Blog / Digital Equalities

Blythe Robertson: March 02, 2020


“I've come up with a set of rules that describe our reactions to technologies: 

  1. Anything that is in the world when you’re born is normal and ordinary and is just a natural part of the way the world works. 
  2. Anything that's invented between when you’re fifteen and thirty-five is new and exciting and revolutionary and you can probably get a career in it. 
  3. Anything invented after you're thirty-five is against the natural order of things.” 

(Douglas Adams)

In my previous blog post, I talked a bit about the need to set some of our work on health literacy in the wider context of addressing inequalities. This is a key piece of work for NDS that will continue to shape our thinking and ensure our various products and outputs meet our standards. 

One idea that popped into my head recently relates to the Douglas Adams quote above. We recognise this humorous analysis in many aspects of our everyday lives. Some of us are living the dream of point two. And perhaps too often in our working lives, we come against the third. The administrative systems of large organisations can feel very different to the nimble ease of booking a taxi or connecting with people in far-flung places through a simple tap of the keys. 

We seem to have rather lower expectations of our work technologies. Or maybe I hold that view because I’ve worked almost entirely in the public sector. But perhaps there’s a more hopeful piece of learning to be gained. If we think of situations not necessarily when we are born, but when we ‘first arriveinto a system or organisation, how do we create a sense that interactions – and specifically in our context, digital interactions – are just a natural part of the way the world works’. That’s not to say digital solutions will suit everyone, but for those who prefer digital, we need to deliver products that most inclusively meet our needs. 

Equality and diversity thinking has sometimes been curiously overlooked in digital developments, often to the detriment of their success. The evidence is strong that technology development’s failure to consider this can lead to a widening of inequalities where you digitally enable health and care processes. There are some simple techniques that could be adopted to guard against this. These might range from targeting health monitoring devices to those who struggle most to keep their levels in range – with whatever condition they’re managing, to designing products or services with as diverse a community as possible.  

We started to explore some of these issues with the help of the NHS Equality Leads from health boards at a workshop on 4 February. This group meets regularly to explore areas of common interest. They were good enough to convene a special meeting to explore the challenges that digital presents, including those specifically related to the development of the National Digital Platform. 

We also recently attended the National Rural Mental Health Forum to understand in more depth some of the digital challenges faced by the one million people in Scotland living in rural areas. We’ll be running a workshop with them at their next event in May. We’re also keen to learn from colleagues within NHS Education for Scotland who have been promoting remote and rural inclusive health education solutions for many years as part of the Remote and Rural Healthcare Alliance (RRHEAL). 

Part of the challenge for NDS is not just that some of this territory is complex, but it’s also a little tricky to understand the practical challenge of what to impact assess and when. There might have been an initial idea that the platform approach or the NES Digital Service itself could be summed up in one single unified assessment process. But brief exploration of this revealed that what we needed to identify were areas/products/approaches where assessing equalities impact felt most meaningful. 

This is very much a work in progress, but while we reach a more strategic set of decisions, we’re testing the waters through an equalities impact assessment of the ReSPECT work in Forth Valley. This is very helpful context as not only did NHS Forth Valley consider equalities aspects when implementing the ReSPECT process, the ReSPECT process itself was developed using a strong service design approach explicitly targeted at delivering a more inclusive approach to care planning. 

We’ll have the initial impact assessment completed as a key part of our compliance approach, but the document will likely need continuous updating to better reflect the experience of live running of the digitally enabled ReSPECT process. This will capture vital learning for additional ReSPECT sites, as we widen and broaden implementation.


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