08th December 2015
The Rt. Hon Jeremy Hunt, MP, Secretary of State for Health
I am delighted to provide my recommendations to the National Information Board on how to increase people’s take-up of internet enabled services and tools in health and social care.
My key recommendations to NIB are that the NHS should:
1. Focus on ‘reaching the furthest first’ and not leave anyone behind
2. Ensure free Wi-Fi for all across the NHS estate
3. Build the digital skills of the NHS workforce, ensuring that everyone has the basic digital skills required to support people’s health needs in the network age
4. Every GP practice should have at least 10% of its registered patients using online services by March 2017 and aim to increase patient registration for online services by at least 10% in each following year. This would mean 90% of registered patients using online services by 2025.
I have developed these recommendations with the support of my team at Doteveryone. Doteveryone has a public purpose 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 for the NHS to build on and support the incredible work of health and social care workers across the country to ensure that Internet enabled health services are delivering benefits to all citizens.
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.
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. Services designed around the needs of the hardest to reach and the least digitally skilled will be easy for everyone to use.
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.
I am therefore recommending four initial priority actions:
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. 12 million people are estimated to lack at least one basic digital skill, 16% of households in the UK do not have internet access and 33% of people with registered disabilities have never used the internet. These figures are shocking and we must ensure that those with the highest health and social care needs are able to benefit from the massive potential the network age brings for health. There are fantastic examples of how internet enabled 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 and ‘reaching the furthest first’ as a central component of the design of new digital services, and where internet-enabled health services are working, they must be scaled.
I would like to see a massive transformation using internet enabled technologies, focussing on those who are digitally excluded. Older people are a traditionally digitally excluded group and people with life-limiting illness have high health and social care needs. We must show that if you focus on what people need and want you can see significant take-up and improved experiences and outcomes, as well as cost benefit to the system. New internet enabled services and tools must be designed around people’s needs.
Enabling free access to Wi-Fi across the NHS estate could significantly increase take up of internet enabled health services. Free Wi-Fi 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 that can support recovery and promote well-being. Importantly, it will also enable the more rapid introduction into health care settings of internet enabled services that could transform health care services to improve people’s experience and outcomes. In addition, it provides an incredible opportunity for real time feedback on health care services.
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 Wi-Fi 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 Wi-Fi 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.
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 are 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 services and tools 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 the skills of staff.
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 help people to increase their skills but also to build awareness of the benefits of digital health services and the motivation to use them. It is critical that NHS front line staff have the confidence and skills to introduce people to new digital services and tools, motivate them to use them and support them to do so.
There are many online tools that 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 and order repeat prescriptions. Many apps and websites which focus on specific conditions or population groups 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 are critical to their increased take up and currently seem to present a 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 exists are likely to have been key barriers to progress. In addition, digital maturity of the workforce and limited staff may impact on the ability or motivation to promote digital services. These barriers must be addressed to support primary care providers in the network age.
Whilst outside of the scope of the remit of my recommendations to NIB, I am acutely aware that my recommendations are all equally applicable to social care. I appreciate that the delivery challenges may be greater and somewhat different, but I will be also be sharing my recommendations with the Minister for Social Care and the Care Quality Commission to ask how my recommendations might be embedded in the CQC inspection framework. Access to free Wi-Fi and support to use the Internet to keep in touch with friends and family should be a fundamental right for care home residents. Ideally, I would like to see an integrated delivery plan across health and social care.
I am looking forward to making these recommendations in person at the National Information Board meeting on 8 December.
My recommendations should be delivered by 2020 at the absolute latest, and I hope that with sustained effort many of them will be able to be delivered before this date.
I therefore look forward to seeing delivery plans for all of my recommendations. Whilst I hope my recommendations are clear and simple to understand, I do not underestimate the sustained delivery effort that will be required to achieve them.
Martha Lane Fox
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