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COVID-19 revealed huge inequalities in digital access and health, yet also showed the potential of digital healthcare. How do we maximise the opportunity created by digital technology?  If inequalities in connectivity and access are not addressed, health inequalities will persist and are likely to be exacerbated.

Strategies to address health inequalities across the country must be reimagined with digital technology in mind, according to a new report from Public Policy Projects.

The report makes a series of practical recommendations to help integrated care systems (ICSs) harness the digital advancements that have been made in health since the start of the Covid-19 pandemic. The findings also suggest that unequal access to digital care and uneven digital skillsets could exacerbate health inequalities, a trend the report describes as a ‘digital divide’.

The report, The Digital Divide: reducing inequalities for better health, explores the extent to which gaps in digital access and skillsets impact health outcomes. It highlights how ICSs can use local data insights and digital innovations to proactively target sections of the population at risk of ill-health, particularly those living in more deprived areas.

Richard Stubbs, CEO of the Yorkshire & Humber AHSN and Vice Chair of the AHSN Network, who worked in collaboration with Public Policy Projects on this project, led a series of interviews and roundtables with senior sector stakeholders in health and care as well as experts in digital poverty. Stakeholders described disparities in digital access and skills as ‘super social determinants of health’ – and stressed that ICSs and local authorities must prioritise online assistance for those who are not currently digitally engaged.

“Digital technology undoubtedly presents a significant opportunity to positively transform the delivery of health and care services. However, if we don’t place patients and citizens at the heart of this transformation then we risk widening the health inequality gaps that exist within and between our communities. This report by PPP highlights the digital divide, and provides a clear set of proposals about the steps needed to address it, both nationally and locally, to ensure that the introduction of digital into patient and citizen pathways is done in a way that benefits all our communities, and especially those most in need of support” Richard Stubbs

The report discusses how the conditions of the Covid-19 pandemic meant that many services, including healthcare, moved online. The NHS began to adopt remote consultations and utilise virtual wards to reduce potentially harmful in-person contact. The vaccine rollout, and subsequent introduction of the Covid Pass, also saw millions of people download the NHS app for the first time.

However, while the report stresses the importance of digital innovation and the digital transformation of NHS England, the report also warns against overlooking the provision of high-quality in person services. Offline care pathways must accordingly always be available to those who are in most need or who are unable to access digital care.

PPP’s report also urges professional bodies to consider mandatory online training for health and care staff, so that new innovations can be developed and implemented with maximum impact to health outcomes. This is particularly relevant to ensuring that data is used effectively to identify areas of need and provide broader insights on population health management. Data insights are crucial to identifying the social determinants of health and at a localised level and can help health providers and local authorities target the root causes of health inequalities. However, it is also crucial that data be interpreted by the communities it is collected from to develop true insight from health data.

Digital health interventions should be co-produced with local communities, this will help improve user experience and create easy to use interfaces. The report emphasises that if innovations are not accessible for the most in need, they will automatically exacerbate existing inequalities. The Digital Divide therefore calls for further updates to be made to the NHS Digital Technology Assessment Criteria to prioritise good user experience for those with additional accessibility requirements.

Commenting on the report, Dr Keelan Meade, Head of Research at the Digital Poverty Alliance, said: “This is a timely and important report, which not only reviews the key issues but also provides concrete recommendations on how we might improve the provision of digital health services in an inclusive way, to ensure a fairer and more accessible health system. As more and more essential services like healthcare move online, it’s vital that we tackle digital poverty to ensure that everyone has access to the benefits of a digital society”

You can download the full report here