Is Access to Services Facilitated by Technology?

Is Digital Service Provision creating greater access or widening the Digital Divide?

I recently needed to see my GP.  Nothing serious or urgent, I had cut my thumb the week before while slicing some lettuce and although it initially started to heal, it was now looking inflamed and had become quite tender.  I didn’t really want to bother my GP, I’m sure she has patients who need her time more than me, but I was concerned that this issue wasn’t going to resolve itself so I looked at my practice’s web site for advice.  At the top of the home page was a banner encouraging patients to contact the practice online for an e-consult.  I entered my details and within a few hours the GP called me back.  She asked me to take a photo of the injury using my phone and, having seen it, advised that I needed a course of antibiotics. 

The introduction of e-consults in GP practices across the country is part of a wider drive for organisations to develop digital access to services, something that was already happening but has been accelerated in response to Covid-19.  For me, as someone who has grown up with technology and seen online services evolve over the past 25 years, the whole process was straightforward and efficient, easier and more convenient than arranging an appointment and attending the practice.   But will everyone, including those less familiar or confident with technology, benefit equally from the digitisation of services?

Increase in Digital Service Uptake

Recently, many organisations have either developed new digital services or encouraged customers to use pre-existing online or app-based platforms to reduce the need for face to face contact and to ease the strain on services such as telephone call centres operating at reduced capacity.  For example, there has been a reported 50% increase in mobile banking use since the start of 2020.  People more familiar with technology and digital services are more likely to be using mobile banking already, so this increase may include many people who were previously reluctant to use or are less experienced interacting with digital services. 

For many people less experienced or confident with technology, the move towards digitisation of services may appear intimidating and overwhelming.  At Link-ages, we spend a significant amount of time talking about technology with older and vulnerable people to develop solutions that work for them.  We have found many apps and online services require a prior knowledge of the language and conventions of technology that ‘digital natives’ will take for granted. 

Risks of Digital Services

Unfortunately, the move towards online services has presented an opportunity for unscrupulous individuals to exploit users’ lack of digital experience, prompting the National Cyber Security Centre to launch a ‘Cyber Aware’ campaign aimed at promoting behaviours to mitigate these threats.  By 21st April 2020, the NCSC had taken down 2000 Covid-19 related scams including 471 fake online shops.  One of the main reasons cited amongst individuals who are digitally excluded for not engaging with digital services is concerns about online safety and, unfortunately, reports such as these will reinforce this belief. Tackling this issue requires education and reassurance.  Organisations such as Friends Against Scams (part of Trading Standards) work to disrupt scams and have produced guidance on what to look out for, both online and in the real world.

Another reason many people give for not engaging with digital services is not seeing the benefit for them – people who have always paid their bills by cheque may be reluctant to switch to digital banking, especially if they are concerned about security, fraud and privacy.  There is a risk that as more services become digital-only, a generation of people are left behind.

Link-ages recommends that family members help relatives with less digital experience build digital confidence by starting with just one app that has a clear and positive benefit to the users.  Messaging, video calling and photo sharing are good example of digital services that provide tangible benefits to those using them.  Once the user has had a positive experience with one app and developed some digital skills, they are far more likely to be willing and able to engage with other services.  Organisations such as AbilityNet and The Digital Champions Network provide practical support to help people to develop digital skills.

Types of Digital Services

The digital services that have been around longest and are most widespread tend to be those that involve processes that can be easily automated and require minimal human input on behalf of the service provider.  The success of online shopping is an obvious example.  Customers search for an item, options are presented, a purchase decision can be made and the item can be paid for and shipped to an address.  But digital services struggle when a decision or judgement is required.  Insurance providers use complex algorithms to determine premiums and these are still based on a series of assumptions.  Similarly, online banking works well for checking a balance, paying a bill or transferring money between accounts but banks have not yet fully automated mortgage applications.

Digital Healthcare

Healthcare services rely heavily on professional judgement and experience.  Decisions about an individual’s care are often made after evaluating information from multiple sources – the patient, diagnostic tests, different specialists or healthcare workers.  Developing digital healthcare services is therefore challenging.

Telemedicine is the practice of medicine using technology to deliver care at a distance.  The concept has existed for over a century but widespread adoption for routine care has been limited by a lack of incentive and issues relating to data security, technological constraints and concerns over medico-legal issues. 

Covid-19 has created an incentive to develop new ways of delivering care, many of which could offer wider benefits long after lockdown.  Despite the NHS’s well documented issues in attempting to modernise and integrate IT infrastructure,  since April 2020, many NHS GP practices have quickly implemented online consultations through their own websites and the NHS app using the eConsult Platform.  As I experienced first-hand, the process starts with the patient filling in an online questionnaire which the GP practice use to assess the most appropriate way to follow up, which could be either an electronic message, a phone or video call or a face-to-face appointment.

There are many situations where healthcare can only be provided in person; for example physical examination, diagnostic tests and surgical interventions can only be provided with the patient present (although remotely performed surgery is in development).  However, the rapid implementation of eConsult has shown that a significant proportion of consultations and review appointments can be completed remotely, and the efficiency savings could allow greater resources to be allocated to those that need face-to-face appointments. 

Similarly, innovative companies such as Living With have developed apps to help remotely monitor a range of long-term health conditions, improving quality of care for patients, allowing medical practices to operate more efficiently and delivering cost saving.  Digital services can also improve psychological well-being.  There are many examples of digital services established since Covid-19 thatt tackle social isolation and loneliness, for example 100% Digital in partnership with Leeds Clinical Commissioning Group are helping to keep older people connected during lockdown. 

The benefits provided by many of these services will be relevant after Covid-19, especially where the digital service offers additional advantages rather than being ‘the same service, but online’.  Social issues such as unequal access to healthcare, loneliness and social isolation were highly prevalent before the pandemic and technology offers another way to tackle them.  This approach will only be successful if the people who would benefit most from these services have the requisite digital skills.  Addressing digital inequality is therefore as important as creation of new digital services.

Digital Services are here to stay

In 2020, many digital services such as online banking are mature, having been around for long enough that the user experience and security have been refined.  Many organisations provide a range of access options so that there is a consistent experience across computers, smartphones and tablets (and, increasingly, other devices) so that people can access services using the devices they already have.  New types of digital access, such as telemedicine, are still evolving as they tackle technological, ethical and legal issues. 

People who have tried digital services as a result of Covid-19 and have had positive experiences are unlikely to want to return to traditional means of accessing services after lockdown has ended.  The convenience of ‘self-service’ – being able to access services at a time and place that is convenient - is a powerful motivator to continue, especially if concerns such as ease of use and safety have been allayed.  My experience of having an e-consult with my GP was easier, quicker and more convenient than the traditional alternative, and while there will be many circumstances that require the patient to be physically present, the benefits of handling a proportion of cases digitally is significant.

There is a risk that in the rush to digitise service provision, people who are less experienced or less confident with technology will miss out on potential benefits or inadvertently be excluded from services.  It is more important than ever that we all provide support and encouragement to friends and family members to help them develop basic digital skills so that everyone can benefit equally.

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