The King's Fund held a webinar at the end of February about designing digitally-enabled health and care services to be inclusive and trusted, which came on the back of a policy brief on the topic.

The UK is seeing many benefits from digitally-enabled health services and receiving new digital treatments, but these services ‘are not used or usable by everyone', according to Pritesh Mistry, fellow of digital technologies at The King's Fund.

Research published by The King's Fund in 2023 found that there are fundamental barriers to digital inclusion - devices, connectivity, data and the user skills and confidence. However, it's not only these barriers that are important. 

Mistry told delegates: ‘People still find themselves digitally excluded because of how service and tools are designed and developed. Largely, the reason for this is because people are not often engaged with how services are being developed and designed. A lot of assumptions are being brought into that process, or incorrect decisions that make services hard to use. So there's a real need to work with people and communities to develop inclusive and trusted, digitally-enabled services.'

In addition, The King's Fund highlights that engagement has to be meaningful, which means reaching out to a broad range of people, and beyond who you may usually talk to. 

‘It's really important that these kinds of mechanisms don't become checking off predetermined decisions,' said Mistry. ‘It's really important that they are flexible, and you listen to people to it and make changes. It's also important to take inclusive and flexible methods, combining in-person digital methods such as messaging or online meetings.'

He said it is also important to balance power dynamics, as there can be different groups of people with different levels of experience and confidence and willingness to contribute, and that confidence and willingness can vary by who else is in the room, as well as where and how you engage. 

Mistry added: ‘Engaging outside of NHS sites, where people are most confident in a community setting, can give more power to people that you're engaging with. Using neutral facilitators can help to keep all voices balanced. Or alternatively, consider engaging with different groups to keep people's voices as representative as possible.'

He told the webinar that staff also need support. ‘If staff are not prepared or supported, the engagement happens poorly or it doesn't happen at all.' 

In addition, Mistry said there is also an important role for leadership of providers and systems, as well as national leadership.

He said: ‘We think that there's a need to invest in staff having the right skills and leaders need to protect tech budgets. Often what we find is the tech budgets get raided, and the support around the technology can be eroded. So there's a real need to protect tech budgets and allocate a portion of that.'

There needs to be an expansion of who supports engagement, Mistry said, this can be frontline staff and should involve engagement with frontline staff but also thinking broader than just procurement staff to ensure that engagement becomes a core expectation when tools and services are procured or commissioned. 

He said: ‘We see that there's huge potential for improvement in digital services through the richness of the data. That richness of data can give sophisticated insights for how people's behaviours and needs are changing and what they what they expect and how they are behaving around accessing, trying to access services.' 

The webinar also heard from Mary Hill, head of policy for healthcare inequalities improvement at NHS England, she said: ‘I think absolutely, co-design, co-production, how we engage with people in communities, is going to be incredibly important within the 10-Year Plan.

‘I think there are a number of opportunities there and policy levers to ensure it is really meaningful, but I'll stop there.'