The Labour Government’s latest eye-catching policy for healthcare is for the NHS App to be the “default route” for accessing key services. GP appointments, medications, information about conditions and providers, even details of the nearest pharmacy will be included. A target was set for 85 per cent of acute NHS Trusts to enable their patients to view appointment information in the app by the end of March this year.
There are significant numbers of people who are either not online or who struggle using internet devices and systems
Yet what patients are we forgetting? This is taking place in a country where there are significant numbers of people who are either not online or who struggle using internet devices and systems. Indeed, 6 per cent of UK homes do not have internet access and a third of people aged over 75 lack basic digital skills. In another study it was found that approximately 2 million people over 65 do not use the internet. Nevertheless, the Health Secretary, Wes Streeting, has claimed that the NHS App will revolutionise the management of healthcare in a manner akin to how people order food on Deliveroo, and will be “as convenient as doing our shopping or banking online.”
It is claimed that the policy will “democratise” healthcare and of course, “tackle health inequalities.” Yet in the context of this policy that hinges on the assumption of being digitally connected, further statistics show that in the 20 per cent most deprived areas of England only 52 per cent of older people use the internet every day compared with 80 per cent of people living within the least deprived ones. Despite the government’s claims, Labour’s supposed natural constituency are therefore likely to be the most adversely affected by the “digital by default” approach. While the NHS App can be accessed via a computer, its use requires a level of digital proficiency that could involve large numbers needing assistance just to set it up. A further survey from the National Pensioners Convention showed that not only were 25 to 30 per cent of members not online, another 30 to 40 per cent would have trouble navigating the online consultation or patient records. In answer to concerns raised by Liberal Democrat health spokesperson Helen Morgan about the threat of digital barriers to healthcare for older people, Streeting glibly replied that app-based NHS care would “free up” the GP telephone line thus maintaining “choice” for those not wanting or able to live their lives through a device.
Another recent policy development is the Government’s requirement that all GP surgeries are to keep their digital booking appointment services open throughout the day. In many cases, this could indeed be an improvement on the existing situation in that the slow-fingered are given more of a chance to book appointments as opposed to only having a small window of opportunity presenting itself for a few minutes at 8am. Certain needs such as medication advice and follow-ups may not require face to face appointments and can be done digitally, with doctors able to prioritise care with the use of online forms. Email and phone consultations can obviously work in specific cases.
The urgent question, however, is whether traditional offline methods will be affected or disadvantaged. Even if kept open throughout the day, digital appointment systems will by definition favour the digitally proficient over the less confident, let alone those who cannot use devices or who have no access to one in the first place. The effectiveness of non-face to face consultations through online portals, emails or even telephone consultations will also depend greatly on the competence of those forced to present their problems in such a way, particularly given possible cognitive decline, visual impairment or digital anxiety. In some cases, digital appointment systems have led to long queues leading out of the GP’s door due to the inability of patients to manage them. Surely there is no adequate substitute, for the vulnerable and confused as well as the diffident, to being seen face to face where GPs can actually see for themselves what is wrong. Or is such an obstinately human and straightforward method to be regarded as otiose in today’s digital-first culture? Given the threat of misdiagnosis due to digital triage that lacks human oversight, as well as of simply not being seen at all, this increasing state of affairs cannot be regarded as constituting a civilised society. Instead, the situation is more akin to a mass of atomised human units ruthlessly divided by their degree of digital proficiency as to whether they receive life-saving treatment or not.
A similar predicament presents itself with the Government’s other digital wheeze, namely that of Digital ID, without which an individual will not be entitled to work in the UK. The plan is for it to be rolled out by the end of this Parliament, with the benefits of Digital ID extending beyond being mandatory for work but also for greater ease in claiming benefits, the paying of rent as well as applying for free childcare. There has been no public information as to what kind of alternative non-digital form of identification would be offered. Not only would Digital ID make life difficult for the elderly, but it would also impact vulnerable adults of all ages, of whom there are estimated to be 8.5 million, who struggle with reading and writing and who are therefore unlikely to thrive within a digital-based society.
Strikingly little is said about the risks the digital world poses to vulnerable people in terms of accessing care that they depend upon for life itself. This has led key figures such as Catia Nicodemo, a Professor of Health Economics to stress that the health risks of “digital by default” for large swathes of the elderly and disadvantaged population mean that in-person and telephone services must remain accessible and widely available for the foreseeable future. Furthermore, Caroline Abrams of Age UK has spearheaded a campaign to mandate non-digital alternatives being made available in order for all members of the public to access vital public services to which they are legally entitled. Classes to improve “digital literacy” for elderly people in libraries and community centres may offer a pragmatic solution but the reality is that there will always be those who fall through the cracks.
It feels like a state that leaves certain sections of the population behind
Reliance on digital technology, particularly in the form of smartphones, has encroached so rapidly on people’s lives that they increasingly appear to have little memory of having lived in any other way. It seems to have resulted in a corresponding loss of empathy within our culture. Inevitably the digitally proficient, who may well include many over 75 who are relaxed about spending their lives wedded to a smartphone, will increasingly view the non-smartphone user with the same degree of condescension and incomprehension as younger people who have never known anything else. Darren Jones, who is leading the Digital ID cards policy as Chief Secretary to the Prime Minister, claims it will be “the bedrock of the modern state.” Yet it feels like a state that leaves certain sections of the population behind.
The Government asserts that the NHS App will end the previous “one size fits all” approach that it claims missed the distinct needs of women and ethnic minorities. Yet in supremely ironic fashion it is imposing that very condition on the elderly, the vulnerable and those who simply do not want to live their lives tethered by digital command. Talk about marginalisation.
