Experts from the University of Sussex and NHS Sussex, supported by the Kent Surrey Sussex Academic Science Network, have developed a framework to help improve access to digital health and care services, for those who need it the most.

The brand new framework – which is designed to be used by health and care commissioners, service leads, and digital teams – explores and aims to remove the barriers people often face when trying to access digital health and care services, due to digital exclusion. 

Research into digital exclusion shows that there are links between those more likely to be digitally excluded and those more at risk of health inequalities.

Digital exclusion impacts significant parts of the population and occurs when a person is unable to access or use digital products that they need to use for everyday life including for health and care. Research has shown that ten million people are at risk of digital exclusion as they lack skills needed for a digital world. Everyone is at risk of digital exclusion over the course of their life; this includes people who are older, disabled, in worse health, poorer, in less stable housing, and less well educated (Digit 2022).          

The new framework recommends how future and current digital health and care services might be designed to break down those barriers and reduce the risk of exclusion.

Prof Debbie Keeling, Professor of Marketing in the University of Sussex Business School, explains: 

“The framework emerged from years of research involving service users, carers and professionals that recognised the need to understand the diverse and complex nature of digital inclusion and exclusion. As digital health and care has rapidly expanded, the need to understand and mitigate against digital exclusion and associated health inequalities across all health and care settings became a priority. With the experience and expertise of this collaboration across academia, health and care partners, and public representatives, we are pleased to be raising awareness of the barriers people can face when accessing digital health and care, and to work with NHS Sussex to mitigate potential health inequalities.’’

Dr Maja Golf Papez, Lecturer in Marketing in the University of Sussex Business School, says: 

“This is a framework that can be used as a thinking tool that can help us to better understand what some of the potential barriers in health care technologies are. We can use this framework to both ensure that we are designing digital health and care pathways in an inclusive way and also assess current pathways to understand if they are inclusive or not.” 

Lisa Emery, Chief Transformation Innovation and Digital Officer, NHS Sussex says:

‘’Digital inclusion is a very complex challenge, and this framework draws on insights from stakeholders from across Sussex including health and care, digital teams, the public, and academia. The inclusion of the implementation tools including the assessment tool, will enable us to apply this framework to new and existing digitally enabled programmes, services and pathways. The assessment tool will be used alongside other impact assessments we undertake for any new project or programme of work and help us mitigate digital exclusion’’

Katherine Sykes, Implementation Lead at the Kent Surrey Sussex Academic Health Science Network says:

‘’Digital health and care has the potential to not only empower people to manage their health and care better, but also improve clinical outcomes, effectiveness and efficiency across the health and social care system. However, the introduction of digital health solutions risks excluding the most vulnerable and highest need populations and worsening health inequalities. Digital inclusion is essential if the NHS is to deliver high quality health and care to all its population by ensuring equitable access, excellent experience, and optimal outcomes. Importantly, this framework and associated implementation tools seek to support the delivery of high quality digitally enabled health and care by mitigating digital exclusion.’’

Research into digital exclusion shows that there are correlations between the populations more likely to be digitally excluded and those more at risk of health inequalities: people who are older, disabled, in worse health, poorer, in less stable housing, and less well educated are most likely to be digitally excluded (Digit 2022). Significant parts of the population are not able to benefit from the opportunities digital provides or are struggling to do so. We know that: 

• an estimated ten million adults in the UK are at risk of digital exclusion 
• one in five adults do not have the digital skills needed for everyday life 
• over one in 20 households do not have Wi-Fi- either fixed line or mobile 
• over two million households struggled with the cost of internet in 2021, a situation that may increase with the cost of living crisis 
• a predicted 4.5 million people (eight percent) of the population will remain digitally disengaged in 2030.   

Prof Debbie Keeling, Professor of Marketing, Dr Maja Golf Papez , Lecturer in Marketing, have led on the research element of the framework in collaboration with Jessica Hadjis van Thiel, Dr Ralitsa Hiteva and Nora Davies from the University of Sussex. Katherine Sykes, Implementation lead, KSSAHSN led on the health and care elements, including the application of relevant research and policy for health and care, and ensuring key stakeholder involvement in the development of the framework. Stakeholders from across NHS Sussex were actively involved in the development of the framework through various workshops, consultation, and public engagement.