The Darzi review has sparked a conversation about the UK’s historic lack of investment and technological foresight while presenting an aspirational vision for the future. A major shift to digital is on the horizon for the NHS, a change that is eagerly anticipated. Lord Darzi described the NHS as being in the ‘foothills’ of digital transformation, a decade behind where it could have been. This is something I know to be true from my experience working with digital health start-ups through our various digital health and innovation programmes at UCL Global Business School for Health. They are eager to engage with the NHS.
The review also highlights how the UK is chronically lagging behind both the private sector and other OECD countries in its digital health revolution. However, it’s crucial to emphasise that health service investment must be coupled with an investment in digital equity. The urgency of this issue cannot be overstated, as it directly impacts the health outcomes of the UK population.
The transition from acute hospitals to community care will need digital tools to provide quality health services at scale. And at the same time, the public will need to be tooled up. This ’tilt towards technology’ not only empowers practitioners and unlocks productivity; it also holds the potential to motivate all stakeholders in the healthcare system – from patients and carers to whole local communities.
Throughout the review, Lord Darzi rightly labels patient-centred care as the essential component of the NHS going forward. He highlights the voices and communities that are often forgotten and underserved yet are facing the highest disparities when it comes to healthcare access. But the truth is technology has not significantly impacted the lives of those most in need in the UK – in fact, research shows it has not had an impact either way on those in the lowest ranks of our population.
Technology, like all other aspects of healthcare, must be purposefully designed with equity in mind to truly revolutionise our health system. Given the substantial taxpayer funding required to bring the NHS up to speed in digital health and telemedicine, it’s imperative that we also invest in bridging the digital divide in our country.
Just as those in need of our best health services are often the ones with the poorest care, those needing digital services may be excluded due to factors like lack of internet access, difficulties using various devices, and other mental and cognitive impairments.
In the UK, 1.7 million households lack broadband and mobile internet connections, and over 2.4 million individuals cannot even perform simple online tasks such as operating a keyboard. Health disparities include access to technology resources and knowledge. Given the ambition for the future of healthcare, we must address digital equity to address health equity. Otherwise, the tragic paradox could be that as we invest more into digital health, which should help those most in need in rural settings and poorly serviced areas, the disparity worsens in health services.
Wealth inequality is also severe in the UK. The top 5% of the UK population is estimated to have 63% of the country’s wealth, while the bottom 5% has only 0.5%. As the Darzi review rightly points out, this situation is not improving, and the regional disparities worsen in certain pockets of the UK.
These pockets of poverty not only need better health services, but they are the locations where purchasing personal devices and having in-home internet services are few – 7% of UK households have no internet connection, and 9% of UK households struggle to afford broadband. This lack of broadband means that many in rural and remote areas in England lack sufficient connectivity to make video consultations meaningful, which is the essence of telemedicine services. The lack of infrastructure and affordable devices combined with the need to purchase internet services make it a challenge to join the digital economy and health services.
Therefore, if the Government wants to seriously invest in technology to improve healthcare productivity, it also needs to ensure the numbers around care per patient include those living unhealthy lives due to low income, inadequate education, and poor health literacy – problems that are exacerbated by the lack of digital access.
As we look to embrace technology for the NHS, we must ensure we bring all our populations on the journey. Adopting an approach where there are free internet services in low-income neighbourhoods and enhancing digital literacy programmes, especially those around healthy living, could be a price worth paying. It would help ensure that the next decade will bring about a step change in health services by targeting those who are most in need and yet most poorly placed to access care.
Making this digital health revolution accessible requires a recognition that the UK has fallen behind in digitising health, its technological infrastructure, and education across our population. That way, we can correct all parts of the system.
Without this vital adaptation, the ‘digital-front door’– through which NHS users could access support and appointments rapidly – cannot exist.
By Professor Nora Colton, Director of UCL Global Business School for Health
