Below is my argument for free access to wi-fi in NHS settings that I made in a recent ‘head to head’ article in the British Medical Journal. You can find the full article, including the ‘no’ argument made by GP Grant Ingrams here.
Aspirations for digital technology to transform health and care systems are high. The UK government’s reportPersonalised Health and Care 2020 sets out a framework for digital technology to improve patients’ experience and outcomes with more efficient services.1 Citizens will have full access to their care records, an expanding set of NHS accredited health and care apps, and digital information services. We will transact with health services by accessing diagnostic results, ordering prescriptions, and contributing patient generated information to our care record.
This bold ambition can be realised only with digitally engaged citizens and the removal of barriers such as lack of access to public wi-fi in healthcare settings. The health divide will widen unless action is taken to ensure that people who are digitally less confident have access to their health information and can make sense of it.2
Digital ubiquity
Digital technologies are increasingly widespread in day to day life, but healthcare seems to lag behind other sectors and the expectations of citizens.1 The telecommunications regulator Ofcom says that 93% of UK adults have a mobile phone and 61% have a smartphone.3 The 2013 Oxford Survey of Internet Cultures, which included around 2600 UK adults, indicated a trend for people to use their mobile handset to access the internet and a growth in “next generation users,” who use multiple devices on the move.4
We have seen substantial increases in use of the internet for phone calls, instant messaging, and entertainment, with 69% of adults using the internet to find health information and a steady rise in use of digital government services.4 However, despite the growth in ownership and use of smartphones, many owners cannot afford the data plans necessary to access the internet outside their homes or free wi-fi hotspots.2
Supporting shared decision making
A systematic review of links between good patient experience and improved clinical outcomes found a positive self rated and objectively measured association.5 Boredom is common in hospital settings and is similarly related to poorer health outcomes.6 Free hospital wi-fi allows patients to seamlessly continue their everyday interactions, keeping in touch with friends and family, accessing information and entertainment, as well as undertaking tasks such as paying bills and keeping in touch with work.4
From a clinical perspective, free wi-fi allows access to online health information and supports shared decision making through access to medical mobile apps and digital personal health records. Transactions such as bidding for social housing are most easily done online and can be an important part of planning discharge from hospital. It is not just patients who benefit: a small qualitative study found that people with caring responsibilities benefit from using devices out and about to access essential information and services during regular visits to relatives’ homes, in hospital, and at general practice appointments.7 And for younger people the idea of being unable to stay connected online while in hospital is simply unfathomable.4
Public wi-fi already exists
Public wi-fi is increasingly being installed in hospitals and is the subject of a campaign by the social media consultant John Popham, who has written widely on the topic.8 The Mount, a mental health and dementia inpatient unit for older people in Leeds, has recently introduced a “DigiWards” project funded by NHS Widening Digital Participation. It provides free public wi-fi and prescribed smart devices for patients. Occupational therapists on the wards already teach digital inclusion skills, such as online shopping, and this approach is set to expand with digital reminiscence work and skills development for patients and carers.
The Sloane Medical Centre general practice in Sheffield is a “digital surgery,” where staff from UK Online Centres, a non-profit organisation that seeks to combat digital exclusion, and volunteers help patients to use the internet and find out more about their health as well as book appointments and order repeat prescriptions.9 These examples show how digitally engaged and included citizens can be supported to manage their health and wellbeing.
Digital inequality
Access to the internet is not evenly spread—54% of the seven million adults who have never used the internet in the UK are registered disabled, and 37% of people who are digitally excluded are social housing tenants.2 A population based longitudinal cohort study found that a third of older adults lack basic health literacy, which is associated with a higher risk of death over five years even after accounting for socioeconomic circumstances and baseline health.10 With health and care policy in the NHS focused on increasing online transactions with public services, alongside promoting use of digital tools and services, it seems clear that digital and health literacy are becoming increasingly related.1
Free wi-fi is already available in an increasing number of NHS settings. NHS Choices includes availability of wi-fi in its information about hospital facilities. Further research into the personal, clinical, societal, and health implications is required. However, the advantages of free wi-fi in healthcare settings in an increasingly digitised world make sense, likely facilitating more patient activation and engagement alongside improved outcomes.
References
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