Pandemic prompts inclusive digital health solutions that will outlast the COVID-19 crisis

The world’s largely analogue healthcare systems are “ill-equipped” to cope with a pandemic like the one we are currently experiencing, says a recent article published in the New England Journal of Medicine.

The arrival of COVID-19 has focused our attention on expanding alternate forms of healthcare, and the quickest and most logical solutions tend to be digital.

“If we don’t get this right, there’s a risk that health inequalities are widened” — Leigh Mortimer

However, as senior product manager for the UK’s National Health Service (NHS) Digital Leigh Mortimer tells The Sociable, shifting this sector to the virtual world also has the potential to segregate groups whose access to technology is limited.

For the NHS, these groups include those with auditory, visual, cognitive, neurological, physical or speech impairments, and people who lack access to the internet, smartphones or computers, or those who lack the skills or confidence to use them, such as the disadvantaged, elderly, or homeless.

According to UK charity Good Things Foundation, approximately 11.9 million people in the UK do not have the full essential digital skills they need to make the most of the health service.

And the stakes are high, Mortimer said, explaining the importance of digital inclusion for the NHS.

“If we don’t get this right, there’s a risk that health inequalities are widened,” he pointed out.

All of this is part of a focus on digital inclusion, a term that Mortimer defines as making sure everybody has access to the skills and means to get online if they want to.

Digital inclusion at NHS Digital

Although the pandemic has prompted the NHS to take a retrospective look at its policies on digital inclusion and re-evaluate its focus on digital health solutions, this is not a new priority.

Over the past three years, the NHS has been working with Good Things Foundation’s digital health lab to run 22 digital inclusion testbed pilot projects across the UK, which are designed to find ways to improve participation for everybody.

These include testing digital health services for young carers, the homeless and those with insecure housing, those with dementia and for those who live in government-funded social housing.

“You might have the best idea in the world, but unless you test it with someone who’s going to be using it you don’t really know whether it works or not,” Mortimer claimed.

Besides this, NHS Digital has made notable advances in digital inclusion over the last 12-18 months, Mortimer explained. At the beginning of 2020, the service opened up a lab to test out the accessibility of its product design.

Although the lab is temporarily closed due to the pandemic, its aim is to enable NHS Digital teams to test what they are designing using assistive technologies, such as screen readers or magnifiers on smartphones with built-in accessibility functions.

The lab also offers tools such as goggles to simulate visual impairments to ensure digital access for these groups in light of the challenges they face.

Room for improvement

While the NHS website, which is over a decade old, is currently being audited to make sure it meets the inclusion and accessibility standards required by the 2018 Public Sector Bodies Regulations and 2010 Equality act, Mortimer admits that there is more to be done.

While all NHS audiovisual content has subtitles or captions, the digital team is also working on providing transcripts as well as provisions for British Sign Language, for those with  auditory impairments, in the future.

“There are things that could be better,” Mortimer added, explaining that some of the older legacy-style content on the website — which brings in over 50 million visits a month — contains lots of PDF files, which are not accessible to all users.

Under time pressure and given the current COVID-19 restrictions in the UK though, he said, the team can only make a limited amount of progress.

A digitally inclusive mindset

While analogue services remain a crucial part of the NHS, and each digital service will always require a non-digital equivalent, the pandemic has revealed that digital healthcare is simply essential.

“Through this pandemic, we’ve seen the impact that digital services can have,” said Mortimer.

And the irony is that groups that are traditionally most likely to have unequal access to these services, such as the elderly, for example, are also the ones being the hardest hit by the COVID-19 pandemic.

In the UK, the majority of COVID-19 related deaths — 45,812 deaths out of a total 51,264 at the time of writing — have been among people aged 65 and over.

For Mortimer, there is a valuable lesson that the NHS can learn from the pandemic.

“I think historically, people tend to think about [digital inclusion and accessibility] towards the end, but we’re trying to embed it across NHS Digital that we’ve got to start thinking about these things from the outset,” he said.

Now more than ever, he says, it’s important to foster a mindset of making sure each and every user — whether they are public or NHS staff — can access each digital service equally before the team even starts working on projects.

So while the pandemic has prompted Mortimer and his team to go back and fix issues that have existed for years, it’s also provided them with a renewed, lasting focus to avoid them moving forward.