Digital Exclusion – a personal perspective

14 September 2021

As part of KSS AHSN’s strategy to do more on inclusion, and in line with the digital skills work George Anibaba is leading on, as outlined in Face to face with digital exclusion, we’ve connected with people coming at exclusion from their own angles.

In the first guest blog we hear from social entrepreneur and life-long digital enthusiast David Barker who has recently launched Techcentre Training, a social enterprise offering accredited online courses to support people to get back into work. 

We also hear from Mark Watson, Digital Programme Director at Sussex Health and Care Partnership, who considers the movement towards digital service provision in the NHS, drawing on his experience of changes across the Sussex system.

David Barker – The positivity of Digital

From the age of 13 I knew that I was going to have a career in technology, and at 15 I started to explore the local college and university route but felt that wasn’t for me – I just wanted to go into work. I went to see my careers advisor and asked if he could help. He told me that I wasn’t going to be able to work in technology without a degree, and especially with my background of a poor, white, working class lad from North Manchester.

He told me he could help me get a job in retail but I said no thanks as it was not my dream and left school unemployed. That was hard, two or three months trying to find work. There were no charities like there are today. You were on your own in 1987.

But, thankfully, Margaret Thatcher’s Conservative government launched the Youth Training Scheme, asking employers to take on apprentices, and I got two applications out, one to Shell Oil to train as an accountant and another to this small education technology company, and received offers from both. I went for the small business who offered a third less in terms of salary but it was the perfect opportunity to kickstart my technology career.

The rise of the internet

This was in the days of the BBC Micro. We specialised in educational software programmes, e.g. teaching maths and English, and it was really exciting to be using technology to help people learn. I was there for seven years, and then the internet came along. I was passionate about the potential of the net, but the company decided it wasn’t going to go in as an early adopter. I left with three friends to create one of the first internet marketing companies in the UK.

Our first client was Microsoft and our second was Intel, who I then worked with for 10 years, specifically working with their futurists, predicting what society is going to look like in 15 years.

It was a really exciting time and I’ve always been an evangelist for the potential of a utopian society through the use of the internet, but ten years in I realised that we’re heading to more of a dystopian version of global growth of technology.

By 2004, I felt there was more unemployment, social breakdown and disorder, which is one of the reasons I left to became a social entrepreneur

The Fourth Industrial Revolution

We’re now in the Fourth Industrial Revolution, which has come about because of the opportunities presented by the internet. But I knew that not everyone had the skills they need to thrive in this age. When I left my internet marketing company in 2004, I funded my own nine-month research project, studying what it is that’s holding people back. I spent a lot of time meeting people, researching why some people are able to find employment and others are not, and it worked out to be two main reasons.

The first is equality of opportunity – you live in the wrong place or you’re from the wrong background.

But the major reason I found was that it’s about skills. It’s very easy to hone in on people lacking the digital skills – the latest statistics tell us that 17 million people don’t have the digital skills they need for their current jobs, and 12 million people don’t have the skills they need to access basic digital services and government.

And of course we need to solve that, but when I was analysing the skills gap with people, it’s not just about digital intelligence. It’s also the fact that many people never quite got the right education at school, college or university in terms of IQ and emotional intelligence.

Intentional training

Employees always say we hire for technical skills and we fire for soft skills. When have you ever had emotional intelligence training as a student in a school, college or uni? It’s accidentally picked up through accidental circumstance. Why can’t we be more intentional about it?

As an entrepreneur my responsibility was to think ‘there’s a gap here and there’s an idea of what we could do, so why don’t I invest some money to try to tackle it and prove something?’

I knew I’d never get any funding for an idea, so I sold my house to fund a pilot. Not everyone would do that but, you know, I thought in for a penny in for a pound.

At the end of my trial I had helped long term unemployed people back into work through a new programme I designed that provided training in IQ, and emotional and digital intelligence at the same time.

Despite its success I wasn’t able to raise the money needed to take it further, so in 2006 I had to park that approach. I went back to commercial work to make money to keep developing the idea, and then in 2010 the New Labour government under Tony Blair launched the Future Jobs fund.

Future Jobs provided funding that allowed us to open pop-up training centres in Glasgow, Newcastle, Skelmersdale, Worcester, London, Guildford and Eastbourne. 54% of the long-term unemployed we worked with left those centres into full time employment or created their own companies, compared to 7% of people taking part in government training programmes.

The impact it made on the course participants was huge. We were working with people that had been unemployed from six months to 19 years. We had people with degrees coming out of their ears but still couldn’t find work. Once you get into the trap of unemployment you slowly get depressed, you lose your confidence.

A scalable approach

While the pilot was a great success in terms of results, the cost base was too high and it just wasn’t scalable, and unfortunately with a change of government policy on training programmes, I couldn’t secure the funds to develop the idea further. So, in 2014 I parked everything and moved on to new projects. When these projects ended last year, it set me free to think about what I was going to do next. And I realised that we could still deliver the training, but we didn’t need to do it by physically being in the community – there were already schools, colleges, universities and charities running programmes and working with the people we’re trying to reach.

What if we focused on accredited online training courses that we believe increases IQ and emotional and digital intelligence, delivering the programmes alongside the work these groups are already doing? And so I launched Techcentre Training.

I’m really excited about this approach, and crucially it’s a really scalable model. People are able to come into an existing setting and take our course knowing that there are already staff in place to support them with any wider issues that could be holding them back.

COVID has been a very negative thing for the world, but if there’s one positive it’s that it has it’s accelerated people’s use of technology.

Digital is positively helping to include more people that were excluded for reasons such as geography, or the need to isolate. However, there’s still too many people who don’t have a device or can’t afford data. There’s a big requirement, again from government and industry, to solve this puzzle, because we do just seem to be spinning our wheels at times. There seems to be too much talk and not enough action.

So the challenge now is how do we sustainably end digital exclusion? It’s not an easy answer, it never will be, but we’ve got to get better at finding ways to help everyone get access.

About Techcentre Training

Techcentre Training was founded by Internet and Social Entrepreneur David Barker, with a mission to ensure everyone has the skills they need to thrive in the 4th industrial revolution.

It achieves this by providing a range of accredited, video-based, online learning and training that helps to increase the IQ, EQ (emotional intelligence) and DQ (digital intelligence) needed to thrive in the modern workplace and careers.

The course categories currently provided include business and employability skills, digital skills for business, health and safety, and health and social care.

There are two models to access the online training courses – pay-per-course and unlimited subscriptions for organisations. Find out more here.

Mark Watson – Digital Transformation in Sussex

I’ve worked across a range of different public sectors including local authority and social housing where the need to move to digital services have been quite normalised and acknowledged, although not necessarily dealt with.

I think part of this shift towards digital has been down to local authorities and the charity sector being in some way defined by their purposeful relationship with their local community. They’ve had to develop digital services to meet their populations’ needs while countering internal challenges, such as needing to do more with smaller budgets.

So it’s interesting how digital services can still sometimes feel like a kind of a revelation in health. The NHS is grounded in a medical model with everyone treated equally, but digital has the potential to help it move towards a socio-economic model where treatment is delivered equitably.

And while this move towards a more fair and impartial delivery of services is welcome, it does shine the light on health inequalities, of which digital exclusion and inclusion are key.

A practical approach

In practical terms, more discovery work is needed in health to understand what’s already established, what’s working and what the barriers are to improving.

Because health tends to approach with a treatment mentality it can sometimes look at digital exclusion as something you can treat through specific interventions.

But that’s not always the best approach. Some of this is around how people choose to live their lives, so it may be that you need to shift your services to recognise the disparities in your population, while also making sure that you’re not exacerbating the problems that can occur because of digital exclusion and the need for greater digital inclusion.

Data-led learnings

In Sussex we’ve been looking to data sources and insights to understand people’s experiences, and the COVID pandemic gave us a great opportunity to understand their response to change.

When we look at the insights we gained from the COVID vaccination programme, we can see how sophisticated and qualitative some of that insight really needs to be in order for you then to make changes that are effective – some of your decisions won’t be about how you design a digital service, it will be more about what that practical face-to-face service might be and who might need to deliver it.

We’re now working with KSS AHSN to pull together different digital sources about the population and then layering our digital services onto that. This way we’ll be able to start to start to gain insights around where take up of a digital services is positive or not, and how that reflects the population and its profile in a particular area.

Digital records

My Health and Care Record is one of our flagship digital services, acting as a personal health record and integrating an increasing amount of information from different data sources. This data is available to the patient and allows them to add information and interact and communicate with clinicians who are involved in their care.

We’ve got more than 100,000 people signed up so far, putting us on track to hit our target of 10% of the population by April 2022. To make the most of that data we need to get a sophisticated insight about the profile of people who are actually using it and their experience of using it.

To do that we’ll be flowing data into our Sussex Integrated Data Set, which will give us a much more nuanced understanding of how people are using that digital service.

A question of trust

We could find that My Health and Care Record is most suited for very motivated patients, or it could be that we’re seeing more use from demotivated patients who are in a kind of dependency relationship.

At the moment we just don’t know enough, but by taking in that feedback loop we will get to test different services in different areas and understand what good digital practice looks like, and then do more user research with different populations to gain insights around what would work for them and what the barriers to adoption could be.

A really interesting insight would be around trust, and understanding that if people don’t trust a service, is it because it’s a digital service, or is it about trust in the NHS, or a around a particular service or clinician?

This is a vital question, as I think there’s a real risk that we could start to see digital inclusion and exclusion as a separate domain from other pieces around inclusive and exclusive design and inequality.

In Sussex our leadership around that sits with our Health Inequality Steering Group, which reports up to our population health management and prevention group. Through this we can design initiatives that tackle digital exclusion and inclusion, pulling together as much information as possible to feed into that overarching strategic view around inequality.

Workforce and digital

While we might see big banner headlines in the press around AI and DeepMind, in reality the maturity of a digital approach within our workforce is still quite behind other industries.

One of the key reasons for the slow take up over the last few years has simply been a lack of time and, to some extent, acceptance. The COVID-19 pandemic has really changed the acceptance factor. Video consultations is a prime example where we had small projects running pre-pandemic which saw a huge amount of resistance. With the emergence of COVID people have suddenly understood the value of that approach.

“Not everybody has accepted it, there have been particular sectors and cohorts that have been more willing to make the switch and this is fine – we don’t need to be absolutists when it comes to digital.”

Leading the change

We have a good core group of clinicians and professionals who are enthusiastic about, and knowledgeable of, digital in our Clinical and Professional Informatics Leaders Forum (CPILF). The forum has really good representation from all sectors and it’s a very tight group with a practical approach that is helping to drive day-to-day prioritisation of work.

For example we have Plexus, our digital shared care record. Organisations and clinical areas are developing their user stories to show where they want to have impact, and what the features are that they need to develop.

Because we’re creating it ourselves we get control over that development roadmap, and can work with CPILF to prioritise specific elements that can have more of an immediate impact. This is the opposite approach to the traditional workforce practice, which tends to go after a small number of very big things which take, say, three years to show a return.

An ICS approach

We are a very collaborative ICS in terms of our digital approaches, so our core programmes are ICS programmes across the whole system, and are fully integrated into our ICS governance.

And because we’ve embedded our digital development functions as an ICS we are able to collectively approach this work. For example, with virtual consultations we know there are differences around different population cohorts and different types of services and how they interact with the public.

KSS AHSN has pulled together those insights into a report for us, and we’re going through to understand what’s happened so far, what we know so far, how it relates to our population.

We’ll take the data that we’ve already established and the qualitative and quantitative research to move towards a user centred design process, supported by the Helix Centre, to understand, across all of our partners, how we need to design those next services, how we will work with the public to ensure that they’re designed in a most positive and inclusive way possible, and how we embed that inclusivity and co-design as an ongoing process. It’s about recognising that these aren’t services that you design once, this is about establishing ongoing service design and service development.

One of advantages you see when you go through that fundamental process of redesign is that you’re forced to address issues, both from the perspective of your users and providers. And then you have to redesign in order to achieve a digital service, and often that new digital service will be more efficient and effective and more in-line with the needs of analogue services as well as digital. So the process of redesign helps everybody regardless of whether they’re using a digital service or not.

More from this issue of Innovate

Face to face with
digital exclusion

Levelling up health: tackling inequalities across society