It’s not a service if....

Pete Nuckley

7th July 2021

Back to blog

Some thoughts on services in the world of digital transformation and health

  • It's not a service if I bend to it
  • It's not a service if everybody doesn't understand how it works
  • It's not a service if it takes more effort from me than you
  • It's not a service if I'm not moving forward
  • It's not a service if it's for others and not me
  • It's not a service if my objectives aren't met

Over the last couple of months my colleagues and I have been, very kindly, invited to present at a number of big conferences on the subject of Inclusive Digital Transformation - in health.

Often in presentations I say the line

“Our measure for success is if in 5 years time we don’t say the word digital anymore” 

I say this because I want to acknowledge a couple of things that seem to be (quite rightly) raised during these discussions.

  1. ‘Digital isn’t for everyone! There are some people who will never ‘do digital’. By the way, I agree entirely with this statement. I do think that the proportion of people who are in this group is smaller than we think though because some will say that but haven’t had opportunity/access to see benefits for them.
  2. ‘Digital needs to compliment services not replace’. Yep. And all too often there are funded programmes of digital transformation that become a thing unto themselves without taking into account the fact that people don’t interact in isolation of your service.  


A quick story

A GP told me that in their practice a patient could come in at 9:00am on Monday morning presenting some cardiovascular problems. If that person has access to a smartphone and Wifi (and the confidence and skills to use it) then they can be seen by a cardio consultant by 15:00 that same day and placed on to a pathway. BRILLIANT. 6 hours and this person has spoken to an expert and is on the way to being better. 

If a person doesn’t have a smartphone/wifi/confidence then getting to that same point takes 12 months!!!! So what we are saying is that people who are excluded (who happen to map identically with those who face the most extreme health inequalities) have to wait 1,460 times longer than those who are included. 

Do we all agree that we have got something wrong here? 


Another quick story

I’m extremely lucky. My finances seem ok(ish) at the moment and I have a stable income. In fact, a couple of years ago I got a modest promotion which increased my wages (slightly). This new income took me over a threshold with my bank where I went from a ‘Basic’ to a ‘Premium’ customer. Genuinely those words. To mark the occasion I got

  • A new sexier bank card with different colours presumably so I could flash it in the bank and be taken through the curtain to the ‘premium lounge’
  • Better interest rate on my account (yep… I had more money and they were going to give me more money because of it)
  • Access to a financial investor-person who could improve my ‘portfolio’ (not quite sure that 1 share I got bought in Jack Daniels as a joke 18th birthday present counts as a portfolio).

Point is….. I got a different service because I had more money.

Suddenly their service was very different.

Now that may work for a bank who wants to keep me and make sure I keep my money there but it doesn’t for the NHS.

Health is health and there are no Basic or Premium customers!!!

Which leads me to my point about services and getting rid of the word digital. There is something in making sure we know what a service is trying to achieve, and making sure it achieves that for everyone (equally). 

So I tried to write a couple of points to try and characterise services in the context of health and transformation. These are just a few I’ve been thinking about. They may not be right and there may be loads more. But it’s something I’m going to keep thinking about.

(NOTE: people much smarter than me will have thought about this stuff and there will be better lists out there.)


  1. It's not a service if I bend to it - we know that the NHS is built on a concentration of clever people in the middle working really hard to help us. Because their time is finite then we (the population) have to go meet them at a time and place that suits them. People who can’t afford 3 buses to a hospital for a consultation or the time off work or the wifi for a video consultation etc are priced out
  2. It's not a service if everybody doesn't understand how it works - I have no idea how the NHS works. If there is a service there are presumably steps within that. People need to know what is coming in a way that they can digest thoroughly. For those who don’t have self efficacy they can feel like they are being done to instead of supported.
  3. It's not a service if it takes more effort from me than you - If I have to carry my own records and keep meticulous notes on the medication that I’ve had or re-tell my story of an impairment over and over again then I’m putting more into this than you. My activation is fickle (because life's complicated and hard) so I need a path of least resistance
  4. It's not a service if I'm not moving forward - there may be waiting lists for things. But not having a date and not having anything to do in the meantime means that I’m not moving forward. If I’m still then I’m not in a service
  5. It's not a service if it's for others and not me - If a consultant can see my rich friend within 6 hours then I’m sure there is some way to see me.
  6. It's not a service if my objectives aren't met - I enter health services with objectives in mind. They may differ from yours. We need to discuss these before we move forward.

So…. It’s all very well finding out what’s wrong, but what can we do about it? I hear you shout. 

That’s a good news/ bad news situation I’m afraid.

Bad news…. Dunno! There’s no perfect example of the perfectly inclusive service. Even if there was it would need to be constantly changed anyway

Good news…. There’s lots of people figuring things out all the time. We’ve put together an NHS Futures workspace where we collate some of the amazing work going on around co-design, service redesign, inclusion and transformation. Which means whilst we are aiming for perfection we can at least improve.

Anyway, these are some things we are thinking about. Let us know what you think.

Pete Nuckley

Read bio