violence…as opposed to employing lots of researchers, we worked with communities.

“I think this is the big question here. The topic of this discussion ‘addressing diversity and health inequalities alongside health tech innovation’ is an interesting one. Because, for me, we need to tackle health inequalities. That’s the primary thing we need to do.”

Lord Patel later added, “engage…these wonderful scientists sitting and developing new technologies [that] might not work for me. Please come and chat to me.”

Providing an example of bringing patients into the discussion, Harpeet dug into his own recent practical clinician experiences. He added: “At my primary care practice we saw the massive switch from physical to virtual.

I said to one of my patients, who came from a South Asian descent…‘isn’t it great that you can now use your cell phones to have a video consultation with me?’

“And he said, ‘you know what doc? Not really, because I’ve got limited data and I’d rather use that data to speak with my family in Bangladesh.’

“It made me realise that even if we have this technology, it’s not necessarily for everyone. But have we thought about…how we look at it from a patient and human lens.

“I think that’s something that needs to be considered, especially for those who are from different backgrounds, who have different needs…we cannot simply offer a generic offering to everyone and it doesn’t work.”

Tara of NHSX picked up on that thread, using it to highlight the ‘danger’ of digital assumptions: “Just picking up that point about it [tech solutions] not being for everyone…so stereotypes are problematic, aren’t they? And can actually be quite dangerous.

“So, I’m concerned that sometimes there can be huge assumptions that we make on the NHS side about who would like to use technology.

“Harpreet gave a lovely example where he didn’t make the decision for his patient, he had a conversation about it to see what was most suitable.

“I think the conversations that we’re having with patients are going to need to change, because even a year ago, your data plan or the device you have at home or internet access, they wouldn’t have been factors that played into your health needs, they were quite separate.”

Richard of AHSN, was also keen to highlight  the importance of accessible pathways into leadership and research. He said: “One of the things that we don’t do very well, which has a huge potential to support this agenda…we don’t think about the 19.1% of our staff who are already in the NHS and are from BME backgrounds.

“The inequity of access…who goes into research roles? Who goes into innovation roles? Who are the gatekeepers in our providers and our commissions…who are dictating who can come into various pathways?

“It’s not just about supporting and championing our BME innovators but it’s also about making sure that our own pipelines and pathways are accessible to all.

“The way I see it from within the NHS is, if we’ve got 19.1% of our staff who are from BME backgrounds that’s potentially a fifth of our future ideas that could transform the way that we deliver our service, that we’re not listening to.

“When we do see the work of our BME innovators…the lived experience of our BME innovators absolutely enriches the types of products and innovations that they develop and it’s a second nature aspect.”

To that point, Shera added that she Googles ‘NHS Chief Clinical Information Officer’ and ‘ Chief Information Officer’ every six weeks. She explained: “I did it this morning…and if you Google it now…you will get a sea of white men, and some Asian men. But overwhelmingly it’s not very diverse.

“And you will probably see one woman of colour, out of about 120 white faces. And if you think about the NHS workforce, we are 80% female, about 20% people of colour…so there is a huge disparity.”

There were plenty of topical areas to discuss, as the conversation covered everything from using data effectively and how transport can be an enabler, through to personal health budgets and examples of panelists’ work.

While Shera rounded the session off after looking at some audience questions and feedback. She concluded: “I’m hearing really strong themes and messages around having conversations with our service users, having those conversations with our staff.

“Hear their lived experience, use that to help develop your digital products and services – don’t do it the other way around….levelling up, how do we make sure that is front and centre of our digital transformation programmes?

“Lastly, I think a strong message is ‘be bold, be brave and be practical’.”