What they did

The Scottish Government are aiming to make the best use of digital technologies to improve how people access health and care services. One of their key goals is to create a secure and user-friendly online platform called the 'Digital Front Door’. This will be available through a website and an app.

Although some services such as the NHS 24 Online app are already available, the Digital Front Door is to provide a single access point for a wider range of health services across Scotland. People will only need one login to access a range of services.

The Digital Front Door is intended to benefit all Scottish citizens. It may however affect some people and communities differently than others. To ensure the Digital Front Door is inclusive and accessible to everyone, the project team engaged with stakeholders in the early stages of the process. 

The team’s objectives included:

1. Co-designing an engagement strategy with knowledgeable partners.
2. Engaging with representatives of key stakeholders to co-produce the EQIA.
3. Influencing the design process through user testing and integrating feedback into decision-making.

An Equality Impact Assessment (EQIA) was co-produced to support these objectives. This helped the project team ensure the work could identify and address potential barriers for different groups. They focussed on the nine protected characteristics listed under the Equality Act 2010 and, alongside this, considered additional groups who may experience barriers: unpaid carers, people with low incomes, and people living in remote, rural, and island communities.

What worked well

The team successfully co-designed an engagement strategy with key stakeholders. The project team conducted interviews and organised events with knowledgeable partners, including members of the Scottish Government Equalities and Inclusion Group. These activities helped shape the Digital Front Door User and Engagement Stakeholder Strategy, which was published in November 2022.

The first phase of engagement was facilitated through organisations such as Health and Social Care Alliance Scotland, Young Scot, and the Scottish Commission for Learning Disability. It mapped stakeholders, their interests, influences, and current experiences of accessing health and care services. Positive and honest relationships with stakeholders was key to ensuring meaningful engagement. The engagement process revealed that all stakeholder groups faced challenges in accessing services, not just digital services. This highlighted the need for trusted organisations to assist with broader engagement.

Co-producing the EQIA was another success. Initially, there was a perception that EQIAs were just ‘tick-box' exercises. The project team had already learned through delivering Near Me that focussed conversations could unearth compelling equality considerations.  Workshops independently facilitated by members of the NHS Scotland Equality and Diversity Lead Network were held to achieve this. Participants included representatives from Age Scotland, Alzheimer Scotland, Change Mental Health, COSLA, Disability Equality Scotland, Inclusion Scotland, Macmillan, MECOPP, Positive Action in Housing, Public Health Scotland, RNIB, SCVO, the Scottish Commission for Learning Disability, the Scottish National Public Sector Minority Network, and Young Scot. 

Through the workshops, priority areas were identified and the Digital Front Door Programme Team began gathering further evidence. Follow-up meetings occurred between workshops, including with those from remote, rural and island communities. When the EQIA evidence was finalised, the focus turned to a mitigation plan addressing the barriers and inequities that had been identified. Other impact assessments, including an Island Communities Impact Assessment were also progressed.

Key learning from the EQIA process highlighted the importance of engaging with people early in the process and not making assumptions about their needs and preferences. Using evidence and engaging with a broad range of stakeholders to influence the programme was invaluable.

Challenges

One of the main challenges faced during the Digital Front Door project was overcoming the perception that EQIAs are no more than an administrative necessity.  Meaningful participation addressed this and demonstrated the value of the EQIA process and its benefits to the project.

Integrating the EQIA findings into project governance presented another challenge. It was important to secure early understanding and buy-in from senior leaders around the importance of the EQIA process. This required regular updates and opportunities for senior colleagues to offer direction around equality considerations within the project. As the EQIA process developed, informal and formal updates were provided to various groups, including the Equalities and Inclusion Advisory Group, the Digital Citizen Board, and the Programme Board for the Digital Front Door. Some of the active participants in the process were also members of these groups, which helped integrate their knowledge into the decision-making process.

Watch our video

This short video explains how the Equality Impact Assessment is guiding the design of the Digital Front Door. You will hear from four contributors involved in the process, highlighting important insights:

• The vital role of leaders in addressing digital exclusion as part of the design.
• The importance of starting an EQIA process early.
• Understanding that some people who currently cannot use digital options would like to but are excluded.
• The importance of acknowledging people have multiple protected characteristics, and potentially experience overlapping forms of discrimination.
• Acknowledging the help of everyone who participated in the EQIA process.

The success of the Digital Front Door project demonstrates that proactive and inclusive approaches can lead to better outcomes for all. It highlights the importance of using Equality Impact Assessment (EQIA) to anticipate and address potential barriers, ensuring that new services are accessible and beneficial to everyone.