The use of IT is ubiquitous, and its benefits and disbenefits within our personal lives are frequently aired in the mass and social media, with calls for some form of regulation of Facebook and Google so personal data are protected unless informed consent is given. Indeed, almost everyone has a mobile phone, and most mobile phones are smartphones (96% adults use a smartphone (Ofcom, 2018a)), with users spending 66 hours per month browsing online (Ofcom, 2016). Ofcom (2018b) has noted how internet use is becoming more mobile, with people increasingly going online at locations other than work or home. However, levels of critical understanding vary regarding the trustworthiness of news, funding of search engines and price comparison sites, and the collection of personal data, including the use of cookies and user locations. There are clear demographic differences between online users and those who eschew the internet, with the latter increasing with age (18% among those aged 55–64 years; 35% among those aged 64–75 years; 47% of those aged over 75 years) and with a lower socioeconomic profile (DE households) (22% vs. the 12% UK average). DE households were also less likely (1) to have internet access, (2) use devices, (3) be able to make critical judgements about content and (4) use security features to protect personal data (Ofcom, 2018b). Thus it is likely that many district nursing clients do not have high digital literacy levels.
A recent policy document (Department of Health and Social Care (DHSC), 2018) and the completed Topol Review (Health Education England (HEE), 2019) remind us that healthcare delivery lags in its use of IT capabilities in terms of online services, infrastructure and devices and clinical tools. Unfortunately, the NHS has had a poor history with IT projects (e.g. the NHS National Programme for IT, which failed after costing £10 billion (Public Accounts Committee, 2013) and the NHS care.data programme (Godlee, 2016)). The DHSC (2018) policy document represents a move away from large-scale projects and the adoption of existing technologies underpinned by guiding principles, including interoperability, data security, use of open web standards, best cyber security standards and efficient data management, which meet user needs. The Topol Review (HEE, 2019) addresses the need to develop a technologically capable workforce to enable effective deployment of digital medicine alongside genomics and artificial intelligence-based technologies, which are less relevant to district nurses at present. Topol argues that the adoption of digital medicine will improve time for care and the opportunity for ‘deeper’ interactions with patients, although he recognises that the healthcare work-force needs to develop the skills, attitudes and behaviours to become digitally competent and confident. Importantly, he recommends creating a culture of innovation and learning within NHS organisations, so that the workforce is cherished and encouraged to learn continuously, with simultaneous investment in people and technology.
The recent Queen's Nursing Institute report (2018) makes for dismal reading, with so many different IT systems in use, over a quarter of community nurses using largely paper-based systems, two-fifths of NHS trusts not using telehealth systems and just over a quarter of services using texts for appointment reminders. Now is probably a good time to agitate for improvements in technology and training opportunities, so that digital skills and literacy are recognised as key to effective care delivery and precious patient care time is maximised.
“It is likely that many district nursing clients do not have high digital literacy levels.”