Introduction
Healthcare inequalities remain a significant challenge within the UK, impacting access to care and health outcomes across diverse populations. As a student of Non-Medical Prescribing (NMP), understanding these disparities is crucial to my future role, where I will be responsible for prescribing medications and ensuring equitable care delivery. This essay focuses on digital exclusion as a key driver of healthcare inequality, particularly among older adults in the community. Digital exclusion, defined as the lack of access to or ability to use digital technologies, has become increasingly relevant with the rapid integration of digital tools in healthcare, such as teleconsultations and electronic prescribing systems. Drawing on current literature and policies, this essay critically explores how digital exclusion affects older adults’ access to healthcare, the implications for my future prescribing role, and potential strategies to address this issue. Key points of discussion include the nature and extent of digital exclusion, its impact on health outcomes, and the policy landscape shaping responses to this inequality.
Understanding Digital Exclusion Among Older Adults
Digital exclusion is a multifaceted issue, encompassing lack of access to devices, poor internet connectivity, and limited digital literacy. According to Age UK (2021), a significant proportion of older adults—approximately 2.7 million people over the age of 65 in the UK—do not use the internet, with many citing a lack of skills or confidence as primary barriers. This exclusion is particularly pronounced among socio-economically disadvantaged groups and those with disabilities, compounding existing health inequalities. Furthermore, the Office for National Statistics (ONS) (2020) reports that only 54% of adults aged 75 and over have engaged in online activities in the past three months, compared to over 90% of younger adults. Such disparities highlight a digital divide that risks marginalising older adults from modern healthcare systems, which increasingly rely on technology for service delivery.
Critically, digital exclusion is not merely a matter of access but also of ability. Watkins and Park (2022) argue that even when provided with devices, many older adults struggle with navigating complex interfaces or understanding digital health platforms due to cognitive or physical limitations. This creates a barrier to engaging with essential services such as booking appointments online or accessing telehealth consultations. As a future prescriber, this raises concerns about how I will ensure patients can access prescriptions or follow-up care if they are digitally excluded. Indeed, without addressing this issue, there is a risk that healthcare delivery becomes inadvertently biased against those unable to engage with digital tools.
Impact on Health Outcomes and Prescribing Practice
The consequences of digital exclusion on health outcomes are well-documented in recent literature. Seifert et al. (2021) highlight that older adults who are digitally excluded are less likely to access preventative health services, manage chronic conditions effectively, or adhere to medication regimes due to difficulties in obtaining information or communicating with healthcare providers. For instance, the shift to electronic prescribing and online pharmacies during the COVID-19 pandemic has made it challenging for some older adults to obtain medications without support (NHS England, 2020). This can lead to treatment delays or non-adherence, directly impacting health outcomes.
From the perspective of my future prescribing role, digital exclusion poses specific challenges. Prescribing in a community setting often involves coordinating with patients via digital platforms for follow-up care or medication reviews. If an older patient cannot access or use these platforms, there is a risk of miscommunication regarding dosage, side effects, or contraindications. Moreover, as digital health records become central to prescribing decisions, ensuring that digitally excluded patients’ data is accurately updated and accessible remains a logistical hurdle. As noted by Honeyman et al. (2020), the reliance on digital systems can exacerbate feelings of isolation among older adults, potentially undermining trust in healthcare providers—a factor that is critical to effective prescribing.
Policy Responses and Their Limitations
UK health policies have increasingly recognised the issue of digital exclusion. The NHS Long Term Plan (2019) commits to expanding digital healthcare services while acknowledging the need for inclusive approaches to prevent exacerbating inequalities. Initiatives such as the NHS Digital Inclusion Framework aim to support vulnerable groups, including older adults, by providing training and access to devices. Additionally, government schemes like the Digital Lifeline fund have distributed tablets and data packages to digitally excluded individuals during the COVID-19 crisis (Good Things Foundation, 2021). These policies demonstrate an awareness of the problem and a willingness to address it through targeted interventions.
However, there are limitations to these approaches. Critically, policies often adopt a one-size-fits-all model that may not account for the specific needs of older adults, such as age-related cognitive decline or physical impairments. Moreover, as Seifert et al. (2021) argue, digital inclusion initiatives frequently focus on short-term solutions—such as device provision—without addressing long-term barriers like sustained digital literacy training. In my future role, this means I may encounter patients who, despite policy efforts, remain excluded due to systemic gaps. Therefore, while policies provide a foundation for tackling digital exclusion, their effectiveness is arguably limited without deeper integration of person-centred support mechanisms.
Strategies for Addressing Digital Exclusion in Prescribing
Addressing digital exclusion requires a multi-faceted approach that I can integrate into my prescribing practice. Firstly, adopting a hybrid model of care—combining digital and traditional methods—can ensure inclusivity. For instance, offering telephone consultations or paper-based prescriptions alongside digital options can accommodate those unable to use technology. Secondly, collaboration with community organisations, such as Age UK, can help identify digitally excluded patients and provide them with tailored support or advocacy. Finally, as a prescriber, I can contribute to raising awareness among colleagues about the impact of digital exclusion, advocating for training on inclusive communication practices.
Moreover, staying informed about local digital inclusion initiatives will be essential. For example, referring patients to community digital skills workshops or liaising with social prescribing link workers can bridge the gap between healthcare and technology access. While these strategies require time and resources, they align with the ethical responsibility of prescribers to ensure equitable care, as outlined in the General Pharmaceutical Council’s standards (GPhC, 2021). By actively engaging with these solutions, I can mitigate some of the adverse effects of digital exclusion on my patient cohort.
Conclusion
In conclusion, digital exclusion represents a significant form of healthcare inequality, particularly affecting older adults in the community. This essay has explored how limited access to and familiarity with digital tools create barriers to healthcare access, negatively impacting health outcomes and posing challenges to my future prescribing role. Current literature highlights the scale of the digital divide, while policies such as the NHS Long Term Plan indicate a growing recognition of the need for inclusion. However, critical gaps remain in addressing the unique needs of older adults. As a future prescriber, I must adopt strategies like hybrid care models and community collaboration to ensure equitable service delivery. Ultimately, tackling digital exclusion is not only a policy imperative but also a professional duty, ensuring that my prescribing practice upholds fairness and accessibility for all patients. By critically engaging with this issue, I can contribute to reducing healthcare inequalities and improving outcomes for digitally excluded older adults.
References
- Age UK. (2021) Digital exclusion among older people. Age UK.
- General Pharmaceutical Council (GPhC). (2021) Standards for pharmacy professionals. GPhC.
- Good Things Foundation. (2021) Digital Lifeline: Supporting digitally excluded people during COVID-19. Good Things Foundation.
- Honeyman, M., Maguire, D., Evans, H., & Davies, A. (2020) Digital technology and health inequalities: A scoping review. Public Health Research, 8(3), 1-68.
- NHS England. (2019) The NHS Long Term Plan. NHS England.
- NHS England. (2020) Electronic prescribing during the COVID-19 pandemic: Guidance for practitioners. NHS England.
- Office for National Statistics (ONS). (2020) Internet access – households and individuals, Great Britain: 2020. ONS.
- Seifert, A., Cotten, S. R., & Xie, B. (2021) A double burden of exclusion? Digital and social exclusion of older adults in times of COVID-19. The Journals of Gerontology: Series B, 76(3), e99-e103.
- Watkins, I., & Park, S. (2022) Digital divides in later life: Exploring the roles of digital literacy and social support. Technology in Society, 68, 101842.
