Rachel Johns
Hi, I’m Rachel Johns. I’m deputy regional director of public health for NHS England and the Office for Health Improvement and Disparities for North East and Yorkshire. And if you think I’ve got a long title, wait till I introduce the rest of the panel.
We’re talking today about addressing health inequalities and the role of digital technology, particularly in primary care. And can it make a difference and where does it help and where might it be more challenging?
This is in the context of a regional health picture where we have higher levels of deprivation than the average in the population, 31% of our population live in the most deprived communities and it should be 20% if we were the same as the rest of the country – in the Southeast that would be 9%. So, we’ve got particular challenges. But that means we’ve got plenty of experience and we’ve done lots of things to make a real difference in in our areas. When we’re talking about inequalities it’s a huge topic and we won’t be able to cover everything today, but there are obviously challenges related to the area you might live in and the income that you might have. But also there are groups who are really at risk of exclusion whose experience and outcomes in health are even worse than the people who live in the most deprived communities because they are additionally disadvantaged. There are lots of people who are additionally at risk, and that’s some of the areas that we’re going to be talking about with the panel today.
We know that primary care experience is different in different communities as well, and that often practices and facilities in more deprived communities have fewer resources – are less able to have as much access, and that’s something that we recognise and that we can address through different solutions, but it means that often people are starting from really quite a different, difficult and challenged position in terms of services. And then obviously there are digital solutions, not just for primary care, but that’s where we’re going to be focusing, which can really help with flexibility, with access, with current connections, but also can be challenging for people to access and that’s one of the things that we’ll be addressing in more detail.
So joining me today is – for the discussion – is Rani Rooke, senior commissioning manager with the East Riding of Yorkshire, part of the Humber, North Yorkshire ICB, Rachael Forbister, digital transformation programme manager for Health Innovation North East and North Cumbria, Natalie Knowles, Primary Care Partnership and Transformation lead at Wakefield Health and Care Partnership within the West Yorkshire ICB and Katie Dowson, Digital Transformation Programme Director at South Yorkshire ICB. Welcome everyone.
So. can we make a start with an overarching question, which is what does health inequalities mean to you? Natalie, can I come to you first?
Natalie Knowles
Yeah. So just like you’ve said, really, Rachel, in your introduction, it’s looking at our most deprived communities looking in terms of poverty and then looking at our health inclusion population. So our socially-excluded populations that have multiple risk factors and a lot worse outcomes in their health and subsequently a lower average in their life expectancy as well.
And obviously some of the cohorts that you’ve mentioned in terms of our homeless populations, our gypsy, roma, traveller, our vulnerable migrant communities, prison leavers and sex workers as well, they are relatively (in our populations) low levels. However, they are the people with the most need, that we really need to be able to bridge the gap into accessing services. And I know you said in primary care as well specifically, in terms of encouraging them to come forward for health checks etcetera and to support their health needs.
Rachel Johns
Thank you. Rachael, do you want to come in?
Rachael Forbister
Yes. So I’ve got a real interest in digital inclusion. So I think when we’re looking at health inequalities as a whole, we’ve got to consider the impact particularly of cost of living crisis that we’ve had. We’ve got higher levels of deprivation in our region. We’ve got families who can’t afford to pay for things like internet or devices. So that becomes a real big problem for us as a region. And how do we influence that and change that for the best for the future. So we’ve been looking at lots of different things where we can help – What do we do? How do we support them? Because actually, digital is not just about their daily lives, but it’s how they learn, it’s how they get job opportunities, it’s some of those basic skills, but also how they access health and care services because increasingly we’re pushing all of those services online. But we can’t leave those people behind. So that’s a really important thing. That’s great to hear, Natalie, about bridging that gap because in terms of digital, how do we also bridge that gap so that we give them the right tools, but also the right skills to help improve their lives overall.
Natalie Knowles
Well, I think Rachael it’s really interesting because I think digital plays a massive role, but we find that most of our deprived communities and specifically our health inclusion cohorts, they struggle with access to mobile phones, to internet, even having a SIM card. Some of the areas that we’ve supported in our local accommodation where our vulnerable migrants are situated, is supporting with SIM cards, enabling them to get online to use online services. But I do think it is an area that we need to support with, but it’s also a challenge due to devices.
Rachael Forbister
Yeah and for me, I think we have the Golden Triangle. So in that triangle you have your devices, which is fairly easy to get actually. We’ve got hundreds and thousands in the NHS and public sector. We’ve got data opportunities like free SIM cards and the Good Things Foundation runs a national data bank. So we’ve been encouraging practices individually to register. So if they identify somebody who can’t access the NHS App because they haven’t got data, we’ll get them a card – give them it, it’s got six months on there, but the final piece of that puzzle for me, and the most important, is about those skills, because you can give them the device and the data. but if unless they know how to use that, how to download that NHS App, it does become a bit of a challenge.
Rachel Johns
Katie
Katie Dowson
Thank you. Rachael and Natalie have given some really good examples there, and I think what it emphasises, there’s three of us talking today that are all responsible for delivery of digital services. And what we have to do is therefore make sure that we have considered delivery and that we are thinking about those populations. We’ve mentioned a few different stats – in South Yorkshire, it’s 37% of our population that are in those most deprived communities.
And just to really bring it to home, I took on my role three months before the pandemic began and what we saw in the COVID pandemic was a sharp rise in use of online services and ridiculously fast implementation of online consultation tools, video consultation tools that people needed to use in order to be able to access information and access services.
And just with the pandemic we saw just in real life what digital exclusion looks like. And that there were many communities that actually we weren’t able to get in contact for to get those vital vaccinations. And so it was, how did we then get that information out there and what we had to do was use already established local community groups, volunteers, people that already have trusted relationships to get important information. And once we’ve done that, and once we’ve built relationships, actually, we could then take stepping stones into how we could then involve them in future uses of online services and just to the points Rachael’s made about then skilling those people up. So it’s learning from real life scenarios where people are struggling to get that information and then us really just needing to be considered in our application then and our delivery and implementation of those services.
Natalie Knowles
Yeah. And Katie, I just wanted to come in just on the back of what you were saying because that’s really important – it’s breaking down the barriers. And I think for me, when we talk about health inequalities, it’s around the importance to that person about their health. So we can have the digital solutions, we can have the mechanisms. But actually, sometimes if you’re unable to feed your children, if you’ve got no heating or there’s bed poverty – your health isn’t the first thing that you think about sorting. I think the other thing as well is about putting health first, but then also about reducing the barriers when they come to healthcare. You know, if you can’t access appointments at certain times because of childcare etc, it’s around working with populations to reduce those barriers as well. And once you start building those relationships with those trusted circles, that helps people to access care and then opens up that world of digital technology in my eyes. But it is all around relationships and it is all about understanding that actually health isn’t, for a lot of people, their primary concern – it is other areas that are linked to poverty.
Rani Rooke
I think, Natalie, that that’s a really positive comment because within NHS we assume health is everybody’s priority. And as you say, that isn’t always the case. I lead the learning disability, physical health, piece of work and one of the things for us around digital technology is, is it accessible? If it’s not accessible to people with a learning disability then they can’t use it and this is a group that’s got multiple inequalities, if you like. So there’s the inequality of their cognitive function. They will also have a level of poverty aligned with that, because large proportions will be on benefits. So you know the poverty aspect plays into it and the cognitive function plays into it. And we also work in a reactive healthcare system now where you have to approach primary care to get the help you need.
And this is a group of people that just doesn’t. And it’s really interesting because we’ve just had some data come through from LeDeR – because we review all avoidable learning disability deaths, and what we’re finding now is that people with a learning disability have a 42% of passing away from an avoidable death, whereas the general population is 22%, so there’s a huge disparity between those.
But the surprising thing I think we’ve found from this particular report in 22 is that those deaths are now occurring amongst the people with low and moderate learning disability. And what that highlights is that reactionary approach of health, which is that if individuals are living independently in the community, then they’re not going to access health. We have to invite them in, we have to build those links, otherwise we will continue to see the avoidable deaths that we’re seeing and the high levels of cancer and people presenting at later stages.
So I think from a sort of learning disability perspective, it’s also reviewing our apps and our digital technology and saying is that accessible to everybody and are we doing things in easy read, are we using tile methodology? And certainly we’ve seen applications that have been co-produced with people with a learning disability and they have been based on those little tile models. And it’s really interesting because we know that within learning disability, constipation can be a real issue. And one of the apps that we’ve seen allows people just to record the number of times they have a drink, if they’ve been to the toilet. And all of that information can be sent through to the GP’s primary care system, which allows monitoring of that person’s health and avoids any sort of deterioration around it.
Rachel Johns
Thank you. I knew this would be a wide-ranging discussion and really, really fascinating. I think what we’ve touched on and we will go on to some of the examples. Rani, you’ve already started to talk about examples where that works, and we’ll talk about some of the others, but I think what we’re kind of highlighting and I absolutely take your point, Katie, that there are areas that have even higher levels of deprivation, aren’t there, across our patch. And so internal inequalities within our regions, within our ICBs, and then the comparison with the rest of the country – they’re relatively easy to describe, but actually, they’re not necessarily easy to address and how we support individuals, but what we’ve already picked up is the need to co-produce, to work with, to make it as easy as possible. And I think that’s where digital comes in, is that for many people, digital feels easier than some of the analogue approaches. Not always, but there can be massive advantages and what we need to be doing is making sure that all of those advantages are seen by everybody in that respect – one of the advantages of having higher levels of need in our population is that there are entire services that only support people with high levels of need and therefore are experts. So, I’m going to come to others who’ve got their hands up at the moment, but I just wanted to think about what we’re currently doing to make it easier for people to access care and some of the initiatives that you’re involved in, as we go around, but Katie, I’ll come to you next.
Katie Dowson
Thank you. I think one of the key themes that’s coming out here is about the need for us to be visible. We need to show that we’ve got the time and the patience and the flexibility and the digital inclusion programme that we are growing and developing in South Yorkshire is very much reliant on a social infrastructure network, so lots of community groups with, as I’ve mentioned, already, trusted relationships.
But being visible to our population and to Natalie’s points earlier, about talking to them about things that motivate them. So, you know, actually someone isn’t going to walk through a door and say, I’ve got a digital problem necessarily. They’re going to talk about a problem that actually after a few conversations, you realise that behind that is that they’ve not had access to an app or they they’re not able to find something on the internet.
So we’ve actually partnered with Citizens Advice across South Yorkshire and one of our main reasons for doing that is because they’re already a very well respected charity with really good links with our different community voluntary and charity organisations and so together as our social infrastructure network grows, we’re making them more visible and being clear on the various different support offer that we’ve got. So we’ve got 7 different work streams that can help but, what we are finding is that we’re responding almost to inclusion in its totality, so from a digital point of view, a financial point of view and that social isolation side of things as well. So that’s what we’re seeing there – where because we’ve got that localised offer, more and more people now are able to see that support’s available that they can point to – because we are seeing more and more people coming through a door with complicated requirements. It’s not always a health issue, but they don’t know where to go. And actually knowing that there’s someone, a friendly face that we can point to, we can help with that. So I think it’s about just being able to be flexible is really important and then what we do – and I have the advantage of being responsible for digital inclusion and the delivery of digital primary care – is blending the two together.
So I think we’re going to talk about the NHS App more later, but we’ve got a responsibility to try and get more people using the NHS App, but then there’s lots of people in our communities that will need additional support in doing that, which will include things like, just making tablets available in their local GP practice so that they can do that.
Natalie Knowles
I think Katie, as well it’s a really good point what you were saying in terms of that localised offer, we’ve got solutions that nationally that are available, NHS App which we’ll probably come on to in a bit, online consultation tools to be able to access your GP practice. But what I’ve learnt working with our vulnerable migrant population and our homelessness population is we have to put additionality in place – we have to do more for people to be able to access and use those tools.
For example, we went in and did a ‘one-stop-shop’ in our hotels to support people being able to log on to the app and if we hadn’t have done that, the populations that we were working with wouldn’t – would have really struggled to be able to access.
I think the other thing that’s really interesting for me is around people’s worth and how you have to work on that. Something that really stood out for me during COVID was we went to our homeless shelter and one of the phrases was ‘I didn’t think someone like me would get something like this’ and it’s stuck with me for the last four or five years and the fact that we are going and giving that additionality and supporting and having a localised offer is really supporting our communities to be able to access healthcare and GP practice and actually making them feel worthy that their health is something that they should be looking after.
And for me that’s really important because they come up against so many barriers, they have so many kickbacks, that they don’t feel that they’re worthy enough to access healthcare. And then we’ve got all the amazing tools that we can use for example, the NHS App, so for me, it is all around understanding the person and their needs and then how we can work with them to make sure that their health is one of their top priorities.
Rani Rooke
We’ve had a similar experience with learning disability. Because again, it’s changing the culture and getting people to understand the needs of people, the learning disability. So we’ve done a piece of work in our Bridlington area where we’ve got high levels of deprivation. We’ve also got one of our largest learning disability populations. And what we found there, was that there wasn’t a positive relationship between people with the learning disability and the GP practice. So, the GP practice didn’t have the skills to communicate and therefore people with a learning disability weren’t coming along and one of the ways that we sort of measured this interaction was that GPs offer annual health checks and within the Bridlington area, we found that only 58% of the population took up these annual health checks. So we started to sort of explore that and we found exactly what you you’ve said, Natalie, that it was around creating that friendly environment and having somebody that could communicate and could explain what the process was. So we did move to employing a care coordinator from a care background rather than from an admin background and that made a huge difference for us because she was able to talk about reasonable adjustments. She was able to invite people in and make them feel comfortable. But one of the things that we did was we set up a meet and greet service, so that people weren’t wandering around looking to see where they needed to be and the meet and greet service sort of guided them through the health check process. But that in itself has identified that people with a learning disability really struggle to access lots of information that is out there. And as we’ve said, there’s greater use of digital platforms now, but if you can’t access them, then you know what you said -what are they to you? And certainly, we started to ask that question of our public health colleague, you know, do you know who accesses your platforms and are they accessible? And as a follow on from that, sort of picking up on Katie’s point, we’re now starting to develop what we call learning disability hubs, which are based on our primary care network footprint. So that’s the way they’re going to operate and we’ll be inviting people into a social event which a bit like the dementia cafe model. So, there’s a social aspect to it, but there will be links into information and that one-stop-shop approach, but one of the things that we’ve got at our first event is we’re using the adult ed IT room. So that’s making it really useful. So we’ll be uploading some of these platforms so people can actually experience them, but be supported to experience them. So yeah, those are the sorts of work that we’re starting to do with learning disability.
Rachel Johns
It does feel like that there’s a kind of common theme which is around making digital accessible, but the need for there to be people as well as part of the system. It’s not an alternative, it’s an add on. It’s a complement and a supplement to what’s available and sometimes that might need a bit more support.
Katie Dowson
It’s a wrap around.
Rachel Johns
Absolutely, absolutely. And I’m going to come to colleagues – can we think about whether some of these initiatives are relieving pressure or are they adding. Or are they relieving pressure on services and how do we handle that to help people? Natalie, I’ll come to you first.
Natalie Knowles
Yeah, I think that it is relieving pressure. So within Wakefield, we have an outreach service, a little bit similar to what Rani was speaking around in terms of additional support into practice, supporting primary care services to go to places where people are. We know that obviously some of our populations might struggle to get to a practice, might struggle to phone a practice. And so again some of those access barriers.
So our outreach bus with our health inclusion team go to our gypsy, roma, traveller sites. They go to our homeless outreach settings and work with populations in those settings to just reduce barriers to access. I do think in terms of when we talk about digital as well, I do think there is a big piece of work that we need to do around health literacy and understanding and health education. Our average reading age is 9 years old and obviously with our platforms that we’re using, it’s not just accessing it and being able to navigate it, it’s around the reading of it as well. So the support that our outreach service does work with people to be able to do some of that and look at health education as well. But yeah, we’ve done a lot of work in terms of our homeless cohorts. And it’s really interesting because like I know Rachael saying earlier around the availability of digital tools, but what we’ve found is that given digital tools out and they might have been lost or they might have been sold on for other gains. So there is something around the lifestyle of people as well, and just having an understanding and acknowledgement of that because we could give ten phones, but the person still might not be using the mobile phone. So I do think we do need to think about that as well and how we how we kind of work with people again around what’s important to them.
Rachel Johns
Thank you – Rachael
Rachael Forbister
Yeah, it’s a absolutely great discussion, isn’t it? And I think what we have to remember is digital doesn’t solve everything. We need those traditional methods for people who can’t come into those services. But at the same time being able to push those online who can transact in that way. We’ve been doing some work creating a massive workforce of digital champions in primary care. And how do they make a difference? How do they support patients to get active? And we’ve seen some great results with five percent increase in NHS App usage and because there are a lot of people who are able to – so it’s about focusing on those things and I think that you know continues to be a bit of a challenge.
I just wanted to touch back on Rani’s thing around the learning disabilities because I think there are some brilliant solutions out there. That’s what we specialise in as an innovation organisation. It’s what’s the market research, what products can help to alleviate some of those problems. You know, we’ve got Natalie talking about reading age of nine. We’ve got learning disabilities in the mix. But how do we do something different rather than that same service constantly? So for example, in Sunderland years ago, rather than doing the health checks in the GP practice, they went to the drop in centre, the community centre, the day centre. So it was a much different way of being trying to able to reach those people and make sure that they were accessing health things. One of the products I’ve seen, which has won awards, it’s about to go live in Romania, is ‘what’s my drug.’
So what they do is, yes, it’s digital, but you scan a QR code and it brings it up in easy read, but also from a learning disabilities perspective in a pictorial format so that people can understand what that is. And I think as a system we need to be really encouraged to look and see, well, where are those innovations that can help make a real difference to some of our patients?
Natalie Knowles
Just coming on the back of that, Rachael. I think cultural competency comes into this as well because some cultures don’t have words for mental health, they’re not acknowledged, or they don’t have words for cancer – it’s seen as a taboo word. So I think it’s really, really important that when we’re looking at this, that’s a consideration in terms of language as well and what is used and what’s not used.
Rachael Forbister
I’d agree.
Rachel Johns
Katie –
Katie Dowson
Thank you. Just coming back to your point about the difference that digital services can make, I think without some of these tools, we wouldn’t have been able to deliver the COVID vaccination at the scale that we did, in the in the time scales that we did, practices wouldn’t be able to cope with the demand on their services right now without the tools.
But having said that, what’s really important and what we’re hearing in this discussion is patient choice. And you know we’ve already mentioned about the fact of having alternative methods because ultimately this is about people being able to connect, communicate, and engage with different service providers and get the information they need and something that I’ve been really reassured in seeing is the movement towards reasonable adjustments.
So actually, a lot more organisations now are asking those questions up front and making those considerations and checking whether or not people want to engage with a particular communication method, and that that’s so important. I was on a meeting with a lady with lived experience where she was saying’ I don’t want you to make assumptions just because I have an LD that I don’t want to be digitally engaged. I love being on zoom calls. They make me feel included. I don’t feel isolated, but please do not send me correspondence and letters digitally, because I can’t cope with that.’ And so there’s just this thing of not making assumptions, asking up front what people are comfortable with and to me something that is scary to our population is the move towards 100% digital. And certainly in my role the ask of me is please don’t make it so that everything is online because when we do that we are causing problems and preventing people from getting the information they need.
Rachel Johns
Yes and there is a big difference, even for people who don’t mind getting stuff electronically, which is what we’re talking about, isn’t it – that if you can do it on a laptop with Wi-Fi, with enough time and trying to do it on your phone with the limited data that you can afford, they’re completely different experiences. And even then, you know, there is, as you say, there’s plenty of opportunities for more traditional ways of communicating and accessing services.
Katie Dowson
And that’s a brilliant example, Rachel and I, and I think one of the things we’ve recently discussed, we have now a regular NHS App drop-in session to try and help primary care in, in coping with, you know, the rise in use of it. And when we’ve talked about people who are digitally excluded, there is the opportunity. You don’t have to use the app, you can use the website version on a laptop as you’ve mentioned. So it it’s just having that information and sharing it widely so that people know that actually there is another way of still getting that information In a way that actually someone is more comfortable with.
Rachel Johns
Rani –
Rani Rooke
I think one of the things that we’ve found really helpful is that we’ve produced a lot of communication cards. So for example, we’ve got a pictorial explanation of the annual health check. And I think if that at the moment we’re using laminated cards. But if we could move those onto a digital platform, that would be readily available in every GP room, that would be amazing. So you know what they could do is just put it on the screen and the individual with the learning disability can just see that and point to it and help them to communicate better.
So I think it’s really important to have those. I think the other bit for me is having those individuals that can promote this within the learning disability community. For me, the other bit that we’ve found really interesting is the use of social prescribers. So we’ve talked about the gypsy and traveller community and certainly the piece of work that we did in Bridlington, we found that there were two gentlemen with a learning disability in our local gypsy community that weren’t engaging with primary care, but our social prescriber was experienced in working with these communities and actually went along and engaged them. And that was a fantastic experience because it was the first time they were coming into the GP practice and they were getting those, their annual health checks. But I think the other thing is about using experts by experience and at the moment we’re doing a piece of work around cancer screening and we’ve employed a number of people with a learning disability to actually develop videos which we will then use on our various platforms to promote cancer screening amongst people with a learning disability, but also to explain to clinicians around desensitisation training and raise awareness about people making informed decisions. So, I think there’s a lot of factors that come into play when we’re talking about particularly with learning disability.
Rachel Johns
Thank you very much. I’m going to move us on to our final question because this has been brilliant, but we are going to run out of time, and I know we could all talk about this for ages. But to start thinking then, what if you were thinking ahead to five years from now, what do you think will have changed in this space? And because you’d already put your hand up, Natalie, I’m going to come to you first, so say whatever you were going to say first and then have a think about that!
Natlie Knowles
Yeah. So I was going to say this is really key, having the resources. But I also think we’re doing a lot of work from a training point of view and an education point of view from GP practices, so training and sessions with front of house reception, admin, going to GP education sessions and just working through the barriers that people from different health inclusion backgrounds may face. Because some of the things that we think are barriers are not actually the barriers, it’s different. So making sure that we are educating our workforce – a trauma-informed, culturally competent workforce, that’s able to support the populations and like Katie was saying about those reasonable adjustments and making sure that we are recording them and people’s needs are being met. And also like Rani was saying, in terms of our gypsy/ traveller populations where there is really low levels of literacy, I completely agree with what Katie was saying is I don’t think we should be moving to 100% digital because we are really excluding a lot of our populations by doing that.
In terms of what I think will have changed in the next 5 years, I am hoping in terms of our digital platforms will continue to develop and will incorporate some of the barriers that we’ve said today in terms of translation, in terms of accessibility, easy read, literacy levels.
And I’m hoping for a really well educated cultural competent and trauma informed workforce that’s able to work through some of the barriers and use digital as an option for our health inclusion populations and for them to feel that some of those barriers are reduced.
I would love in five years’ time to go out and speak to our populations and them tell us it’s easier to get into general practice, it’s easier for them to access healthcare and that their health needs are being met. So that would be my hope for what I would like to have seen change in the next five years.
Rani Rooke
I think for me it’s around accessibility, so making access easier. Things like easy read, far more pictorial usage. But I think it’s also around having two-way conversation between primary care and the patient. So what we’re finding is yes, people with a learning disability can monitor their health, but where does that go and can we feed that in digitally to our primary care teams so they can provide that oversight, which is missing at the moment.
Because it’s great supporting people with the learning disability to live independently in the community. But we need those safety nets, and I think at the moment we haven’t quite got them and I’d agree with Katie and Natalie, I don’t think going 100% digital would work. So, we also need to have that community link, even if it’s those community drop-in sessions or hubs. It’s a hybrid. It’s a bit of both and I think that’ll be the way forward.
Rachael Forbister
For me, I think there’s three key points. I think our workforce, the human factors are one of the most important things. And I think both Natalie and Katie and Rani to a certain degree have touched on that. You know, how do we upskill our workforce? How do we support them to make every contact count with their patients when they do see them to make sure that we’re transferring that knowledge and that skills over. And I expect in five years’ time to really see an improvement and much more of an uptake in that area, you know digital’s not going anywhere – it’s here to stay, and how do we maximise that opportunity?
The second thing is, one of the programmes we’re working on with our ICB, is around how do we repurpose devices that public sectors buy and get those into the hands of patients that need it? So that’s a really big programme that we’re working on. It’s across North East and North Cumbria, but we’re designed a blueprint to go alongside that. So any ICB across the country in theory could pick that up and look to adopt in their local area. It’s getting the trusts on board. Yes, some of the devices we won’t be able to use, but we could resell them or we could recycle them and get some of the value back. So, it’s supporting corporate social value, it’s supporting the net sustainability (Net Zero figures), but ultimately it’s supporting us making a difference in those health inequalities. We’ve got examples of how that is working in renal and type one diabetes with Grace Murray at South Tees hospital with maternity patients. So I think that’s it for me in five years’ time that should be business as usual and it’s just something that we’re doing to make a difference to reduce down digital poverty.
And the final thing for me, as I would expect as a result of all of this good work initiative that we are seeing less digitally disadvantaged people, we’re bridging those gaps, that we’re streamlining our digital services, we’re making it more accessible for people to come and engage in digital if that’s their preferred method. For me, I see that in general practice by doing this, it’s saving time in practice, as that frees up time to see the people who need to be seen, and I think that’s what we’ve got to keep in the heart – that a patient is at the end of this process.
Rachel Johns
Katie –
Katie Dowson
Thank you. I mean, there’s been some amazing things said there that I agree with. Two things from me, I’d just love to see inclusion health just baked into everything that we do – that it is just part and parcel of what we deliver. I’d also like to see nationally some policy that helps with the connectivity issue. And getting connectivity and devices and equalising that across our population would just make such a huge difference. So those would be my two things I’d hope to see.
Rani Rooke
I think connectivity is a real issue in the rural areas, so East Riding we are rural, and we have got areas where you do struggle to get a signal. But I think there are also advantages out there. So one of the tools that we use is libraries. So if people want to go and access digital technology, they can use the library and they’ll be supported to do that. But the other things that we’re starting to do is to look at our partners. So, one of our projects is where we’ve integrated the annual health check with their social services review. So, it’s looking at how we get that closer working between systems as well. So, it’s not just the patient-facing digital, but it’s also how we work as partners across our systems as well.
Natalie Knowles
Can I just say one final thing, Rachel? Just what Katie said really in terms of it needs to be in five to 10 years’ time that health inclusion is built into everything that we do. Health inequalities is everyone’s business and it should be the heart of everything that we do. And I think everyone is really passionate about that. I think that’s played through, but it has to be, it can’t be seen as a subset, it has to be threaded through everything.
Rachel Johns
Thank you everyone. This I found this really invigorating. I think everybody else has. I think hopefully our listeners will find it just as enthusiastic as we’ve enjoyed it in the room. Inequalities is often a really difficult area and often challenging and it’s lovely to talk to people who are addressing it and are still optimistic in terms of the progress we’re going to make. I want to say thank you to all of you for your contribution and your engagement. It’s been fantastic. Thank you.