Equity in digital transformation: 10 questions NHS board members should be asking

The rapid adoption of digital tools and ways of working across health and social care has brought many benefits, from improving efficiency to enhancing patient care and experience.

But digital transformation also creates barriers, particularly around exclusion and inequality. Board members and senior leaders must address this challenge and play a key role in ensuring that equity and equality are embedded in every stage of digital change, from strategy to service delivery. 

Do your digital teams reflect the diversity of your workforce and local communities?

A diverse team is more likely to design inclusive and accessible digital services as a result of increased diversity of thought and lived experiences. Board members should ask for data on recruitment, retention, and progression within digital roles, with attention given to underrepresented groups. 

Does your digital strategy identify and explain how the organisation will mitigate against exclusion?

Ensure your strategy includes plans to identify and address barriers such as digital literacy, language, disability, and connectivity. Do you have assurance that minoritized and digitally excluded groups were involved in co-producing the strategy and digital project planning?

How will you know if patients or service users are being excluded by digital services?

NHS leaders must have assurance that patient feedback, complaints, and access data are monitored and acted upon. Look for regular reports highlighting uptake and access across demographic groups. 

Are your digital services co-designed with communities most at risk of exclusion?

Without this, technology that is fundamental to care pathways risks excluding groups most affected by health inequalities. Ensure your teams are conducting user research with seldom-heard and minoritised communities during the development of products. This will be particularly important with evolving technologies such as artificial intelligence.

Is there always a viable non-digital option for those who need it?

Not everyone wants, or is able, to use digital tools. Ensure services remain available through face-to-face, phone or postal channels, especially for those who are less able to access digital services.

Are you partnering with suppliers that reflect your values?

Procurement and contracting processes should prioritise fairness, transparency, and equity, encouraging suppliers to demonstrate a commitment to inclusivity. Ask how suppliers consider equity in their design processes, workforce, and governance.

How was this considered and evaluated as part of the procurement process? Are they transparent about their ethical standards and how they meet the Public Sector Equality Duty (EA2010)?

Are you confident that the data used to build digital tools is fair and representative?

Data collection and algorithmic design must be carried out ethically, avoiding bias and ensuring fairness, representation and accountability. Often, the main issues arising with AI bias come from the data sets used, rather than the tool itself. To ensure your data is capturing the full picture, board members must challenge the data and whether it is representative of the population.

Are equity and inclusion built into your organisation’s digital maturity assessments?

Digital maturity assessments, both those commissioned externally and internally, tend to focus on infrastructure and use but organisations should consider how they can monitor whether digital tools are reaching and benefitting all groups equally, as part of their assessment.

Are we supporting and enabling our peers and teams to feel confident in raising concerns around fairness or inclusion in digital practice?

Leaders set the tone for equity by prioritising inclusive policies and day-to-day practices, ensuring that all individuals have access to the resources, support, training and opportunities they need to succeed. One avenue to explore is support mechanisms such as reverse mentoring or lived experience panels to bring diverse perspectives to leadership.

Do you have assurance that your digital programmes are reducing health inequalities?

Digital transformation should be a lever for reducing health inequalities, not exacerbating it. Ensure that progress for your digital programmes tracks equity-focused KPIs, not just uptake or efficiency metrics. 

As new models of care shift to being digitally-enabled, NHS leaders must play a role in ensuring that inclusion is at the heart of innovation, by challenging, guiding decision making and empowering teams. The Equity Charter has produced a set of 10 principles to support leaders on this topic, with resources and behaviours that NHS leaders can use to guide their decision-making.