‘You can talk to a nurse and book your appointment, without leaving Facebook’ – inside NHS Digital’s inclusion drive

Social media training for nurses and tools for people with sensory impairment are among projects from an NHS Digital programme to boost digital inclusion. Gill Hitchcock reports on its progress.

Credit: Christoph Scholz/CC BY-SA 2.0

Across England, nurses in general practice are being trained to use social media to encourage women to come forward for potentially life-saving breast screening.

The model, designed by NHS Digital’s Widening Digital Participation programme, started as a pilot in Stoke on Trent. After training nurses in how to use Facebook to provide information and reduce fear about breast examination, first attendances rose by almost 13%. 

So impressive were the results that NHS Digital is extending the scheme nationally. 

It has been adopted by other cancer-screening services too, and charities have approached NHS Digital about using it.

Nicola Gill, director of Widening Digital Participation at NHS Digital, is proud of the breast screening model. She believes technology has the power to reduce health inequalities and to help the NHS to deliver better services that are more convenient for patients.

“Technology is a way to change traditional approaches where we ask people to come to us and we design and deliver services that don’t necessarily suit their day-to-day needs,” she says.

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Gill’s views chime with those of the World Health Organization. In a two-year review, it saw positive results from sending online reminders to pregnant women to attend antenatal care appointments and, later, prompts to bring their children for vaccinations.

WHO is similarly sanguine about other digital approaches. For instance, decision-support tools to guide health professionals as they provide care, and enabling them to communicate and consult on health issues from across different locations.

Director general of WHO, Tedros Adhanom Ghebreyesus, cautions: “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe and serve the vulnerable.”

‘Serving the vulnerable’
Figures from NHS Digital show that 11.3 million people in the UK lack basic digital skills, and nearly five million do not use digital technology at all. These are likely to be people who are older, live in rural areas, have lower incomes and are in poorer health than the rest of the population.

The NHS Long Term Plan is peppered with references to technology. Significantly, the document commits to ensuring these technologies work for everyone – from the tech-savvy to the most digital-averse. 

Asked about the barriers to digital inclusion, Gill says: “Motivation is a key one, so it’s showing people the value of digital health. Skills too, because some transactions are complicated. For example, to use an app I might have to verify my photograph and attach documents. So, it is making sure that people have all the right skills.

“Then there’s cost and access. Perhaps you don’t have a phone which is internet-enabled, or a laptop or a tablet and it’s about getting access to devices and WiFi. For some people, it’s language, perhaps where English is not your first language. And for some people it’s cultural, they just don’t go online. Our approach is to carry out research and use data to identify where the greatest need is and to better understand the challenges and needs of patients, citizens and NHS staff.”

The programme’s experiences and insights are shared with commissioning groups, local authorities and community groups. The aim is to build inclusion into all digital services across the NHS.

To date, it has established 20 year-long digital inclusion pathfinders, 13 of which are up and running. 

They include a model in Yorkshire to help people with hearing and sight loss to access GP services more easily. Online appointment booking, tools which convert speech to text or text to speech, an app which turns a mobile phone into a hearing aid are part of this.

To build on this, Gill and her colleagues need to present to clinical commissioners and local digital teams. They have created a digital inclusion module as part of the NHS Digital Academy, a virtual organisation to develop a new generation of digital leaders in the health service. 

And there are ‘how to’ guides and resources to help digital health commissioners, designers and service delivery teams to ensure they are providing inclusive services. 

The programme has learned a lot from its failures too. 

“Technology is a way to change traditional approaches where we ask people to come to us and we design and deliver services that don’t necessarily suit their day-to-day needs”
Nicola Gill, NHS Digital

For instance, a lot of the pilot projects were delivered at a local level and needed one person to keep them on track. Although NHS Digital provided support and checked in regularly, some of the pilots lacked local ownership because of staff changes or posts being lost.

Sometimes things were too complex. Gill has learned that interventions have to be simple, to fit in with people’s everyday lives and, where possible, use tech that already works well.

“I think the breast screening model is a good example of going to where people already are and using tools they already have,” she says. “Without ever having to leave Facebook, they could ask a question of the nurse through a direct message and get an appointment booked there and then. The obvious success rate contrasts with a national decline of 10% each year. So that has been fantastic.”

Two days each week, Gill is working with NHSX on the next phase of the programme: to embed digital inclusion in all online NHS services. 

“We have got all the learning, the toolkits and we know what works, and now we need to hand that on at a local level.”


Sam Trendall

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