What we don't know about going digital

This trend seems irreversible. Post recovery it seems inevitable that we will at least retain what they are already calling hybrid services, with a mix of actual and virtual contact.

Anecdotal evidence from both service users and professionals is largely positive about the transformation  and there is no question that digital offerings save both time and money.

However the pandemic forced change so rapidly that use of digital tools is being used before their effectiveness has been analysed and innovation is outpacing the  structures organisations have put in place to improve delivery and protect both individuals and organisations. Additionally it necessitates finding means to tackle digital exclusion, and to do that we have to understand that problem better.

These issues need to be resolved and two separate reports have recently been published which help us understand why this is so important and what we should do to address them.

Ironically, as if to prove the point, the bulk of research for both of them was carried out before the pandemic and their authors have had to supplement their findings in the light of subsequent events.

The first is from The King’s Fund which looks at the future for digital technology in Health and Social Care.  

Before pandemic there was a lot of talk about the potential for digital technology to transform health and social care: the experience of Covid-19 saw a rapid acceleration of remote care delivery, digital communications and the use of apps.

And as the health service attempts to claw back on waiting lists and staff shortages it seems inevitable that increasing hybrid and digital services will be an important part of the response.

When pandemic struck there was a shift to remote consultation in primary care – mainly via phone and text rather than video.

The health service in Northern Ireland, as elsewhere, increasingly used its website to disseminate information and to enable online bookings for Covid 19 tests and vaccinations. This was supplemented by the 119 call number.

In addition a number of apps were developed, for example the Stop Covid 19 app for Northern Ireland.

Given that these measures were introduced during an emergency rather than on the back of thorough research, preparation and planning the King’s Fund suggests three areas for examination.

The first is around the digitally excluded. Smartphones were first released in 2007. Today more than  80% of us use them. Aside from those who can’t afford them there are significant age differences around usage: 95 per cent of people aged 16– 24 own one, with rates dropping through older age groups to 51 per cent for people aged 55 and over. It is also worth noting that for many (20% of those aged between 16 and 64 who are semi-skilled, unskilled or unemployed) a smartphone is their only means of getting online.

These variations need to be studied. For example young people may be easier to reach through digital technology than previously. And we know that the difference in digital capability between age groups is closing. But what we don’t yet know is how the shift to digital during the pandemic played out between age groups and between those who access it in different ways, nor is there a shared understanding of its relative cost-effectiveness or a consensus about what needs to be done to help the digitally excluded both now and in the future. Specifically, if we are going to rely on digital technology for health care how can we do so without exacerbating health inequalities?

The debate is likely to throw up further evidence that we need to see online/digital access as a basic utility, just like water and electricity.

Secondly whilst it is self-evident that these technologies enable health care to be delivered more flexibly because of the speed at which it was rolled out we still don’t have evidence on the effect it has on patient outcomes, whether they are better for some conditions, or cohorts of people than others nor do we yet have the detailed cost benefit analysis to allow future planning for expansion with all the implications for hardware, software and training.

Finally we have the issue of trust, not just in whether digital interventions are effective, but also around how potentially valuable data will be used from apps and those health tracking devices which are likely to be more prominent in health care and the digitisation of patient files. We saw concern in England and Wales at how its Covid-19 app was originally going to operate. There will need to be a full, informed public debate about this. Without it and the right levels of reassurance there is a risk of a health “techlash” making progress slow or impossible. Trust is key.

The second report Digital Kind is from the Carnegie Trust. It is an absolute must-read for the Third Sector. Digital Kind is a manual for those organisations which are choosing to use digital technology – and especially useful for those who shifted from face-to-face to digital interaction during the pandemic.

It is primarily intended for organisations which work with children and young people but its principles apply to all. The report states: “The use of technology in services can clearly support wellbeing for individuals through increased participation, social connection and access to resources. But there are also challenges in ensuring there is appropriate infrastructure, guidance, and support in place for organisations to develop effective digital policies and practice and ensure outcomes are improved rather than undermined.

What follows is an exploration of the issues that organisations need to consider in making sure that they are digitally capable and confident, that their staff have the right levels of skills and that, perhaps most important of all they have a clear focus on the ways and whys of delivering services digitally.

It is commonplace if not ubiquitous for the use of digital technology to have outpaced organisations’ policies and processes and it is important for this to be corrected so that policy and day-to-day demands of services are aligned. Otherwise staff can be put in the unacceptable position of having to choose between doing what’s right and what an outdated manual says they should do.

And whilst there are clear benefits to digital because of its speed, flexibility and efficiency it is equally important to make sure they fulfil the organisation’s mission and outcomes. Per the report:  “If organisations can find a bridge between their desire to deliver person-centred practice and the capabilities and the affordances that digital provides, then digital can positively add to meeting outcomes. If not, then a tension may remain that could in some cases undermine an organisation’s mission.”

That’s where kindness comes in – finding ways of ensuring that digital practices enhance rather than reduce human interaction and are measured by the extent to which they do, not just their speed and reach.

All Third Sector organisations are under intense pressure at the moment, but taking some time to study this manual and apply it to their working practices is a must as use of digital increases.

Perhaps funding organisations should also take note and be prepared to step in to support training.