By Krissie Ferris, Research Analyst, Centre for Health Solutions
In February 2020, our report Realising digital-first primary care highlighted the limited progress in achieving the NHS Long Term Plan’s ambition for all patients to have access to online primary care services by 2021. The COVID-19 pandemic has changed this irreversibly. In a matter of weeks, healthcare teams moved most of their non-emergency, face-to-face consultations online in an effort to maintain access while keeping themselves and their patients safe. What these past nine months have also shown is the impact of the digital divide on those who are unable to access or use online services and digital technologies. The groups disproportionately affected by the divide are vulnerable people, low-income groups, the elderly and the more marginalised communities in our society. Importantly, those with the greatest health needs are also the most at risk of being disadvantaged by digital exclusion.1 In a world where healthcare is fast becoming ‘digital by default’, this blog explores how to reduce the digital divide and the risk of exacerbating health inequalities.
Mind the growing gap: the digital divide
While much progress has been made to move care into a virtual setting throughout the pandemic, the risk of digital exclusion has increased for people who lack the skills, motivation or means to use digital healthcare technologies. Deloitte research shows that smartphone ownership peaked in the UK in 2019, with 89 per cent of adults having access to a handset. With this high level of adoption, it’s easy to take for granted the ability to access essential services and connect with others whenever we like.2 However, in 2020 approximately four per cent of UK households still lack internet access and 4.8 million people never go online.3,4 Throughout the pandemic, these individuals have had fewer opportunities to socially connect and access health care information and support. For example, an estimated 175,000 to 500,000 of those instructed to shield via letters had no internet access so couldn’t use the signposted websites.5
Having the means to access online services is one challenge, having the skills to use them is another. The Consumer Digital Index 2020 shows that 11.7 million people in the UK are without the digital skills needed for everyday life, and those who lack the skills are often already disadvantaged by society.
- Around 9 million people are unable to use the internet or their devices without assistance.
- 6.5 million (12 per cent) people cannot open apps.
- Two thirds of those online have not used the internet or digital apps and tools to manage their health.6
- Almost half of those over the age of 75 have never been online, and almost a fifth of people with a disability have never been online.7
- 40 per cent of benefit claimants have very low digital engagement.8
We explored some of the barriers to digital inclusion in our September 2020 report, Digital transformation: Shaping the future of European healthcare and identified the groups of people who are more likely to be digitally excluded (see Figure 1).
Figure 1: The sections of society at higher risk of digital exclusion
Source: Deloitte research adapted from NHS Digital and Eurostat, 2020
Being able to afford and use the internet is not only crucial for accessing healthcare and information, it is also essential for accessing education, employment and participating socially. As a result, digital inclusion is now recognised as a wider determinant of health.9
Tackling digital exclusion from multiple directions
Many stakeholders across the healthcare ecosystem have a role to play in addressing digital inclusion. Some of the most concerted efforts have been led by the Good Things Foundation’s (GTF) Widening Digital Participation programme. From 2013-2016, Phase 1 of the programme focused on improving digital health literacy in communities across England through a ‘blended learning’ model of community-based and online learning, partnering with community organisations with the relationships to reach those most in need of support. As a result, 221,941 people were helped to use digital health resources and 8,138 volunteers were trained. An evaluation suggested that around £6 million in healthcare visits were saved - a return on investment of £6.40 for every £1 spent.10
In Phase 2 of the project, GTF worked with NHS England, NHS Digital and NHSX to support 23 locally-led ‘digital inclusion pathfinders’ CCGs, GPs, hospitals, local authorities, care homes, and voluntary and community providers to improve digital and community interventions. A further 166,162 people have been helped to access digital health and 53,173 people have improved their digital health literacy through GTF’s free online learning courses. A third of those who have used the courses said they made fewer visits to their GP (average 4.8 visits saved) and A&E (average 3.1 visits saved).
Since April 2020, GTF has worked with community partners through DevicesDotNow to deliver devices, data and digital skills to support vulnerable individuals and families without internet access throughout the pandemic. Deloitte is one of a number of supporters of the campaign. Within the first four months, multiple fundraising bids were submitted, which resulted in £1.4m in funding, and nearly 12,000 people being provided with devices or connectivity. Twenty-nine per cent of people supported had never used the internet before COVID-19 and 80 per cent felt more confident with their digital skills as a result.11
GTF’s September 2020 report, Digital Inclusion in Health and Care: Lessons learned from the NHS Widening Digital Participation Programme (2017-2020) emphasises how COVID-19 has changed the dial on digital, with digital central to our national response, across all settings, and that further funding is needed to help those who remain ‘locked out’. To reach one person costs between £200 and £300 depending on the devices needed. To help 50,000 people requires approximately £10m.12 “Unless action is taken, millions of people will be left further behind with deeply damaging consequences for health inequalities”.13
Thriving in a digital society
GTF’s lessons learned report concludes that digital (access, skills and confidence) “is now one of the wider determinants of health, affecting our ability to access health care, chances of employment and opportunities for a healthy life”. As we highlighted in our Shaping the future of European healthcare report, as we attempt to recover from the COVID-19 pandemic, many of us will continue to embrace new ways of engaging with healthcare. Estimates suggest that unless the digital divide is addressed proactively, by 2030 4.5 million people (eight per cent of the population) are likely to be digitally disengaged. Ensuring digital inclusion is systemically addressed at every level of service planning and delivery will increase the opportunities for people to participate and thrive in a digital society.14
1 Gov.UK, The future of healthcare: our vision for digital, data and technology in health and care, October 17, 2019.
2 Deloitte LLP, Impact Stories, Staying connected throughout the COVID-19 pandemic, accessed October 20, 2020.
3 NHS Digital, What we mean by digital inclusion, accessed October 20, 2020.
4 Office for National Statistics, Internet access – households and individuals, Great Britain: 2020, August 7, 2020.
5 Parliament UK, Impact of COVID-19 on DCMS sectors, accessed October 20, 2020.
6 Lloyds Bank, Lloyds Bank UK Consumer Digital Index 2020, May 2020.
9 DevicesDotNow, Interim Impact Report #3: 24 March – 31 July, accessed October 21, 2020.
10 Social Tech Guide, NHS Widening Digital Participation, October 13, 2020.
11 Deloitte LLP, Impact Stories, Staying connected throughout the COVID-19 pandemic, accessed October 20, 2020.
12 DevicesDotNow, Interim Impact Report #3: 24 March – 31 July, accessed October 21, 2020.
13 Good Things Foundation, Digital Inclusion in Health and Care: Lessons learned from the NHS Widening Digital Participation Programme, September 2020.
14 HS Digital, What we mean by digital inclusion, accessed October 20, 2020.