Social Justice

Virtual healthcare is discriminatory and breaches Equality Act, say charities

New NHS figures show half of all adults in England have signed up to access digital healthcare. But charities say it creates health risks for many people who are unable to use the technology.

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Nearly 100,000 people make a repeat prescription request through the NHS app every month. Image: The Big Issue

The digital NHS booking and appointment systems discriminate against people who struggle to access online services, charity bosses have said.

This week the NHS revealed some 16 million people have signed up to use the NHS app and 28 million – around half of all adults in England – have registered with NHS login. That’s up from 2.2 million in September 2020, which highlights the switch to virtual healthcare during the pandemic.

But the age of people using it help indicate what many say is the problem with the switch. The biggest users of the NHS app in August were in their 20s, followed by those in their 30s, then 40s. 

Digital access charity Wavelength says the switch to virtual appointments during the pandemic is increasing health risks for people unable to use the devices and as a result breaches the Equality Act.

It may also be playing a part in the widespread confusion over the booster jabs programme that aims to protect 30 million of the most vulnerable people in the UK, they say. Many people have yet to be invited for a jab and others are thought to be unsure of how to go about the digital booking process.

GP surgeries are also still using online systems for booking and cancelling appointments as well as ordering repeat prescriptions.

“This is an issue which affects a wide range of people including the elderly and those who do not have English as a first language,” explained Wavelength CEO Tim Leech. 

“The use of portals and online systems which certain people are going to find difficult to access coupled with the lack of alternatives is discriminatory. It means certain people are more likely to fail in completing the task they set out to do, and therefore their health is more at risk.”

Wavelength helps equip an estimated 35,000 people a year with technology, both those who cannot afford it and also disabled people who cannot use it independently. Leech explained that problems with accessing healthcare are prevalent.

“Looking at the Equality Act, where it talks about accessing goods and services, this contradicts that. Individuals might be unlikely to argue this themselves but the Equality and Human Rights Commission should be dealing with this,” he said.

“There’s lots of people who have cognitive processing difficulties, who have problems dealing with written communication, so they want to do things via a phone.

“It’s about having the right to choose. Disabled people have an absolute right to choose the way they are communicated to, and that’s enshrined within the articles in that act.” 

Ruthe Isden, Age UK’s head of health explained: “We certainly see challenges for people who are digitally excluded. And that actually cuts across a lot of age categories.

“It includes people who don’t have access to digital technology, or who are worried about the cost of it, particularly if they are relying on pay as you go data. All these groups will have problems if they’ve been asked for a digital consultation or to send a picture of something in, for example.” 

Age UK published a report in 2019 which found treatment rates drop disproportionately for people above 70 in areas including surgery and chemotherapy. The report called for health services which do not discriminate. 

Isden said: “There’s a more specific issue around people who have sensory impairment, cognitive impairment, hearing loss, extra with manual dexterity. And actually, what people have told us quite often is that they find it very disempowering speaking remotely.

“Where they could communicate for themselves in person and they could gain an inclination about what was going on, when it’s a remote consultation, they’re really reliant on a third party so they have to get a friend or a family member to actually handle the phone call on their behalf.

“It’s about good systems and choice […] There are places where it’s working well. There are other places where the systems aren’t in place and you can’t get through on the phone. 

“Even a well-resourced system we would still need to be making sure that we’re really conscious that we’re giving people multiple ways to get into service.”

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The Care Quality Commission rates 90 per cent of GP practices ‘good’ as of July 2021, with as few as 4 per cent of surgeries rated as ‘requires improvement.’ 

Professor Martin Marshall, chair of the Royal College of GPs, said: “GPs recognise older patients can be amongst our most vulnerable and have been continuing to provide care in the safest way possible throughout the pandemic.

“The shift to largely remote consultations was a crucial part of restricting the spread of Covid and protecting patients from the virus.

“However, face to face appointments are important and have also been facilitated throughout the pandemic, wherever clinically appropriate.

“More than half of consultations in general practice are now being conducted in person and GPs are well aware that some older patients might struggle to use technology so they will take this into account when making decisions, with their patients, on the type of appointment.” 

NHS England has been contacted for comment. 

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