Changing the NHS – New Technology – 2

In my introductory piece to this series of posts “The Mechanics and Morality of Change in the NHS” I identified six themes that I believe any innovator needs to consider before, during and after the process of introducing change to the NHS. (New readers may want to read that first).

Developing and using an overarching narrative to improve technology in the NHS.

The main issue about the application of new technology in the NHS is that it is both a narrative and an issue of practice. The NHS prides itself on its founding principle of equal access for all. (As I often say “this is such a good principle, that one day, we should try putting it into practice”) and it’s clearly right that in 2024 we shouldn’t knowingly add to the existing inequalities of access.

One of the obstacles to the greater use of technology in the patient/public interface has always been the ‘digital divide’. Over the last 20 years whenever I have discussed, with national or local leaders, the possibility of using more technology to change the interface with the public, NHS leaders have quite rightly brought up the impact of the digital divide.

They are right to point out that the median NHS patient is older and poorer than the median member of the population, so the digital divide is an issue. This is NOT to say that all old people and all people are digitally unequal, but it is to recognise the differential.

And if, when we apply technology to the interactions between the public their health, health care and the NHS, we are not prepared to tackle the impact pf the digital divide, we are in danger of increasing inequality of access rather than diminishing it.

However rather than just accept this as a fact of life we could, with others, do something about it.

The digital divide, as with many of the inequalities of our society, has a very bad impact for those on the wrong side of it. It makes their social and economic outcomes worse. The inequalities of outcomes are not abstract but concrete and practical, and of course include ill health. (Telling people of my age that they need to walk 10,000 steps a day only makes sense if they have a machine that counts them).

For me, this makes a strong case that if the NHS could work with others to overcome the impact of the digital divide, it would have an impact not just on access to the health service but also on health.

I am not saying that it is the responsibility of the NHS to overcome the digital divide. Just as I am not saying in my posts on prevention that it is the responsibility of the NHS to overcome the inequalities of health. These are both wider social issues that will need solving by a much wider set of social and economic forces. But the NHS has a role.

The analogy with health improvement is a useful one to use.

If, over the next decade we are to reduce inequalities in the number of healthy life years that different sets of the population experience. If we are to ensure that more disadvantaged 50-year-olds have more healthy years with their grandchildren than they do at the moment, we will need a very wide coalition of forces to make it happen.

To stick with this analogy. We will need every government department to develop an understanding of health in all its policies. And that work will need to be coordinated centrally. We will need sections of the business community to take health improvement much more seriously, to improve their products and how they sell them with this in mind. Above all we will need civil society to fully engage nationally and locally with health improvement as many are increasingly doing. Any successful policy of health improvement amongst disadvantaged people wll need a close and detailed understanding of how local assets can be brought together to play their role.

And we will also need the active involvement of the people. Without their increased agency, very little will happen. These big national policy and business interventions will need to increase it.

Many estimate that 20% of health improvement could be found by changes in the NHS and this is true for a policy and practice of reducing the digital divide, so let’s start by saying that no more than 20% of the solution is down to the NHS.

Then let’s agree that every government department needs to play a role in overcoming the divide.

To give some examples. The Department of Work and Pensions, works with people who are looking for work through job centres. They could, at each centre, learn about how to use new technology to help them not only get, but keep jobs. There need to be people at job centres who, alongside their other job, can familiarities job seekers with the internet.

A friend of mine is the principal of an FE college in a deprived part of London. Readers will know that there are two main groups of students in FE – younger people learning for their first job, and older adults retraining. My friend estimates that 40% of the older adults at the college do not have access to the internet. FE could provide that as well as the facility to use it.

When I grew up in South East London my public library helped me to overcome the 1960s equivalent of the digital divide – the book divide. I wasn’t from a poor family, but we didn’t have books at home. The public library provided me not just with the necessary books at school but extended my knowledge enormously. The librarians saw that as their job, “We haven’t got the book on your reading list, but this one might help”.

I live close to my home suburb and when I go to the big local library during the day, I am struck by the extent to which the computers in the library are being used by people to run their businesses. The machines (and some help to use them) are free. The internet is free. (Just like books in the 1960s).

Government and local government departments need to work together to tackle this divide. But so do the tech companies and other parts of business. A part of awarding public sector contacts could be – what are you going to contribute to overcoming the digital divide?

To take another example. Whilst banks are closing their branches, they are working together to try to ensure that there is one branch open in a locality that people with accounts from different banks can use. These branches will almost by definition bring together customers who can’t use tech. Some of them may want to learn.

Then a local analysis of civil society assets would help.

Over the last two winters local authorities have developed warm rooms for people who can’t afford to heat their homes during the day. These could, for a couple of hours a day, offer some computer assistance for people who need to use the internet for their health or health care.

To underline the point that the NHS are not responsible for overcoming all inequalities. But their new structure does have a legal responsibility to, with others, tackle inequalities in outcomes, experience, and access.

One way I am suggesting that ICSs carry out that role is by working with the full range of local partners to reduce the digital divide. If ICSs tackle the digital divide, they can also meet all three of their other legal duties to, Help the NHS support broader social and economic development. For some people their social and economic development is limited by digital incapacity.

And to return to our original aim of greater use of technology in working with the public to deliver better health and health care, they may then be able to meet their first and second aim to Improve outcomes in population health and health care. And Enhance productivity and value for money.

To recap, it is very difficult to see how, over the next decade, if the NHS is to use technology to improve its interaction with the public to improve health and health care it can succeed if the digital divide continues to exist.

It cannot be the job of the NHS to overcome that divide on its own, but if the NHS is to be sustainable it does need this to happen.

There needs to be a national approach by all pf Government and all the major institutions of society to overcome that divide.

ICSs are well placed as partnership organisations to lead these policies in their sub regional localities.

And to put it negatively if, at the end of the next decade the digital divide remains or is enhanced ICSs will fail in their four aims.

Have a look at the web site of The Good Things Foundation for much more on how to achieve this.