Digital First, Not Digital Only: Health Inclusion

Digital first, not digital only. What a room full of practitioners taught us about digital inclusion

At One HealthTech's recent Digital Poverty: When Access Isn't Equal event, in partnership with Leeds Community Healthcare, practitioners, clinicians and people working directly with communities came together to talk honestly about who gets left behind when services move online. Aire Logic was proud to support the evening, which our PR and Marketing Director Emma Raftery-Kenworthy joined as a panellist. The conversation was frank and full of the kind of insight that only comes from people who spend their days alongside those most affected. Here is what stood out to us.

The panel brought together Adele Bunch, Head of Portfolio at Health Innovation Yorkshire and Humber, Amanda Jackson, Associate Chief Clinical Information Officer at Leeds Community Healthcare NHS Trust, Ian McArdle, Senior Digital Inclusion Officer on the 100% Digital Leeds programme at Leeds City Council and NHS West Yorkshire ICB, Hannah Farthing, Health Equity and Learning Disability Improvement Manager at Leeds Community Healthcare NHS Trust, and our own Emma Raftery-Kenworthy.

One of the clearest messages from the room was that a lack of kit is almost never the whole story. Someone can have the best possible equipment and a project can still fail them if they cannot get online at the moment that matters.

A tobacco dependency team shared a telling example. They had rolled out a stop smoking app across twelve trusts in their region, and it had gone well. But there were moments when advisors stood in a hospital trying to install the app on someone's phone, only to find the hospital Wi-Fi was too poor and the person had no mobile data of their own. Those people, unable to download the app there and then, disengaged from the programme entirely.

That story captures something important. The barrier was not motivation or skills. It was a small, practical gap at exactly the wrong moment, and it was enough to lose someone.

The barriers are interlinked, and they are human

Several panellists pushed back on the idea that digital exclusion is a neat, standalone problem. It sits inside people's wider lives, tangled up with material poverty, debt, safety, language and trust.

Ian McArdle, whose team works across Leeds to strengthen digital inclusion in communities, put it plainly. When someone is worried about their safety, about their children, or about having their windows put through, downloading a health app sits right at the bottom of their list. The route in is not to lead with the app. It’s to understand the whole person first, sort out the most pressing problems, and let the conversation about health arrive naturally further down the line.

Cultural barriers came up too. The panel heard that some women from ethnic minority backgrounds are not allowed access to a phone at all, or only at certain times. Others raised sensory and cognitive impairments, health literacy, the cost of data and a very reasonable fear of being scammed. When you have received suspicious links and messages before, being asked to click one more is not a small ask.

Exclusion inside the workforce, not just among patients

A theme that does not get enough attention is digital poverty within the NHS itself. Staff enter healthcare as a calling, not because they are technologists and yet every few years they may be handed a new electronic patient record system, or a stream of software changes and internal notes, with little or no training. They are expected to use it straight away.

The knock-on effects are real. Admin time goes up, which means less time with patients. Staff who are not confident with the tools may not fully understand things like the NHS App, or the stop smoking apps they could be signposting. If we assume digital poverty only affects patients, we fail to give the workforce the knowledge and confidence they need to spot exclusion and help close the gap.

When products are built for the people in the room

Perhaps the sharpest challenge, from Emma, was aimed at how products get designed in the first place. Too often a target audience is considered at the very start and then quietly forgotten. There are no focus groups, no proper research, no follow through, and when the product evolves it is shaped by people in a room who may never use it themselves.

One example landed hard. A woman had tracked a pregnancy in a mainstream health app, then experienced a very early miscarriage. There was no way to record a pregnancy ending, so the only option available pushed her straight into a postpartum pathway, serving up advice on postpartum bleeding and breastfeeding. For someone who has just lost a pregnancy, that is a distressing failure of design. If a company of that scale can miss it, what hope do smaller startups have? The question the room kept returning to was simple. Why are these questions not being asked at the start.

What needs to change

The panel didn’t just diagnose the problem. They were clear about what good looks like.

Build inclusion in from the beginning rather than bolting it on. Bring in voices different from your own and test with real people much sooner. Co-design with the communities who struggle most, going to where they are rather than asking them to come to you, and doing it with them rather than presenting something finished.

Hold on to the principle, as Hannah Farthing summed up. as ‘digital first, but not digital only’. High quality alternatives, whether that is face to face, phone or paper, should always exist for people who need them. As Ian noted, even reaching so called full digital inclusion would not mean much if people still could not use technology to build better health, work, learning or social connection in their lives. The point is what actually makes a difference.

And finally, personal responsibility. Look around your next meeting and ask who is there and who is missing. Think about who grew up without a computer at home, or who struggles with the bus fare to get to work. If the room looks too much like you, ask what you can change, whether that is apprenticeships, work experience or hiring from different backgrounds.

Plenty of people say this is what we need to do. Not enough say this is what I am going to do. That, more than any single piece of technology, is where change begins.