Often when I’m describing our work at Good Things Foundation I talk about us being the glue in the system – acting as the link between national Governments and senior people in big, often global, corporations, and our networks of small, local community based partners. A great example of this is supporting people to use digital, which leads to them being healthier – working with national governments and community organisations to make real change happen. In England, we’re in our seventh year of working in this way, and in Australia this is our first year of thinking and working to blend digital inclusion (or digital literacy) and digital health literacy – building on our successes. And in Wales, we’ve just this week embarked on a new 3 year partnership supporting Wales Co-operative Centre to deliver the Welsh Government’s new programme on boosting people’s digital confidence, health and wellbeing. Exciting times!

Digital and community have been the cornerstones of our approach for over a decade. We believe in a world where everyone benefits from digital, so it’s not surprising this is central to the work we do. Our work spans a continuum from deep reach and impact – building new relationships, and changing systems – through to lighter touch engagement, which involves introducing people to digital health resources as part of their digital skills journey. And all of this is done with our movement of community-based organisations across both the UK and Australia who tailor support based on the needs of the people they’re helping. So it makes sense that community is one of the key ways to overcome the inequality digital can drive in our society. Digital exclusion is exacerbating social exclusion, but it can also drive inclusion too – and that is what we are trying to do, working with our partners both big and global, and, small and local.

In the UK, people who are digitally excluded (eg with no or low digital skills) are more likely to be older and/or experiencing social exclusion. You are three times more likely to be offline if you live on a lower income (‘DE household’) than if you live in a higher income household (Ofcom 2019). So while we deliver support around inclusion and digital literacy, this is done through different lenses – such as employability, financial resilience, and health – so we are not only improving people’s digital skills, but helping them to overcome a range of issues, from loneliness through to mental health issues, poverty and unemployment. We’re stopping people from becoming even more excluded. By leveraging the power of both digital and community, we can help people tackle some of the challenges they face, such as preventing illness and taking charge of their own health.

We’ve learned so much over the years, but two key things I’d like to talk about are how improved digital health literacy can drive better health outcomes, and how relationships between the NHS and those in the community help us to affect change.

Improved digital health literacy drives better health outcomes

Technology is revolutionising the way that healthcare is delivered around the world. Apps are making it easy for us to track our weight, food intake and exercise – as well as to manage long term conditions, or to connect with peers.

There is no doubt that digital technology offers huge opportunities to improve health and healthcare. But we can’t leave anyone behind. Everyone must have the choice to get the support and skills they need to use fast, efficient, well designed, convenient, flexible digital health tools and apps.

Digital health literacy has to be the next step from basic digital literacy. There are 11.9 million people in the UK who do not have all the essential digital skills for life (Lloyds CDI 2019), and an estimated 7 million people in Australia – and this means they’re not able to search for information, fill out a form, or send an email. These people are more likely to be older, poorer and living with disabilities, to be at risk of conditions like type 2 diabetes, depression and anxiety, and so it follows that they’re more likely to need health services and support.

We want people to have digital skills so that they can have better lives. We want people to have basic digital health literacy so they can have better health. And this also means that they’ll have equality of access to great digital tools – the NHS App in England, or My Health Record in Australia.

And improved digital health skills don’t just mean people can use apps to manage their health. With improved digital literacy, through the support of hyperlocal community venues, people feel not just digitally able but empowered too. This leads to people improving their health, like Simon who has lost weight and reduced his blood sugar level by developing his digital confidence after being diagnosed with type 2 diabetes. People are able to manage their conditions better online, and to take important steps that will improve their health in the long term.

The large overlap between people who are digitally and socially excluded, and between social exclusion and the drivers of health inequality, means that action on digital literacy can help drive better health outcomes – and, equally significantly, can help to prevent existing health inequalities from widening further.

Local + Scale: Improving people’s health

In England, over the last two years we’ve moved from a hyperlocal focus on people and the community outside the formal NHS, to creating evidence on new ways of enabling some of the most excluded groups in our society to benefit from digital health resources. We’re doing this through supporting 20 innovative pathfinders across England, focussing on a range of audience groups and health conditions.

We supported Nailsea Town Council to bring digital health to the high street, developing a high street digital health hub which connected people with each other and with the digital resources they need to live well. One man living with dementia was able to learn how to use Skype to communicate with his family. As he was able to read visual signs, this was a much more successful way of communicating.

We investigated socially prescribing digital skills in Sheffield and worked with Dr Ollie Hart and the Sloan Medical Centre to answer the question: Can the introduction of digital within social prescribing help people to take more ownership of their health and wellbeing? That’s where Simon – the case study above – was supported, and this ‘social prescribing’ model is persisting beyond the pathfinder and is now spreading further.

And In Hastings, we worked with the Seaview Project and their partners to enable people who are sleeping rough to access the health services and information they need – resulting in a whole range of positive results which will have a preventative impact in the long term, including improving eating habits to help prevent diabetes to learning how to take blood pressure medication correctly.

These Pathfinder projects – as well as our wider work in digital and social inclusion – have taught us some important things. To fully harness the potential of a ‘digital first’ health services for the most socially and digitally excluded people in our society, we need to remove the significant barriers that exist for people in a person-centred, community-based way – using trusted relationships especially between people working in the community (community centre staff or volunteers) and the people working in the formal health service (GPs, health visitors, paramedics, et al).

We are now spreading and scaling this hyperlocal digital health hub model in five more local health and care systems across England: North West London, Liverpool, Middlesbrough, Staffordshire, and Blackburn. We’re doing this so we can stress test what we’ve learned, to see if our model can be replicated and scaled up further.

Just this week we’ve launched a new grant funding round in England to see how far we can continue to scale – funding mini Digital Health Hubs with a focus on building or enhancing those all-important trusted relationships especially between local people and those working in the health service. Building these relationships is so important – I think of these Digital Health Hubs as being the bridge that makes these bonds stronger and lead people to have better health.

Now that Good Things is global – working in the UK and Australia – we’re hoping to spread this knowledge and commitment to digital skills and improving health. In Australia, we know the demand is there from our network partners – with 70% of them saying they were already blending digital literacy and digital health literacy or that they were very interested in doing so. We’re really keen to help them with this.

It’s never been a hard ‘sell’ to convince people that they want to apply their newly learned basic digital skills to accessing better health services. Everyone gets ill, everyone has loved ones who get ill – it’s universal.

It’s so important that, as digital health services take off and really deliver better and more personalised services, we work harder to ensure that nobody is left behind.

All the findings mentioned here are available online: for the first phase of our NHS Widening Digital Participation Programme (2013-2016) and for our second phase (2017-2020) on our Digital Health Lab site.