Access Denied: Addressing Inequalities in Digital Healthcare Tools

    October 6, 2022

    James Friend, Director of Digital Strategy at NHS England London region, writes about how the Access Denied report is shedding light on digital inequalities and what you can do to help.

    The NHS has the potential to transform services for patients, from assessment to treatment, through digital technology. But it is crucial that this is done in a way which reduces rather than increases inequalities.

    The Covid-19 pandemic led to a rapid increase in the use of digital technology in healthcare, whether this is the use of the NHS app for vaccine passports, the proliferation of online doctors’ consultations or the development of new tools for remote monitoring or self-management of conditions. This has many benefits. It can make services more flexible by enabling out-of-hours access, and digital services can be an improvement for people who are visually impaired or who have limited English skills.

    But while for many people accessing services digitally is now the norm, this is not yet universal, and there is evidence of a link between digital exclusion and social disadvantage. People with protected characteristics under the Equality Act 2010 (age, disability, race) are less likely to have access to the internet, and the skills to use it (NHS Digital, 2019); and the impact of this has not yet been fully understood.

    The role of digital is currently being considered by the newly-formed Integrated Care Boards, and this presents a unique opportunity to make sure that people without digital access are not left behind. That’s why the Health Innovation Network, the Academic Health Science Network for south London, hosted an important roundtable with experts on this topic which I chaired. The Access Denied report takes the key points from this discussion and explores the impact of digital inequalities in healthcare, making a series of recommendations for those seeking to adopt new technologies:

    • Work with digital innovations that meet the highest standards for accessibility and usability.

    • Test digital products and services thoroughly with a cross section of patients, providers and commissioners.

    • Use data to optimise delivery to improve outcomes and minimise exclusion over time.

    • Understand how people may need specific channels of delivery at different times or for different services.

    • Ensure you capture data so you can measure and compare outcomes and experience by channel.

    • Don’t plan care pathways for the majority – ensure it is optimised for those from minority backgrounds too.

    • Consider the support needed to move people to digital pathways.

    • Ensure equality impact assessments for transforming care pathways pay attention to digital exclusion as a potential risk of inequality.

    We are also calling on designers, developers and the NHS to work together in two ways:

    • We need to develop frameworks, similar to those seen for information governance and clinical safety, which would set out guidance for mitigating against health inequalities that could become adopted and embedded by design.

    • Ethical considerations must be built into the clinical safety case of the tool and data used to inform or train algorithms must be thoroughly examined for bias.

    You can find out more about digital inequalities, their impact and what you can do about them in the Access Denied report.

    Find Out More

    Find out more about digital health inequalities and how to avoid them.

    Read the Access Denied Report