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Betsi Cadwaladr puts digital inclusivity at the heart of health care

Here’s how the Health Board went about implementing its new 'Our Digital Future' strategy.

Betsi Cadwaladr University Health Board is the largest health organisation in Wales and employs over 17,000 staff to deliver services to approximately 703,000 people across North Wales.   

At present, 7% of the population of Wales do not use digital devices of any kind, and with an increasing number of public services being moved online, this leaves those individuals unable to access key support services.   

In this blog Andrea Williams, Betsi Cadwaladr’s Head of Informatics Programmes, Assurance, and Improvement, talks to us about the development of their new strategy to tackle digital exclusion, improve digital skills and confidence and promote a digital mindset.

Read on to discover how Andrea and her team recognised the impact of digital exclusion on the delivery of health services and how they paved a clear path for the development of digital skills within the workforce.

Where to start?

Good strategy starts with a rich understanding of the environment an organisation is operating in and how it is likely to change.

We started by considering ‘Where are we now?’ looking at demographics, statistics, existing strategies, policies and programmes, as well as undertaking SWOT and PESTLE analysis and stakeholder engagement. We also considered the risks, challenges, and financial considerations. By having a clear understanding of our starting point, we were able to understand where we wanted to move to over the lifetime of the strategy.

How did you involve staff, carers, and citizens?

Effective engagement helps translate stakeholder needs into organisational goals and creates the basis of effective strategy development.

An engagement plan was developed which involved a 2-phase approach. The first phase focused on engagement, asking how public/patients/carers and staff could support the vision and delivery of the Digital Strategy, and any foreseeable challenges. The engagement team asked:

  • What experiences the public, patients/carers and staff want to have in the future.
  • What was important to them and what they felt BCUHB needed to do to deliver the experiences.   

The second phase involved surveys, virtual facilitated session, virtual public question sessions and one-to-one meetings with all stakeholders to see if we had got it right.  

We followed up with a “We asked, you said – we did/did not report” to show the difference the engagement had made.  

How much did the consultation affect the structure/content of the draft strategy?

The consultation resulted in some significant changes to both the structure and the priorities of the Digital Strategy, which allowed us to focus on the experiences that were most important to the public/patients/carers and staff. The strategy was also re-shaped as we initially had principles which would not have had delivery plans, they would have just been agreed ways of working. The principles were reviewed and changed to be enablers, each one with its own delivery plan. This change was made due to the feedback received regarding concerns around digital exclusion as we had to actively work on this collaboratively as the strategy is so reliant on digital inclusion.

Were you surprised by the level of importance placed on digital inclusion following consultations with staff, carers, and citizens?

Yes. Digital inclusion was a comment in various questions throughout the survey, especially in relation to “What do you think might stop or get in the way of the above experiences happening?” – digital exclusion was the third highest response for Public/Patients and Carers and lack of digital skills was cited as the second highest response to the same question by staff.  

What impact did the Covid-19 pandemic have on the development of the strategy?

Covid-19 has made us realise that we need to increase the pace of change and get the basics right, so that we can build on them. It was one of the key drivers for the development of the Digital Strategy! 

A significant amount of work was being delivered by the Informatics Teams, from the rapid deployment of Virtual Consultations (safe and secure virtual clinical appointments), to virtual visiting (video calls between patients and families), and rolling out Office 365, which enabled staff to work from home and support the delivery of the field hospitals.  

What did DCW do to support?

DCW were involved from the very beginning and played an advisory role and supported the Team by:

  • Providing an overview of the collaborative work that they were already undertaking at BCUHB.  
  • Providing links to all the key reports and research and guiding on the key ones.
  • Quality assessing and improving the wording around digital exclusion prior to the first phase of engagement. 
  • Quality assessing and improving the wording of the draft digital strategy and delivery plans prior to the 2nd Phase Engagement – including how we can work better together. 
  • Regular meetings to ensure delivery of the Digital Strategy.

Dewi Smith, DCW Programme Manager, said,  “The strategy really gets to grips with the issue of digital inclusion, for both staff and citizens. By highlighting this excellent work, we encourage other organisations to take inspiration for the development of their own digital strategies.” 


Three key success factors in developing the new strategy

  1. A strong team, with the capacity to fully commit to the work.
  2. A good plan.
  3. A wide range of engagement.

Considerations for others embarking on a similar journey

  • Consider these questions:  Where are we now? , Where do we want to be? , Who needs to be involved? , How are we going to get there?  
  • Assess your digital maturity (tool/resource).
  • Use the rich information from your consultation, as the strategy should be about the needs of the end users. It also builds trust and increases the possibility of future engagement.
  • Due to the operating environment, modern day strategies must be more dynamic, so review how they are being delivered.
  • Work with key partners from the very beginning.
  • Work with patients to develop the “service now” narrative.

Useful Links

Betsi Cadwaladr’s ‘Our Digital Future’ strategy

Digital Strategy for Wales

NHS assess your digital maturity