Since the COVID-19 pandemic began earlier in the year digital contact between patients, NHS services and in particular GP surgeries have very much increased. Digital is not wholly new. We make appointments online or by phone. We reorder medicines online. We get routine test results by phone. Consultation on low level conditions has gradually moved to digital platforms. Etc.

This move to digital has some real benefits for both patients and surgery staff and patients. Busy surgery waiting rooms can be places for COVID-19 transmission. Public transport journeys to a surgery may not be safe. A short phone call can safe a long journey, a long wait in a queue and, importantly, time for both patient and surgery staff. Etc.

However, as our supporters have told us, exclusive reliance on digital first may worsen already existing health inequalities. This is not just a matter of many of us not having the appropriate (perhaps expensive) digital platforms. The story below from one of our supporters can stand for many of our North West London population

My mum does not speak English, neither do most of her friends or similar aged family members (70’s). For someone like my mum to try and access her health care related letters, results and booking system is impossible, mostly because of the language barrier, but even if she could read/speak English she has arthritis in her dominant hand and would struggle to type. Her GP surgery has a large Bangladeshi patient base and so the automated message on the phone allows for a Bengali recorded message to be listened to which is obviously much easier for her to use.

I suppose some might wonder why she doesn’t/has not learnt English and I guess it is because economic immigrants like my parents never saw themselves staying here for more than 10 years after arriving because most of their loved ones where ‘back home’. But once they started having children, they understood that their children would benefit more in terms of education and employment by remaining in the UK. My mum had also got used to having my dad manage the doctor’s appointments and so forth, and in a patriarchal society like Bangladesh, this was the norm. I am sure there are other reasons too, but these are the biggest ones. She eventually joined an ESOL class in her late 50’s but found it difficult to retain anything she learnt. Eventually, she became more and more poorly with various health issues and learning to speak English was not high on her agenda. My father spoke English reasonably well, but it took him a long time to get to grips with his android phone, he would have to make copious notes to read so he could add contacts, listen to a voicemail message etc. He too would have struggled to use the NHS digital platforms. He also had early onset dementia before he died so I imagine this condition would have made it even more challenging for him to learn to use an online booking system.

Since COVID-19, she has all her appointments etc on the online system but because she cannot use it, I manage it for her. This is not just a nuisance in the sense that she is not able to use the digital platform, but more importantly it undermines the autonomy and privacy she should be entitled to as a grown woman when it comes to her health, she may not want her daughter to know everything about her health through letters that are uploaded to her account with test results and prognosis. The system itself is not always efficient, for example when booking for a blood test, all the clinics available are not listed. We ended up going to a health centre that was awkward to get to and needed two buses – during COVID-19! On calling the booking line and speaking to an actual person, I learnt there was another clinic much closer to home.

I think the online system has its place, it can be a more convenient way of managing appointments etc for those who firstly, have the means to buy a computer or smart phone, and secondly are tech savvy. But it is important to have other means of managing health care for those who are already at risk of becoming more unwell because they are not able to manage or stay informed on their health matters.