The problem
- 12.6 million people in the UK lack basic digital skills and 5.3 million have never been online before.
- Health inequalities account for well in excess of £5.5 billion in healthcare costs to the NHS annually*, and if the causes remained unaddressed then obesity alone would cost the NHS £5 billion in healthcare costs by the year 2025.
- There is a huge synergy between groups that are digitally excluded, and those at increased risk of poor health.
- As the shift towards digital by default services becomes more widespread throughout health services within the UK there is a danger that the inequalities in health already felt by these groups may become more pronounced.
There is significant crossover between those groups who are digitally excluded and those are risk of poor health, for example there is a clear correlation between the socioeconomic status of a ward and both the levels of basic digital skills of its inhabitants and their average life expectancy, with people in deprived areas tending to be more digitally excluded and in worse health. The shift towards digital by default and digital first means that those who are digitally included can more easily access services that will have positive impacts on their health; be it employment and benefits or health information and services.
The programme
The NHS Widening Digital Participation programme, which ran from September 2013 to March 2016, aimed to improve the digital skills and digital health literacy of groups most affected by health inequalities, by using local community networks to support the use of expert online content.
“This programme is about ensuring – regardless of income, location, age, gender or ethnicity – people can access the support and information they need to improve their health and make informed choices. The fact that those most in need of NHS services are those least likely to have the skills they need to access online services is something that needs to be addressed urgently.”
Tim Kelsey, Former National Director for Patients and Information, NHS England
Co-ordinated by Tinder Foundation, the programme supported people in some of the hardest to reach communities in the UK through a network of local places that offered specialised digital health literacy support. This local delivery meant partners could respond to the need of their individual communities, supported by national coordination of expert online content, best practice sharing and relationship brokering.
Tinder Foundation funded hundreds of hyper-local UK online centres to support their communities to improve their digital health literacy skills. These centres embedded digital health literacy within existing digital skills provision, and formed local partnerships with GPs, CCGs, other health professionals and other organisations to reach people who could benefit from improved digital health literacy skills.
A smaller number of Innovation Pathfinders also tested innovative approaches to embedding digital health literacy within existing provision, testing new technologies and working with new partners.
Tinder Foundation has also created new resources on the Learn My Way learning website to support people to improve digital literacy skills. Two courses – one focused on finding information on NHS Choice and another on using GP services online – helped local organisations to deliver digital health literacy learning, and helped individuals to improve their skills.
The delivery
Tinder Foundation is a charity which makes good things happen through digital technology, ensuring people don’t become socially excluded through a lack of digital skills. We do this by working with the 5,000-strong UK online centres network to support people in communities – as well as hundreds of national partners who help us to amplify our impact.
The UK online centres network is made up of a broad range of different types of organisation, from community centres to churches and arts groups to job clubs. One thing the network has in common is that they all deliver digital skills training in their communities, whether they do it within their centre, through partners or out in the community in outreach locations.
The results
The programme has seen how digital can drive efficiencies for doctors and the wider NHS, relieve pressure on frontline services and deliver flexibility, convenience and control for patients – ultimately improving health outcomes.
Patient activation was identified as key in improving health outcomes, and digital health support was recognised for its potential role in prevention, improving the ongoing management of chronic health conditions, and building patient trust and interaction with health and social care services.
The community-centred, deep dive approach trialled ways for the NHS to work more effectively with voluntary organisations to support broader health goals in local communities. By connecting people to online communication tools, online support networks and information on anything from benefits to hobbies – the programme supported wider wellbeing and began to address the often complex issues behind poor physical and mental health. That in turn had an impact on people’s use of frontline services, giving GPs options for signposting and patients new options for information and assistance.
KEY THEMES AND FINDINGS
Scale and reach
81,049
People were trained to use digital health resources and tools in year 3 of the programme
This builds on the 140,892 from from the first two years of the programme giving a total to date of 221,941 people supported to learn to use digital health resources and tools since the beginning of the project.
152,005
People were reached with messages promote awareness of digital tools and resources that can help them manage their health
This builds on the 235,465 reached from the first two years of the programme, giving a total to date of 387,470 people engaged to raise awareness of digital health resources and tools since the beginning of the project.
3,694
People have been trained in year 3 as digital health champions or volunteers to help promote the awareness and use of digital health resources.
This builds on the 4,444 people trained in the first two years of the programme, bringing the total to 8,138 volunteers trained since the beginning of the programme.
The programme has targeted the most vulnerable patients – the heaviest users of NHS services and those also most likely to be amongst Britain’s 12.6 million digitally excluded. Of the learners which have used the digital health courses or visited the Health page on Learn My Way, Tinder Foundation’s online learning platform:
• 82% fall into at least one category of social exclusion
• 60% are in receipt of benefits
• 44% are disabled
• 34% are unemployed
• 19% are aged 65 or over, and another 21% are aged 55-64
• 16% are from BAME groups.
“I think that this stuff is a very big help for disabled people. I can still get around; I can still drive, but there are a lot of people that can’t and I think that if they could find out about all this information at their fingertips and could use it, it’d make things much better for them.”
Richard Grindon, 69, Learner, Blackpool
Impact on learners
Evaluation data suggests that the programme has had a significant impact on learners’ skills and confidence, with
41%
of those surveyed saying they have learned to access health information online for the first time; a further 32% have learned to do this more effectively
65%
of respondents feeling more informed about their health
59%
of learners feeling more confident using online tools to manage their health
52%
of respondents strongly agreed or agreed that they feel less lonely or isolated and 62% stated that they felt happier as a result of more social contact.
Through the Innovation Pathfinders and other funded UK online centres, the programme has enabled successful approaches to be developed, adapted and tested for engaging with and delivering training to people from particular target audiences, as well as identifying barriers to achieving this, including:
People with dementia
Carers of people with dementia and other unpaid carers
People with learning difficulties or disabilities
Young people (including those at risk of offending).
56%
of learners went on to find information on the internet about health conditions, symptoms or tips for staying healthy
54%
of learners in need of non-urgent medical advice would now go to the internet first, to look at sites like NHS Choices
51%
of learners have used the internet to explore ways to improve mental health and wellbeing (e.g. strategies for managing stress).
“I feel that I can talk to my GP as an equal. I am able to get my point across and we are now managing things together. I feel that I have got some sort of control back and I’m not going to lose that again.”
Anonymous learner, South Tyneside
“Fibromyalgia is a chronic fatigue disorder, and being able to explain that to the kids has been wonderful. We’ve learned about it together. Now ‘Mum’ isn’t just fat and lazy – there’s a reason I’m so tired – and there are ways to deal with it. I’ve done the Learn My Way health course and been on the NHS website and other support sites – and I’ve been able to find tips and strategies to help me cope.”
Marita Sherwood, 34, Bath
“When they told me I could order my prescriptions to get delivered, I thought it was amazing- and I couldn’t believe how easy it was! It means I don’t have to get myself out and about every time I need to top up on my tablets. And if I really need an appointment, I don’t have to wait in queues on the phone.”
Betty Fitzpatrick, 66, Doncaster
Health transactions and impact on health services
The improved skills and confidence that learners gained to access health information online, with support from UK online centres, has led to people turning to the internet as a first port of call, saving expensive calls and visits to acute health services. Doctors prescribing ‘digital skills’ have also seen patients become more proactive about their health and less demanding of frontline services as a result.
After finding information online or using online tools to manage health:
21%
of learners made fewer calls or visits to their GP, with 54% of those saving at least three calls in the past three months and 40% saving at least three visits over the same period
10%
of learners made fewer calls to NHS 111, with 42% of those saving at least three calls in the past three months
6%
of learners made fewer visits to A&E, with 30% of these saving a minimum of 3 visits in the past 3 months.
This behaviour change has resulted in significant cost savings to the NHS.
Our evaluation findings have demonstrated potential annual savings of:
£3.7m in saved GP visits
£2.3m in saved A&E visits.
That’s savings of £6 million in just 12 months.
These savings alone represent a return on investment of £6.40 for every £1 invested in year three of the programme.
“Ultimately, I believe the sustainability of the NHS is not only about increasing Doctors and nurses – or even increasing investment – to my mind it’s also got to be about increasing the capacity of patients. If we can get someone to do things for themselves, take charge of their own health and work in partnership with their Doctor to improve it, we’re actually taking pressure off frontline services and improving the quality of our care at the same time. That’s the real potential for digital health.”
Dr Ollie Hart, Sloan Medical Centre, Sheffield
Delivering digital health training
Successful models for delivering digital health training and engaging learners in year 3 included:
- Embedding digital health within wider digital skills training delivered by UK online centres as part Tinder Foundation’s other funded programmes
- Outreach work in other community settings and in partnership with other organisations including GPs
- Partnership with health and other community organisations, local authorities, housing associations, education providers and charities
- Tailoring approaches around target audiences and understanding the barriers faced by particular groups
- Providing training for health professionals
- Multi-use spaces with integrated facilities, such as GP surgeries on the same site as community services, IT facilities and drop-in sessions for those with particular needs
- Integrating digital health in ESOL provision.
In year 3 of the programme, the Innovation Pathfinders have had a particular in-depth focus on understanding the role, benefits and challenges of:
- Social prescribing and digital health;
- Setting up and using public WiFi in ward and other health settings, for both patients and staff.
“Poor health in our community is compounded by issues such as poverty and housing resulting in severe social impacts. Following the digital skills training in the Edlington Practice surgery, there has been a marked reduction in repeat GP appointment bookings, which shows the impact of taking a more holistic approach to health and wellbeing.”
Leigh Calladine, tutor for digital inclusion & community health co-ordinator, Edlington Hilltop Centre, Edlington
Partnership, sustainability and capacity building
- 29% of UK online centres developed new partnerships with community organisations in year 3 of the project, building on the partnership development achieved in years 1 and 2.
- Partnerships with GP practices and CCGs have been particularly effective, but are difficult to develop in many cases. Other local partnerships and regular, coordinated contact between UK online centres and health professionals have managed to overcome these challenges.
- The majority of centres (57%) funded through the programme now offer digital health training to most/all of the people to whom they deliver basic digital skills training.
- 56% of funded centres state that their digital health provision is now embedded in their service offer and they want to continue supporting people with it in the future as they recognise the need amongst the people with which they work.
“Health is often a conversation starter for our clients. This programme has given the conversation somewhere to go.”
Centre manager, Richmond Annexe, Whitehaven
CASE STUDIES
LOCAL DELIVERY
DOWNLOADS & HISTORY
Download our Widening Digital Participation infographic,
with all the key stats, facts and figures
Download our full research reports
YEAR 1&2
YEAR 3
