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Levelling up healthcare: why NHS Trusts in coastal communities need a clear digital strategy

Coastal communities in Britain have consistently worse health outcomes than communities inland. Substantial investment in digital will be crucial to levelling up.

The Chief Medical Officer’s 2021 annual report highlights how coastal communities across Britain face stark inequalities in terms of both health outcomes and health and care provision. According to the analysis by Professor Chris Whitty and his team, coastal communities “have some of the worst health outcomes in England, with low life expectancy and high rates of many major diseases.”

Levelling up healthcare: why NHS Trusts in coastal communities need a clear digital strategy

For example, the map below, sourced from the Chief Medical Officer's report, shows how rates of coronary heart disease are consistently higher in coastal communities than inland.

What are the causes of poor health in coastal communities? 

There are several reasons for this: 

  • They generally have large populations of older, retired citizens
  • Large numbers of former guest houses and caravan parks provide cheap housing for residents, leading to concentrations of deprivation
  • Many coastal communities were created around a single industry (e.g., tourism or fishing) which has since disappeared, meaning work can often be scarce or seasonal, exacerbating deprivation levels
  • Attracting NHS staff to peripheral coastal areas, often with poor transport links, is more difficult

Unfortunately, as the report identifies, coastal communities “have been long overlooked, with limited research on their health and wellbeing… As a result, deprivation and ill health at the coast is often hidden by relative affluence just inland.” Moreover, despite having an older and more deprived population, coastal communities have 14.6% fewer postgraduate medical trainees, 15% fewer consultants and 7.4% fewer nurses per patient.


Substantial investment is needed, particularly in digital

To level up population health outcomes across the UK, we need greater investment in health and care in coastal communities. The Chief Medical Officer’s report and the national focus on levelling up may catalyse this increase in investment.

However, it’s equally as important to consider where any new investment is spent. At The PSC, we believe substantial investment in digital is especially crucial to levelling up health and care for coastal communities.

Digital is more than just IT: it’s about using the power of technology, data and digital services to change patient care and transform the way the NHS works for the better. Consequently, digital is becoming increasing vital to the day-to-day running of efficient and effective NHS services. For example:

  • Electronic patient records facilitate seamless sharing of information across organisational boundaries to improve the safety and efficacy of patient care
  • Digital clinical alerts and decision-support tools help clinicians make the right decisions for patients fast
  • Smart rostering, single sign-on and performance analytics allow for greater organisational efficiency
  • Patient portals and patient-held records empower patients to take greater control over their own health and care
  • Population health analytics enable Trusts to proactively deliver targeted and preventative interventions in the community to improve general population health

It’s therefore unsurprising that it’s now considered best practice for Trusts to spend 5-7% of their total expenditure on digital (based on recommendation from NHS digital healthcare experts we have consulted). 

NHS Trusts in coastal communities are particularly in need of digital investment for two reasons. Firstly, coastal Trusts tend to be less digitally mature than average, as demonstrated by their underrepresentation amongst NHS England’s digital exemplars. And secondly, digital tools are especially valuable for Trusts serving populations with high rates of long-term conditions, as we know are common in coastal areas. For example, whilst population health analytics can help Trusts target preventative care at those with long-term conditions, patient-held digital tools can help patients manage their conditions better themselves.

Recent NHS Planning Guidance has stated that significant levels of capital will be made available over the next three years to support the digitisation of acute, mental health, ambulance and community services, with funding prioritised for those providers who are the least digitally mature. Meanwhile, NHSx’s Unified Tech Fund is already providing a range of opportunities for digital funding.


A clear strategy is needed 

In order to attract this funding and accelerate their digital transformation, coastal NHS Trusts need to lay out a clear strategy for how they will make best use of digital tools to improve care.

Alongside identifying where digital technologies will most improve quality of care and organisational efficiency, such a strategy should also include a plan for making digitally-enabled healthcare accessible to those with low digital confidence, skills and/or access. Socially prescribing digital skills workshops, offering access to digital technology in community hubs and continuing to provide access to all services non-digitally are just some of the ways Trusts can ensure digitally-enabled healthcare is inclusive, reducing rather than exacerbating health inequalities.

During our recent work with the University Hospitals Plymouth (UHP), our team drew on their wealth of experience in both digital healthcare and healthcare strategy to develop a comprehensive and engaging digital strategy.

The strategy identifies clear priorities for digital investment, alongside a plan for mobilising a programme of delivery, providing a simple and practical roadmap for UHP to embark on its journey of digital improvement. It provides an invaluable foundation for UHP to: build business cases for the key digital technologies it needs; embed digital considerations into its New Hospital Programme build; and attract funding for digital from central NHS organisations.


We are now hoping to help more NHS Trusts, and particularly those in coastal areas, develop a clear and ambitious digital strategy, propelling them into a new era of digitally-enabled healthcare which saves money, improves care and keeps us all healthy.


Author: Josh Myers, The PSC Strategy team 

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