NHS England has published ‘Inclusive digital healthcare: a framework for NHS action on digital inclusion’, designed to help services in designing and implementing inclusive digital approaches and technologies which align appropriately with non-digital services and support.
Five domains are identified as requiring action: access to devices and data; accessibility and ease of using technology; skills and capability; beliefs and trust; and leadership and partnerships.
Access to devices and data
The framework sets out an action for all NHS staff whose roles contribute to the commissioning or design of digital services – to determine the service’s target populations and decide whether the digital offering is “fully useable on all devices that may be used by the populations”, along with identifying areas where further support may be required. In particular, the framework encourages consideration of provisions for socially excluded groups such as people experiencing homelessness and asylum seekers.
Another action here is to collaborate with other agencies or organisations working within the area to provide access to technology and data; and to ensure that messaging is clear so that service users understand that they will be able to access devices to use digital healthcare when they want.
For senior leaders at ICS, PCN and provider level, the framework states a need for understanding around which communities might be most affected by digital exclusion, using tools such as the Digital Exclusion Risk Indicator. Preferred methods and routes to get equipment and connectivity to those who need it should be agreed, and should ensure that the approach is sustainable.
For senior leaders in national or regional programmes and functions, NHSE encourages collaboration with NHS colleagues and wider partners “to determine to extend of need for access to digital technologies when designing new initiatives, and to facilitate responses”.
Accessibility and ease of using technology
For those involved in commissioning digital services, the framework emphasises the importance of understanding and adopting the planned NHS inclusive design framework; the accessibility guidance from the NHS digital service manual; and the accessible information standard.
They should also ensure that information for the public is “accessible and understandable to people with lower literacy or low confidence”, and identify where additional support may be required by ensuring that needs assessments and impact assessments specifically consider the needs of disabled people, and people with language barriers.
For senior leaders at ICS, PCN and provider level, the framework encourages them to “make provision within any digital skills or support offers to help people get accessibility software”, to ensure that any digital provision supports additional amounts of data use required for accessibility software, and to invest in culturally appropriate support for those with literacy or language barriers.
Skills and capability
With regards to actions to build digital skills among the workforce, carers and patients, NHSE encourages commissioners to determine target populations and their need for skills development in collaboration with VCSE organisations and partners. It also suggests that they “consider development of tools, scripts or support to enable NHS staff to explain the purpose and benefits of specific technologies or approaches”.
For senior leaders at ICS/PCN/provider level, the framework advises commissioning and provision of training for members of the public in collaboration with the local government, VCSE organisations and the private sector, along with additional training to support NHS staff.
At a national programmes and functions level, the framework states a need to “consider the workforce capability implications of any digital transformations and ensure that any ongoing training and support needs are given attention in workforce plans”. NHSE also suggests that the learnings around supporting confidence in general practice from this pilot project could be of use when developing communications around digital care.
Belief and trust
For those involved in commissioning, the framework encourages identification of opportunities to make digital services seem “relatable”, such as using trusted messengers and communications using everyday language. Commissioning staff should “undertake mixed methods research to understand how beliefs or trust affect engagement with digitally enabled pathways’.
In addition, the framework suggests that organisations “promote use of lower-risk, transactional touchpoints” such as managing an appointment booking or checking test results online, to help people try our digital services for themselves and build trust in its efficiency and security for future interactions.
It is key to “ensure that new digital health and care pathways are at least as good as alternative non-digital service channels”, the framework states.
For senior leaders at ICS/PCN/provider level, the guidance reminds organisations of the need to ensure routes for users to feedback on experiences, and suggests that leaders consider opportunities for peer support, to help people build their trust.
Leadership and partnerships
The final domain states that NHS staff contributing to commissioning digital services should follow NHSE guidance on working in partnership with people and communities to develop digital strategies and digital pathways; should ensure that impact assessments or similar explicitly consider the risk of digital exclusion; and should collect data and monitor information to assess inequalities impacting access to, experience of or outcomes from digital healthcare.
The framework shares a number of key actions for senior leaders at ICS/PCN/provider level: to create structures or forums to allow joint work by senior leaders with accountability for health inequalities and digital transformation: to consider whether to target capacity for digital inclusion initiatives to where work is most needed; to identify which community-centred roles could help connect people for digital support; and to promote use of social prescribing to enable access to device and data support, along with building digital skills. It also advises these leaders to encourage routine recording of communication method preference and to consider establishing a digital inclusion lead role, as well as encouraging ICBs to develop a digital inclusion strategy that is joined up with local authority equivalents.
Finally, looking at actions for senior leaders in national programmes and functions, the framework states: “Ensure that any steers to the wider NHS highlight and encourage response to specific digital exclusion issues” and “consider ways to monitor how digital inclusion is being tackled through specific initiatives”.
The framework can be found in full, alongside supporting case studies, here.
In July, we shared NHS’s guidance on supporting digital inclusion in general practice; click here to read.