What can health and care commissioners, programme teams, digital teams and service providers do to design out exclusion?

Use all health and care opportunities to raise awareness of trusted digital health and care transformation and individual pathways/technologies to relevant populations.

Only use trusted, accessible, useable, digital health and care technologies to aid people accessing these independently.

Ensure the service/pathway/technology is designed to be as easy to access and interact with as possible for all health and care service users and workforce. This includes:

• Ensuring that digital health and care services/pathways/technologies can be understooaccessed with basic digital literacy skills.

• Ensuring all the public facing service/pathway/technology information is accessible, written in plain language, and is translatable.

• Reducing specification requirements for digital health and care technologies- and that they are fully useable on all devices our population may have access to.

• Ensuring the digital health and care pathway/technology is interoperable with assistive technologies and other health and care pathways/digital products.

• Moving towards single sign-on (SSO) where users are asked to enter their login credentials one time to access all health and care related applications.

• Commissioning formal support to enable access to digital health and care where there is a known/unavoidable skills gap.

Consider how to meet requirements for service users with no/limited/unsuitable access and those who are unable to afford the relevant technology.

Provide service/pathway/technology support whenever that is needed to ensure safe and equitable access.

• Avoid the need for informal support in more complex or sensitive health and care pathways.

• If informal support is needed, consider the support needs of informal carers/workforce, their skills, capacity and capability, and the service user’s right to confidentiality and privacy.

Pay special attention to populations where more personalized/health-specific information may be needed including populations more likely to mistrust health and care services (e.g., mental health, asylum seekers).

Routinely measure:

• populations at risk of digital exclusion

• populations not accessing digital health and care

• access and usage data of digital technologies

• service user experience and satisfaction in relation to the service, pathway, technology

• clinical outcomes including safety.

Be transparent about what happens to data, data security, and how health and care data can be used to benefit the individual.

• At the same time be aware of overwhelming people with information - some people will trust the NHS and will be burdened by too much information. Others will want access to the details.

Ensure clinical safety and clinical oversight is transparent and built into the pathway and feedback mechanisms.

Ensure service users can easily feedback any issues, concerns, adverse events, complaints.

Collate and respond to feedback and any clinical issues raised.

Ensure the digital health and care pathway is as good as, if not better than, the alternative for service users.