Ruw Abeyratne: Health Inequality: Let’s Get Digital

The Covid-19 pandemic brought home to the NHS the potential for digital solutions to unlock new ways to deliver healthcare. I can recall at the beginning of the pandemic asking if it would be possible to host a meeting online and having to wait some time for an answer. Contrast this with the fact that many of us now spend whole days logged into online meetings, checking results on the electronic patient record, enabled by our VPN access at home, sharing screens (not always the right screen), talking about virtual wards and remote monitoring of patients and things are changing.

Those in the know have been talking about the ability of digital to transform care for many years now. Clarity on what this means and for whom will be key to realising the potential of digital to enable healthcare delivery that is efficient, patient centred and equitable for all.

Mitigation for digital exclusion is one of NHS England’s five strategic pillars for tackling health inequalities. However, before we can mitigate for exclusion, we must agree on a shared understanding of what the problem is, who is impacted and the consequence to the patient and the service they are accessing.

Individuals who experience health inequalities can be digitally excluded for a myriad of reasons. Take for example Rutland, the relatively small and rural area that forms the ‘R’ in Leicester, Leicestershire, and Rutland (LLR) Integrated Care System. Residents of Rutland experience some of the slowest broadband speeds in the country, impacting their ability to reliably engage in web-based health care, whether that is virtual appointments or remote monitoring.

By contrast, assumptions may be made about digital capital, or access to the hardware that enables patients to engage with digital healthcare solutions. Despite Leicester having some of the most deprived neighbourhoods in the country, 99% of children have access to the internet, 75% of these children access the internet on a phone. Add to this that local communities tell us that the best way to share information with them is via WhatsApp or YouTube videos, we start to move towards how we can share health (care)-related information with underserved communities in ways that work for them.

Access to the hardware does not guarantee digital capability or competence, that is the skills and knowledge needed to interact with and make the most of digital solutions. Patients who are experiencing the impact of health inequalities often belong to deprived communities. Intersecting with this is (educational) reading status and English as a second language; ensuring that information is shared digitally on the right platform, in an accessible way underpins the success of any digital solution.

The potential for digital to drive action against health inequality is much broader than digital inclusion, exclusion, capital, and capability. Access to data is crucial for surfacing health inequalities in our services and populations and indeed ensuring datasets are timely and accurate is a further strategic pillar of NHSE’s approach to tackling health inequalities. Nationally, NHSE’s Healthcare Inequalities Improvement Dashboard provides actionable insights for all organisations to focus on improvement through a lens of equality and inclusion.

The NHS is data rich; a vast amount of patient and service level data is collected day-to-day. Using this data intelligently enables teams to understand inequalities, to define specific service improvement aims and proactively address health inequalities. At a local level, working with Business Intelligence colleagues to interrogate and understand health inequalities data can add further depth and context to this.

This is by no means an exhaustive exploration of the potential for digital to transform action on health inequalities. However, getting the basics right in terms of having a shared understanding of which digital interventions and barriers are relevant locally and using local systems to interrogate data to drive service improvement through a lens of equality and inclusion are a good place to start.