1 October 2020 - 1 October 2023
Over the course of 2020-2021 there has been a profound shift in the way in which healthcare services are accessed in the UK. In response to COVID-19 most non-acute healthcare service delivery has been made remote. This has accelerated a move to digital service delivery in the NHS, which was already underway.
There is a recognition of strong and persistent inequities in health outcomes and healthcare access in the UK, however it is not yet fully understood how digital healthcare will impact on this. Whilst there are hopes that digital healthcare will remove many barriers to accessing healthcare experienced by marginalised individuals it is also possible that this form of service delivery will both engender new types of inequities as well as replicate and re-embed existing ones.
This PhD research project will examine how processes of marginalisation shape experiences of digital healthcare in the UK. I will be taking an ethnographic approach, conducting qualitative research across a range of field sites (see Methodology). I will be focusing on three primary areas of interest: self-management of healthcare and patient burden of ‘work’; candidacy for healthcare and perception of eligibility for digital versus face-to-face care; and relationships to public services and processes of marginalisation.
This research is being carried out with the intention of informing public policy and service design. Ensuring that vulnerable populations are not excluded from healthcare services by a move to digital engagements is of paramount importance, especially in light of the NIHS long term plan which aims to have a digital option for all patients by 2029, thus, dramatically shifting the norm of face-to-face healthcare encounters. This means clinicians understanding the specific needs of their populations, and also policy makers and service designers taking these into account when designing digital healthcare. Further, the many assumptions inherent in policy planning around digital healthcare in the NHS must be unpacked and examined, to ensure that policies and services aren’t being designed which assume homogeneity across population groups, which ultimately lead to groups of individuals being rendered invisible.
We all benefit from living in a fairer, and more equal society, a message that’s been bought home by the COVID-19 pandemic, and the disproportionate effect on BAME communities and low socioeconomic groups. If some of us lose, we all lose. More inclusive healthcare services are not only advantageous for the populations they are designed for but become easier to use for all users. A system which lets down its most vulnerable populations is not working- and those who are systematically excluded from healthcare services must be taken into account as we face a dramatic shift from face-to-face to digital healthcare encounters. This research will contribute to an understanding of how vulnerable and marginalised populations access and use digital healthcare, or healthcare in the age of digital healthcare. The UK has persistent and ingrained healthcare inequalities which risk being further entrenched by a shift to unequitable digital healthcare practices. Alternatively, digital healthcare may offer up possibilities of reaching the most vulnerable in ways not done before.