A critical juncture for public services: lessons from COVID-19 Contents

Chapter 10: Digital technology and innovation in frontline public services

“Social workers have had to adapt and completely overhaul how they engage with children and families. We have seen some great examples of how digital technology has improved social care, which I believe should stay for the future. We have heard the same from social workers as well; we are hearing that creative methods on WhatsApp, Skype, Zoom, Microsoft Teams have allowed connections with certain children that were not there before.

“We have social workers reporting that attendance from professionals has increased, so they are having a better professional conversation with families. Often that is centred on health, education or the police. People are now in a virtual room and can contribute.”197

189.Ryan Wise and other witnesses said that digital technology had enabled more efficient service delivery and improved users’ access to services—particularly for those, such as vulnerable children, who are often considered ‘hard to reach’. Technology has given frontline public service workers more autonomy to innovate to meet people’s needs.

190.But digital technologies also bring risks. Ryan Wise warned:

“There are extreme creative benefits from going digital that we should keep, but we should also not forget that those relationships, those sensory moments with people—that sense of feeling, touching, being in the moment—tell us a whole lot about what is going on.”198

191.This chapter considers how public services benefited from digital innovation during the pandemic, and looks at some of the potential drawbacks of providing services online.

Better access and engagement

192.The pandemic precipitated a rapid introduction of digital technology in primary care. The 2019 NHS Long-Term Plan set an aspiration for all general practices to offer patients remote digital consultations by 2024.199 In February 2020, 80 per cent of GP appointments happened face-to-face and just 14 per cent by telephone. In May 2020, two months into the pandemic, 99 per cent of practices had activated remote consultation platforms.200 The Nuffield Trust suggested that this had been achieved by devolving decisions to the frontline. One GP told the think tank that they felt a “freedom to innovate that I’d never before experienced”. Nuffield Trust added that NHS leadership “played a supportive role by issuing guidance and fast-tracking assurance processes”.201

193.The Royal College of Midwives reported that technology had enabled its members to reach women in remote and rural locations. These women had benefited from “virtual triage”, which had “reduced the number of unnecessary visits to hospital”. NHS trusts had rolled out “blood pressure monitors and software for women to record their blood pressure and sugar levels at home, with a clinician checking results remotely”.202

194.Changing Lives, a charity working with vulnerable adults, explained that the way that its staff interacted with service users had “changed radically as a result of COVID-19” with many addiction recovery services, such as group therapy and outreach, now offered online. Technology gave service users more ways to engage with addiction services, leading to more engagement during the first lockdown. Changing Lives reported a “reduction in relapse and, in some services, fewer drug-related deaths” as a result.203

195.Digital technology gave frontline workers in drug and alcohol treatment services greater freedom to make decisions.204 Changing Lives stated that this approach would previously have been hampered by restrictions written into its contracts with commissioning authorities, which prescribed specific ways of delivering services.205 Nathan Dick of Revolving Doors described how this “reduction in red tape” had given frontline workers more scope to innovate and build trust with users.206

196.However, Richard Sloggett of Policy Exchange cautioned that the “real acceleration [in] the use of digital [technologies]” at the front line of service delivery would need to be secured “on a longer-term, more sustainable basis”. It was important to address the “real gap in the expertise and ability of the public sector on digital”. He concluded that “all public bodies” needed to “look at training and education” and “the way people are recruited”.207

Maintaining face-to-face services

197.There will be greater demand for digital services in future. However, relying too heavily on technology could exacerbate inequalities experienced by those who cannot access digital services. There is a link between deprivation and lack of access to digital technologies. The Children’s Commissioner told us: “About 700,000 children do not have access to an iPad or a piece of tech, and about 60,000 of them do not have broadband.”208

198.We heard that face-to-face services should not be reduced if this risked diminishing the quality of public services, or if it put people in danger. Changing Lives wrote that some of its services, such as those for homeless people, would continue to be offered face-to-face. It added that for some people, “home may not be a safe place to access support—for example, people who are experiencing domestic abuse or exploitation. Therefore, we would expect to offer a range of digital and face-to-face services in future.”209

199.Healthwatch argued that it was important to evaluate how the digitisation of GP services had affected patients’ outcomes, regardless of any advances in efficiency.210 The Nuffield Trust advocated users’ involvement in the design of digital services:

“Digital technology works best when it embraces user-centred design. Evidence shows that poorly designed and implemented systems can create opportunities for errors, and can result in frustrated healthcare professionals and patients.”211

200.There is a clear requirement for central Government and local services to evaluate the performance of services that moved online during the first lockdown, ensuring that public services maintain face-to-face services wherever they are needed. They should work closely with service users in conducting this evaluation, because users are best placed to advise on which services should be delivered online, by telephone, or in person.

201.Central Government and local services should build on the advances made during the pandemic by prioritising funding for public sector digital services. The Government should put a particular focus on improving the digital skills of the public service workforce, and improving digital access and skills for those parts of the population that are at risk of digital exclusion.

197 Q 151

198 Ibid.

199 NHS, ‘Online version of the NHS long term plan’ Chapter 4 : https://www.longtermplan.nhs.uk/online-version/chapter-1-a-new-service-model-for-the-21st-century/4-digitally-enabled-primary-and-outpatient-care-will-go-mainstream-across-the-nhs/ [accessed 9 November 2020]

200 Written evidence from the Nuffield Trust (PSR0041)

201 Written evidence from the Nuffield Trust (PSR0041). See also Q 28.

202 Written evidence from the Royal College of Midwives (RCM) (PSR0051)

203 Written evidence from Changing Lives (PSR0042)

204 Written evidence from Collective Voice (PSR0050)

205 Written evidence from Changing Lives (PSR0042)

206 Q 71 and written evidence from Changing Lives (PSR0042)

207 Q 6

208 Q 32

209 Written evidence from Changing Lives (PSR0042)

210 Written evidence from Healthwatch England (PSR0115)

211 Written evidence from the Nuffield Trust (PSR0041)

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