Digital exclusion refers to the lack of access, skills, capabilities needed to engage with digital devices or digital services.

Digital inclusion covers the following:

Digital skills

• Having the skills and confidence to use digital devices (such as computers or smart phones and the internet).

Connectivity

• Access to the internet through broadband, Wi-Fi and a mobile device.

Accessibility

• Services designed to meet all users’ needs, including those dependent on assistive technology to access digital services.

Affordability

• Having the financial means to get online.

Below are some examples of reasons as to why some people are digitally excluded.

• Lack of skills, knowledge and confidence – using digital, benefits of digital, knowing what is already in place/available Wi-Fi and connectivity
• Access to devices with internet connectivity and Wi-Fi
• Attitudes and previous experience
• Affordability
• Language barriers
• Sensory and visual impairments
• Some physical disabilities
• People choosing to opt out of using digital technology due to choice
• Digital Safety including trust, safeguarding, fear of scams
• Infrastructure

Person

• Empowering the individual, families and/or carers to take a more active role in their health and care
• Ease of using health and care services e.g. not needing to attend services in person
• Increased access to ‘Technology Enabled Care’, digital wearables and non-digital, where needed
• Increased confidence using digital technology, which will reduce social isolation and improve independence and health outcomes
• Improved access to health and care services and better quality of life
• Supporting people to understand the next steps in their care, finding reliable, trusted advice and guidance

Health and Care System

• Reduced demand on face to face services, creating time for those who require it most
• Reduce the risk of health inequalities – Digital exclusion is a social determinant of health inequalities, leading to poorer health outcomes and a lower life expectancy, increased loneliness and social isolation
• Ensuring health and care services are accessible by all and enhanced by the use of digital technology to support joined up care
• Support local and national priorities surrounding self-care and long term condition management
• Providing our professionals with information they need to make more timely and informed decisions

Economy

• Financial Inclusion – access to a wider choice of financial products and services, improved financial independence and online payment services
• More access to education opportunities
• More opportunities to find and apply for jobs
• Drive and generate more businesses and jobs in the IT sector
• Increased productivity and sustainable economic growth
• Increased engagement by providing access to public service, information about policies and issues, and platforms for public advocacy

Environment

• Reducing the impact on the environment, e.g. reduced travel, reduced paper based processes
• Enhancing efficiency and achieving cost savings by delivering services digitally

Intelligence is key to identifying areas which may be at risk of digital exclusion. The Lincolnshire Digital Health Toolkit has been created in a bid to reduce digital exclusion in Lincolnshire by highlighting areas at greatest risk of being left behind as a result of digitalisation by including indicators that give greater granularity and context to Lincolnshire and its population. It shows that there are higher rates of digital exclusion in the more deprived areas in Lincolnshire, with Boston as the most digitally excluded, followed by Lincoln and East Lindsey.

We recognise that digital inclusion is a complex issue, and that those who are excluded are hard to define.

We acknowledge that anyone could be digitally excluded in their lifetime, at any time and that there is no one category of people who fit this label.

The “scale of potential of Digital Exclusion” in Lincolnshire infographic shows the groups who are more likely to be digitally excluded due to a range of different barriers.

In order to further explore, understand and target those who are likely to be digitally excluded, personas/profiles of representative people will be developed through engaging with communities. Personas are designed to give a deeper insight into people’s needs and help understand the experiences and barriers of people experiencing digital exclusion. These are then tested and validated across the groups so that our communication and support offerings are tailored.

21.3% of Lincolnshire’s population live in the most digitally deprived areas.

The Digital Inclusion Strategy aims to increase the number of people who are digitally included in their health and care and ensure that equitable access is made for those who cannot or choose not to engage in digital services/technology.

Our Principles and Approaches

• Clearly defined deliverables
• Person centred
• Value for investment
• Inclusive and adaptable
• Unified approach
• Simplicity
• Co-production approach
• Honest and brave
• Active listening
• Not leaving people behind
• Change what we can change!

The Digital Inclusion Strategy Oversight Group has a wide range of skills, expertise and experience. This group has worked in partnership to develop this strategy.

This includes representatives from:

• Voluntary Sector organisations
• City Council & County Council
• District Councils
• Financial Inclusion Partnership
• Healthwatch Lincolnshire
• NHS organisations across Lincolnshire
• People with lived experience
• Primary Care Networks
• University of Lincoln

Vision

Everyone in Lincolnshire who wants to be digitally connected to health and care services and the community will have the skills, accessibility and confidence to do so.

Access to devices and data

Everyone can access health and care digital services if they choose to and experience the benefits.

Accessibility and ease of use

Increasing digital uptake in health and care services by ensuring things are clear, simple and accessible to use.

Access to services

Providing face to face alternatives for those who are unable or don’t want to access health and care services digitally.

Skills and capability

Everyone to have the skills to use health and care digital approaches with confidence.

Trust, Awareness and Digital Safety

People to understand and feel confident and safe using digital health and care approaches.

Leadership and Partnerships

Digital inclusion efforts are co-ordinated to avoid duplication and help to reduce health inequalities.

Why?

Everyone can access digital health and care services if they choose to and experience the benefits.

How?

• Volunteers with digital skills, information and support available at community hubs

• Device bank – loan and replacement schemes

• Assisted in person digital support and training available locally

• Free public computer maps

• Developing digital skills and confidence in our people

• Awareness and promotion of current schemes and digital support such as social tariffs, subsidised data, data banks for free wifi and training

• A digital front door/directory of what is available in Lincolnshire showing accredited schemes available

• Ensure that there is a sustainable approach to enabling connectivity, particularly where devices are provided

Outcomes after 3 years

Impact on person

• Increased knowledge of schemes across the system so those who choose have access to devices and data
• Improved skills and confidence to access digital services
• Improved access to services
• Increased choice for people

Impact on workforce

• Staff are able to signpost people to the correct resources/where to get help

Impact on the system

• Reduced demand on services, allowing those who can access digital to free up time for those who cannot

Measure of success

• Increased number of people accessing device and data banks, social tariffs and digital support and training

Why?

Increasing digital uptake in health and care services by ensuring things are clear, simple and accessible to use.

How?

• Digital health and care systems to be user friendly and accessible

• Accessible digital access for Health Inclusion and PLUS groups – adaptable formats and languages to be standard

• Enable a ‘digital first, not digital only’ approach

• Joined up partnership working with existing established programmes

• Co-production approach with people with lived experience

• Ensure feedback is acted on and any future service design complies with accessible information standard and NHS service standard.

Outcomes after 3 years

Impact on person

• Reduction in existing digital barriers for Health Inclusion and PLUS groups.

Impact on workforce

• Improved partnership working across the system

Impact on the system

• Reduced health inequalities for our Health Inclusion and PLUS groups (e.g. English as a second language)
• Reduced duplication/resource
• Improved digital services through a co-production approach

Measure of success

• User satisfaction surveys
• Feedback from Inclusion and Plus Groups
• Compliance with accessibility standards

Why?

Providing face to face alternatives for those who are unable or don’t want to access health and care services digitally.

How?

• Understand which groups may need additional support through face to face channels
• Health and care providers to offer face to face services to people who cannot/choose not to use digital services
• Accessible digital and face to face platforms for future service designs and improvements
• Ensure routine recording of preferences for modes of communication for people
• The face to face health and care offer to be as good as the digital offer
• Increase NHS app uptake and maximise its capability.

Outcomes after 3 years

Impact on person

• Those who need to be seen face to face are, resulting in a more personalised approach
• Improved experience as preferred methods of communications used
• Benefits of using NHS app i.e. faster repeat prescriptions

Impact on workforce

• Improved staff satisfaction in role as they are able to offer the right service for individuals i.e. face to face/digital

Impact on the system

• Reduction in calls to GP Practices due to increased requests of repeat prescriptions through NHS app
• Greater insight into preferred methods of communication for the local population

Measure of success

• Increased uptake of NHS App
• User satisfaction surveys
• Feedback from Inclusion and Plus Groups

Why?

Everyone to have the skills to use digital health and care approaches with confidence.

How?

• Upskill staff and co-produce digital training that meets different learning styles and needs
• Ensure that any ongoing digital training and support needs are included in workforce plans
• Digital Community Champions available where needed to help people feel confident in using digital
• Provide specific digital training for people in the community, working with local government, VCFSE organisations and the private sector

Outcomes after 3 years

Impact on person

• Increased access to Digital Champions
• Increased knowledge, skills and confidence with their digital skills

Impact on workforce

• Increased knowledge, skills and confidence with their digital skills

Impact on the system

• Increased uptake of digital health and care services
• Reduced Health Inequalities

Measure of success

• Pre and Post Training Assessments
• Enrolment and completion rates
• Demographic reach of training
• Reach of Digital Community Champions

Why?

People to understand and feel confident and safe using digital health and care approaches.

How?

• Transparency about how data is used and kept safe
• Working in partnerships to ensure people are aware of trusted and accredited schemes available
• Signposting to other services for more information
• Resources in different languages and formats
• Communication and monitoring the impact of using digital and the effects on other services
• Digital Champions approach – offering consistent messages
• Make digital health and care services relatable and seen to be used by ‘people like me’ through use of advocates and communications using everyday language
• Ensure that new digital health and care pathways are at least as good as alternative non-digital service channels
• Encourage peer support for people to build confidence and trust
• Promote the benefits of using services online, tailoring messages to the identified personas.

Outcomes after 3 years

Impact on person

• Increased trust and confidence in using digital health and care services
• Understandable information and confidence around how data is being used
• Improved knowledge on scam messages and less likely to be victims of fraud

Impact on workforce

• Increased consistency on safety messages and knowledge around scams

Impact on the system

• Increased uptake of digital health and care services leading to improved capacity for those who need it most

Measure of success

• Increased number of people accessing digital health and care services

Why?

Digital inclusion efforts are co-ordinated to avoid duplication and help to reduce health inequalities.

How?

• Shared vision, understanding and consistent language across all Lincolnshire organisations
• Collective and agreed policies showing expectations of commitment
• Interdependencies highlighted with other system wide strategies and programmes
• Collect data and monitor health inequalities information impacting access to, experience of or outcomes from digital healthcare, including by gathering feedback from people about digital health and care services
• Identify which community-centred roles in Lincolnshire can help connect people to digital information and support e.g social prescribing link workers, Age UK, community connectors, patient participation groups etc.
• Create a network of Digital Inclusion Leads across the system.

Outcomes after 3 years

Impact on person

• Improved access to digital support in the community
• Improved digital service experience

Impact on workforce

• Improved advice and recommendations from Digital Inclusion Leads.

Impact on the system

• Greater insight on monitoring health inequalities
• Reduced duplication across services and organisations
• Reduced digital exclusion

Measure of success

• Digital Inclusion Strategy Pillar Leads in place across the system
• Progress against Digital Inclusion Strategy priorities

Access to data and devices 

2025/26 – Develop and implement communication and engagement plan to support promotion of current accredited schemes available e.g. social tariffs, subsidised data, data banks, digital training etc. 

2026/27 – All organisations to review process of recycling/donation of old devices and technology and work together to develop equipment standards and a collective process. 

2027/28 – Review gaps of accredited schemes and ensure equitable provision across Lincolnshire.

Across all 3 years – Work with internet providers to discuss improving network coverage across Lincolnshire rural and coastal areas.

Accessibility and ease 

2025/26 – All organisations to collaboratively look at accessibility of websites, user guides etc.  

2026/27- All organisations to review what digital offer/products are in place, current uptake and accessibility of these services and analysis of population groups who are not accessing digital services.
 
2027/28 – Assess organisational readiness and appropriateness of use (through personas) so people can navigate and access pathways more easily.

Access to services 

2025/26- Identify where people are being digitally excluded and use learning to influence immediate and future improvement. 

2026/27- Use learning from findings in Year 1, build a simple and standardised engagement plan (for NHS app) for staff and patients.
 
2027/28- Use findings from NHS app to enhance other offers. 
 
Across all 3 years- Face to face services as good as the digital offer .

Skills and capability 

2025/26- Identify advocates to lead on strategy and gather digital skills and capability insights. 

2026/27- Development of digital training and engagement plan to address gaps and test with selected groups. 
 
2027/28- Use learning to implement and expand digital training offer.

Trust, awareness and digital safety

2025-2028 – Establish working group to lead on trust, awareness and digital safety. Develop simple and clear communication messages around digital safety – all organisations to promote the same consistent messages.  

Leaderships and partnerships

 2025/26- Establish strategy pillar workstreams and leads with clearly defined deliverables and measures of success.

2026/27- Identify collective funding opportunities and develop business cases to support digital inclusion strategy.
 
2027/28- All organisations to maintain commitment of delivery. Evaluate impact of strategy and review overall objectives beyond 2027. 

Across all 3 years- Quarterly review of objectives and plan.

The digital landscape is an ever changing one for the Integrated Care System.

The below act as key drivers for the Digital Inclusion strategy:

National ​

• Inclusive digital healthcare: a framework for NHS action on digital inclusion
• NHS England Health Inequalities Improvement Programme – Mitigating against digital exclusion
• Department of Health & Social Care – A plan for digital health and social care
• The What Good Looks Like (WGLL) framework – Digital working in adult social care: What Good Looks Like
• The Minimum Digital Living Standard
• National Digital Inclusion Alliance
• The Darzi Report (2024)

Local​

• Digital exclusion as a barrier to accessing healthcare: a summary composite indicator and
• online tool to explore and quantify local differences in levels of exclusion.
• The Integrated Care Partnership Strategy 2023
• Integrated Care Partnership Strategy – Digital Technology
• The Integrated Care Board 5-Year Forward Plan​
• Our Shared Agreement
• Director of Public Health Annual Report 2023- Ageing Well
• Lincolnshire County Council (LCC) Customer Strategy – Customer Experience (Objective 3)

Glossary

Assistive Technology is used to describe products or systems that support and assist individuals with disabilities, restricted mobility or other impairments to perform functions that might otherwise be difficult or impossible

Broadband is the ‘always-on’ way of connecting a computer to the internet using a copper, cable, fibre or wireless connection

Co-production is an equal partnership where people with lived and learnt experience work together from start to finish

PLUS groups are population groups, defined by integrated care systems (ICS), which experience poorer than average health access, experience and/or outcomes across their communities

Smartphone is a mobile phone that performs many of the functions of a computer, typically having a touchscreen interface, internet access, and an operating system capable of running downloaded apps

Social Tariffs are cheaper broadband and phone packages for people claiming Universal Credit, Pension Credit and some other benefits

Technology-Enabled Care is referred to as any digital solution that helps someone with their care and support. Also known as “assistive technology” or “assistive equipment”.

Wi-Fi is a wireless networking technology that uses radio waves to provide wireless high-speed Internet access.

Acronyms

• GP: General Practitioner
• ICB: Integrated Care Board
• ICS: Integrated Care System
• IT: Information Technology
• LCC: Lincolnshire County Council
• LCHS: Lincolnshire Community Health Services
• LPFT: Lincolnshire Partnership Foundation Trust
• NHS: National Health Service
• PCN: Primary Care Network
• ULHT: United Lincolnshire Hospitals Trust
• VCSE: Voluntary, Community and Social Enterprise
• VCFSE: Voluntary, Community, Faith and Social Enterprise