Our project was about ensuring that digital innovation in the NHS serves all residents in Hackney. We wanted to develop an approach to digital transformation that proactively considers and addresses digital and health inequalities. We set out to:

• Understand how residents have experienced the increasing digitisation of NHS services, and to co-develop ideas for what great digital support in the NHS would look like.
• Understand digital literacy and confidence amongst our workforce, to identify priorities for training and support around digital systems.
• Develop a digital inclusion toolkit, with resources and processes to support services to consider digital inequalities when they introduce new digital patient-facing systems.

A few lessons from our work so far:

1. Add your local flavour to existing frameworks for digital inclusion: The barriers that prevent people from accessing and using digital systems are well understood (and I’d be really happy to share my digital inclusion reading list!). It is how these barriers play out and which are most significant that will vary between different individuals and communities. Build from others’ research and speak with local residents and community groups to see how these ideas resonate with people.
2. Lead with digital inclusion as an enabler (rather than digital exclusion as a barrier): when getting colleagues and partners on board, start with the benefits that come from helping more people to access digital systems, rather than the costs of digital exclusion. By ensuring that everyone who can and wants to is using digital systems, we maximise the benefits and savings, freeing up time and resource for those who really need it.
3. Centre patient-voice in digital services: ultimately, if you have good systems in place for involving service users (including people who are digitally excluded) in the planning, design and implementation of a digital system – truly understanding their experience and iterating your approach based on feedback – you will have services that are more inclusive and accessible, you will build trust with service users, and you will avoid excluding people or exacerbating inequalities.
4. People’s digital lives extend beyond the NHS: Remember that people’s experiences with digital services and technology start and end beyond the NHS. What they want help with, and where they want to get that help might not sit within your remit as an NHS organisation – can you build relationships with support services in the community or within the local authority? If there is a gap in provision, can you advocate and secure additional funding together with partners?

What next?

We’re out of the research phase and into piloting new ideas. We will continue to share learning and resources here over the next few weeks and months. If you want to compare notes, discuss any of these ideas, or if you’d like us to come and share some learning with you and your team, please get in touch! Madeleine.Maxwell@nhs.net

Hi Q Community! My name is Madeleine Maxwell. I joined Homerton Healthcare last week as Digital Inequalities Project Manager. I wanted to use this update to share a bit about me, and some information about the project.

My background is in patient and public involvement, social research, and design in healthcare. I’ve worked in research groups and consultancies, working closely with multidisciplinary teams: professionals and practitioners, and lived experience experts. I’ve worked with lots of different NHS organisations, as well as local government and voluntary and community sector organisations. I’ve had a really warm welcome from Annabelle and others on the team, and I’m really excited to take this important work forwards.

We are thinking about this project in 4 main phases:

Phase 1: Scoping and problem definition
Phase 2: Discovery
Phase 3: Co-design and piloting
Phase 4: Sustainability planning and dissemination
In this first phase, I’ll be getting on top of existing data and insight about digital inequalities in City and Hackney, and speaking with key stakeholders from across the system. The main aim at this point is to build our understanding and test some of the assumptions we have around where the big problems, and which communities are most affected. This will help us to identify a clear focus for the rest of the project. Once we have decided on where we’re going to focus, the second phase will be about going deep – understanding the specific challenges from different perspectives through a combination of different research and co-production activities. We also want to ensure we’re building on previous successes and learning from across North East London and beyond, so we’ll conduct asset-mapping around our specific focus area. We’ll then be in a good position to co-design and pilot specific change ideas in the third phase, through a series of Plan Do Study Act cycles. The fourth phase will be about developing a plan for the sustainability of successful change ideas, including through seeking additional funding. We will also aim to share learning and the planned/recommended next steps in an accessible and engaging way.

The following are some of the principles informing our approach:

Collaboration (bring different stakeholders together)
Learn in the open (share learning and seek input and feedback)
Asset-based (build on others’ successes and learning)
Depth over breadth (start small and learn fast)
Co-production (involve people with lived experience)
Sustainability (proactively seek opportunities to extend impact)
We will update this community regularly to you can see what we’re learning, and where we end up focusing, but if anyone would like to have a conversation in this early phase, please do get in touch! madeleine.maxwell@nhs.net

Great news! We have now appointed to this post and very excited to have found someone with enthusiasm, skills and experience to help us take this project forward.

We are a bit behind on our stated milestones as recruitment processes took longer than we anticipated but we are laying the ground work to get started on our scoping and engagement phase in the next couple of months.

We used the recruitment process itself as a way of sharing information about the project across our system and engaging with key stakeholders. Our interview panel consisted of members of the QI team, a representative from the Council’s Learning and Development Team (who has a particular responsibility for digital work), and clinical and managerial staff.

Listening to the answers candidates gave to our interview questions and discussing and connecting as a panel has been a really useful experience. I particularly liked this question:

“Many staff tired and busy with many competing priorities. How would you enthuse and inspire others to think about digital exclusion and get involved in this project?”

Candidates were able to demonstrate their own passion and enthusiasm for the area of digital exclusions, as well as their understanding of the barriers to engagement that we anticipate facing once our project has started properly.

We are continuing to share information about the project and build anticipation about what we can achieve. The Q Exchange funding is going to be invaluable in moving the project forward and having a dedicated person in post with time and focus will really start to make an impact.

Our job is out to advert

Current vacancies | Homerton Healthcare NHS Foundation Trust

Full time band 6 project manager position – flexible working considered. Please get in touch!

Examples of Good Practice to Build On

One of our teams has already started working closely with Primary Care to trial some innovative ways to combat digital inequality. We’re looking forward to building on this good practice as our project develops.

FCPs find innovative ways to tackle patient demand | The Chartered Society of Physiotherapy (csp.org.uk) 

Partner Engagement

We are really keen to use this role as a connector and coordinator of the work that is going on across our place-based partnership. There is much going on to support and think about digital inequalities in many different places across the borough. This includes the council’s adult learning team, the public health team, libraries, a host of voluntary sector initiatives, the council’s resident engagement team, tenants associations and others.

We’ve having some connection and engagement meetings to tell people about the project. On the request of some colleagues, I’ve written this summary document so that they can share it with others they think might be interested. We’re generating general enthusiasm but next step is to formalise this into a structure for governance to steer and guide the project going forwards.

We want to try to embody from the start our the best practice principles of quality improvement methods, good use of data and learning and user involvement.

I’d appreciate any thoughts and ideas on models to use or ways of working so we can structure our project journey right from the beginning.

digital innovation is for everyone – summary doc July 2022