The increasing use of virtual consultations is likely to widen the gap between people who are familiar with technology and those who are not. This will lead to ‘digital exclusion’ and inequalities in accessing care.
The practitioners we spoke to identified a need for improving digital skills and access to technology for patients and also for themselves, so we've pulled together some guidance for both practitioners and patients to help address the problem.
Choice of type of appointment is important
Some people will find it easier to access and use technology than others; it is not just older people that may struggle, but also people who cannot afford the technology, people living in rural areas who might have problems with their internet connection, and people with fewer qualifications. People with a disability are also less likely to be online (Office for National Statistics 2019 ‘Exploring the UK’s Digital Divide’) Other people may simply choose not to use technology.
Use of technology is great for some families, but for those more vulnerable or with fewer resources it can put them at a disadvantage
Physiotherapist, Neurology
While support with accessing and using technology is available, it is important that patients have a choice in the type of appointment they have. There should be a discussion between practitioners and patients, who should make the decision together. Remember that video consultations are just one option, and may not be suitable for everyone:
Many patients do not have access, wish or desire to use telerehabilitation when asked. Promoting technology is important but for those who cannot, or prefer not to, services should be offered via alternative means
Physiotherapist, care of older people
There are lots of online and national resources to help to improve your digital skills and help with using technology.
Here are some of the best ones:
Your local council or library might be able to help not only with digital skills, but also to access technology if this is something that is difficult for you.
Check out what is available locally. For example, if you live in Devon or Cornwall:
See our patients’ guide to remote appointments for further guidance on using technology for video consultations.
“Try to get support from a relative or carer. You could even borrow a computer, smartphone or tablet if they are willing!”
Physiotherapist, Musculoskeletal/Rheumatology
“Systems should be easy to use. Hospital sites can be really complicated to navigate.”
Patient with Cystic Fibrosis
“Are there any other patients who have already had a video appointment that could act as ambassadors, or ‘digital buddies’? This could be a really good way to become familiar with the technology and support one another.”
Patient with Multiple Sclerosis
“Older people want to engage with technology but don’t necessarily have the skills. They need a bit of a helping hand. They need one-to-one support. A ‘practice run’ can be really useful… Write instructions down in the patient’s own words so that it makes sense to them.”
Community Worker
“Consider using Digital Connector volunteers who can support and develop people’s skills, confidence and motivation to use digital technology. Find out the key issues the individual needs help with so that the digital connectors can focus on these. Offer support to carers too.”
Equalities and Community Development Support Lead
You could also look at our specialist guides, which contain useful tips and resources to help certain groups of people (such as people with visual or hearing impairments) take part in video consultations.
We were not all brought up with IT when we first joined the NHS
Rehab Assistant, Neurology
Several practitioners told us they had learned to carry out video consultations through practice, and it took ‘trial and error’ to get used to the video consulting platforms and new ways of working. Only a minority had undertaken any formal training. Most had got information from ‘informal’ sources like web searches and talking to colleagues. These are valuable sources of information that should continue to be used, but check out the resources on this page, find out what training is available in your area or organisation, and see our guide to technology for video consultations and assessments.
The modified computer self-efficacy scale (developed by Laver and colleagues in 2012) is a validated self-reported tool to assess patients’ readiness to use technologies. It was designed to be used in a clinical setting for older people and people with disabilities.
Full reference: Laver K, George S, Ratcliffe J, Crotty M. Measuring technology self efficacy: reliability and construct validity of a modified computer self efficacy scale in a clinical rehabilitation setting. Disabil Rehabil. 2012. 34(3):220-227
Health Education England has developed a digital competency framework for Allied Health Professionals. It is designed to support the development of digital knowledge and skills of practitioners from band 3 to band 9. The PDF is available online.
NHS Digital ‘Digital inclusion guide for health and social care’ (2019 guide aimed at health and social care professionals and commissioners, lots of information and resources to support digital inclusion at a local and national level).
