Digital technologies have already offered a significant shift in how health and care services are being delivered. Whether it’s virtual wards enabling people to get ‘hospital care’ at home, on-line consultations, or one-click prescription ordering, digital health services offer convenience and efficiency for those who are able to use them as well as for those delivering them.
Beyond what is immediately publicly visible, digital technologies are bringing a wide range of emergent possibilities from care coordination to diverse training opportunities to enhanced diagnostics. They also bring more ‘behind-the-scenes’ benefits, as tech-driven data insights take us beyond surface-level data into sophisticated modelling of needs and health-related practices of specific patient groups. As such, they throw up the promise of a thoroughly modernised healthcare system, built better by being built closer to the people it serves.
Overall, while recognising that technology isn’t the panacea for every healthcare challenge, it does seem to be laying down real opportunities for tackling some of the system’s knotty problems, including the perennial conundrum of how to respond effectively to health inequalities.
The government has clearly set out its stall on the matter, with Lord Darzi’s ‘tilt towards technology’ signalling a route to modernisation of the health and care system that is lain down in the government’s touted ‘shift’ from analogue to digital. And insofar as the zeitgeist is all about tech, albeit not without controversy, there is some level of acceptance in extending its benefits to healthcare if, for example, the popular response to recent announcements on testing AI use in breast cancer screening can be seen as any kind of benchmark. But if the real potential of digital technologies is to be fulfilled, public acceptance needs to reach a level where the use of digital tools and willingness for data sharing is widespread.
Public acceptance will only happen if services are trusted and inclusive which, in turn, is made possible by putting people at the heart of the design process in digital services. Recent research from The King’s Fund has identified various strategies centred on meaningful engagement and addressing power imbalances that those designing digital services can undertake to make coproduction effective. It is important that providers have the flexibility to tailor activities to locally specific patient need and responsive services, but there is much that leadership at integrated care systems (ICSs) and national scale can do to facilitate this sort of work. This includes:
- Support and incentivise organisational prioritisation of coproduction: Healthcare providers need resource and guidance to develop the appropriate skillset for coproduction across their staff teams, and the flexibility in their service provision to prioritise participation in public engagement and inculcate that within delivery teams. This sort of shift in organisational culture requires resource, guidance and commitment on the direction from across the whole system: commissioners, ICS leadership, NHS England and the Department of Health and Social Care.
- Foster conditions that make meaningful engagement business-as-usual: ICSs can actively encourage provider organisations to engage meaningfully on projects with local communities, from the outset and drawing on existing local insight. They can support efficacy in provider engagement with communities via data-led identification of demographics, community groups, and which services and tools to focus on. Local professional networks are vital spaces for sharing best practice and existing insights. By developing or supporting existing networks, ICSs can set an intention as well as space for collaboration and information sharing.
- Make sufficient resource available: None of this work will proceed unless resource is made available. There are ways in which providers can maintain good engagement despite working within a constrained system, but ICS and national leadership can support this by protecting public engagement budgets and building public engagement into procurement and commissioning exercises.
- Look to the future: It is vital that national leadership take action to stay on top of developing technologies and their potential to support healthcare services. Marketing and consumer insight approaches could provide fertile ground, with their ongoing innovation in tech-focused service improvements, analysis tools and workforce requirements. And to ensure sustainability, national leadership could mandate an ethos of using patient and public voice to improve data insights within its own programmes and initiatives, as well as fostering a culture of sharing best practice
The rationale behind these multiscale – national, ICS, and provider – expectations is that it takes a whole systems approach to embed genuine coproduction in digital healthcare service design practices.
ICSs need to be looking to what they can do to support provider organisations, but also what they can realistically expect from them. And, in turn, national leaders need to think about how they can establish conditions that support and incentivise ICSs to incorporate coproduction in their strategic approach, while also giving room for the flexibility necessary to accommodate local variability. If each part of the system plays its part, we could see a modernised system that really works for patients, staff and providers, with better care woven into the efficiencies that digital services promise.
At one level, digital healthcare services should not be exceptionalised. Essentially, the principles of coproduction are the same here as they are for all healthcare services, and the recommendations are simply a reflection on system working in a moment when the importance of patient voice is being recognised.
However, the capacity for digital in/exclusion to challenge or exacerbate existing patterns of health inequalities does mean that systems would do well to attend to the patient-centredness of their digital service provision as a priority.
Cheryl Gowar is a researcher at The King’s Fund and co-author of Designing inclusive and trusted digital health services with people and communities
