by Freya Graham
In March, Health Secretary Matt Hancock made a confession: ‘I’m a tech geek’. In the same speech, given at the Digital Health Rewired Festival, Hancock laid out his plans for a tech-driven future for the NHS. Praising ‘the power of technology’, he said that “digital technologies are not a bolt-on, or a nice to have. They must be a transforming force, that can help us fundamentally improve by reshaping health and care as we know it” (Hancock, 2021).
As video GP consultations and health-tracking apps play an increasingly important role in healthcare in the UK – in part thanks to the Covid-19 pandemic – new digital technology has the capacity to vastly improve the NHS. However, the success of digital technology in healthcare depends on how many patients can access the online world.
While the last decade has seen a huge rise in the number of people accessing the internet on a daily basis, 7 per cent of the UK population remain ‘almost completely offline’ (Lloyds Bank UK Consumer Digital Index, 2020). It’s also estimated that around 11.7 million people in the UK – that’s around 22 per cent of the overall population – lack the digital skills required for everyday online usage (Lloyds Bank UK Consumer Digital Index, 2020). These skills include opening an app without assistance and connecting to the internet.
The Lloyds Bank UK Consumer Digital Index 2020 found that “age remains the biggest indicator of whether an individual is online”. 77 per cent of over-70s have Very Low digital engagement, and only 7% of over 70s have the capability to use online banking and shopping services (Lloyds Bank UK Consumer Digital Index, 2020). In 2017, 54 per cent of adults aged 65 to 75 living in the EU had used the internet. (Sourbati, 2018). Several have labelled the exclusion of older adults from the online world as ‘digital ageism’.
Digital inequality runs parallel to another significant inequality – health inequality. According to Public Health Scotland, “health inequalities are the unjust and avoidable differences in people’s health across the population and between specific population groups… they are socially determined by circumstances largely beyond an individual’s control. These circumstances disadvantage people and limit their chance to live longer, healthier lives” (Public Health Scotland, 2021). Statistics from the UK government show a major discrepancy in life expectancy between those living in the most and least deprived areas of England. People living in the most affluent areas of the UK are likely to live roughly 20 years longer in good health compared with those living in the least affluent areas (Connolly, Baker, and Fellows, 2017).
Health inequality is impacted by many factors. One is quality and experience of care, which, as digital becomes more prevalent, is now partly determined by acmes to technology. The Covid-19 pandemic forced many aspects of healthcare to operate remotely. For instance, online consultations increased from 90,000 to over 1.8 million in March 2020 (Stone, Nuckely, Shapiro, 2020). Similarly, 2020 saw the use of online bookings for GP appointments increase by 19% (Stone, Nuckely, Shapiro, 2020). Before the Covid-19 pandemic, 10 per cent of GP practices in England ran video consultations. By April 2020, more than 75 per cent of GP’s made use of video appointments (Donnelly, 2020). Apps for tracking health, registering symptoms, and aiding recovering patients are also being popularised, while NHS websites are a major sources of health information. More and more online users are reaping the benefits of digital technology in the health system; 44% of people with high digital engagement said that being online helped them to manage physical and mental wellbeing (Lloyds Bank UK Consumer Digital Index, 2020).
As more and more of the NHS becomes digitalised, health inequality is amplified by digital ageism. Those who have low digital engagement – for a myriad of reasons, including lack of motivation and the cost of broadband and data (Lloyds Bank UK Consumer Digital Index, 2020) – are excluded from tools like online booking and video appointments, which may impact how easily and swiftly these patients can access healthcare. The solution is two-fold. While digital skills and technology need to become more accessible for all, the health system also needs to, in part, remain offline; access to the internet should not be a prerequisite for access to adequate healthcare. In the words of the Good Things Foundation, “too many are still locked out. If we don’t act now, millions of people will be left further behind with deeply damaging consequences for health inequalities. Digital (access, skills, confidence) has become a social determinant of health” (Stone, Nuckley, and Shapiro, 2020).
Connolly, Baker, and Fellows, 2017, “Understanding Health Inequalities in England”. Available at: https://publichealthmatters.blog.gov.uk/2017/07/13/understanding-health-inequalities-in-england/
Donnelly, 2020, “How the NHS is innotvating as part of its fight against coronavirus”. Available at: https://www.nhsx.nhs.uk/blogs/how-nhs-innovating-part-its-fight-against-coronavirus/
Hancock, 2021, “Driving Digital in the NHS”. Available at: https://www.gov.uk/government/speeches/driving-digital-in-the-nhs
Lloyds Bank UK Consumer Digital Index 2020. Available at: https://www.lloydsbank.com/assets/media/pdfs/banking_with_us/whats-happening/lb-consumer-digital-index-2020-report.pdf
Public Health England, 2020, “Health Inequalities Dashboard”. Available at: https://www.gov.uk/government/statistics/health-inequalities-dashboard-march-2021-data-update/health-inequalities-dashboard-statistical-commentary-march-2021
Public Health Scotland, 2021, “What are health inequalities?”. Available at: http://www.healthscotland.scot/health-inequalities/what-are-health-inequalities]
Sourbati, 2018, “When Ageism goes digital”, Dr Maria Sourbati, Ageing Equal, November 25 2018. Available at: https://ageing-equal.org/when-ageism-goes-digital/
Stone, Nuckley, and Shapiro, 2020, “Digital Inclusion in Health and Care: Lessons learned from the NHS Widening Digital Participation Programme (2017-2020)”. Available at:https://www.goodthingsfoundation.org/sites/default/files/research-publications/digital_inclusion_in_health_and_care-_lessons_learned_from_the_nhs_widening_digital_participation_programme_2017-2020__0.pdf