By Yiannis Stirling and Gary McFegan 

Lord Darzi’s independent review into the NHS and appeal for digital investment has garnered plenty of attention, with the prescribed shift from ‘analogue to digital’ expected to feature prominently in the 10 Year Health Plan. Less has been said, however, about the potential risk of widening health inequalities which a digitally forward NHS could pose. 

The risk of exacerbating health inequalities  

Digital exclusion refers to people who ‘‘are unable to access the internet because they do not have the connection, device or skills to get online.’’ As the NHS moves towards a more digitised model of care, a significant proportion of the population could be affected without proactive planning to ensure their needs are met. 

An NHS report (“Inclusive digital healthcare: a framework for NHS action on digital inclusion”) estimated that 7% of UK households do not have internet access at home and around 10 million adults lack foundation-level digital skills. Without complementary “analogue” care pathways, digital exclusion will compound health inequalities by making care less accessible to the most vulnerable populations. 

The potential benefits of digital  

Lord Darzi highlighted the urgent need for significant capital investment, including in technology, to enable the NHS to address increased demand, missed targets and increased waiting lists. Improved digital capabilities throughout the NHS can unlock enormous potential in capacity by optimising efficiency while improving quality of care and patient experience, and can enable key NHS targets to be achieved. These include reducing waiting times and tackling the waiting list backlog. 

Although hospital staff numbers grew by 17% from 2019 to 2023, this didn’t result in an increase in the number of available appointments, operations or procedures. Many factors are driving a critical shortage of capital affecting hospitals and leading to a significant decrease in productivity, including a 7% drop in daily outpatient appointments per consultant, a 12% decrease in surgical activity per surgeon, and an 18% reduction in A&E activity per clinician. 

Often this is the result of time-consuming manual tasks that clinicians undertake, including locating available beds for their patients. Digital tools can help to cut down administrative time and enable clinicians to focus on the work only they can do in the service of patients. There is also huge potential to unlock productivity by improving operational management, as well as investing in modern buildings and equipment. 

Further support for this position was provided by a public deliberation report published in November 2024, which states: “There is enthusiasm for the opportunities that digital and technology can offer to the primary care system…. [Participants’] positive outlook suggests that well-designed digital access routes, supported by adequate capacity in the system, could significantly improve patient experiences and satisfaction with primary care services….” 

However, the report stresses that enhancing digital healthcare access should not replace traditional access routes. ‘‘Maintaining options like walk-ins, phone calls, and direct contact with staff through digital platforms was deemed crucial to ensure equitable access for all, particularly those who face barriers to digital engagement. Clear communication about the continued availability of these non-digital options was considered vital to prevent discouraging or excluding any patient from seeking care.” (“Primary care transformation in London”, IPSOS UK & Imperial College Health Partners, IPSOS 2024). 

Digitisation to enable integrated neighbourhood care  

Key themes for the upcoming 10 Year Health Plan have been clearly signalled. These include movement to a neighbourhood NHS, delivered by integrated neighbourhood teams of primary, community, mental health, social care, voluntary, and other services working together collaboratively and with patients and communities. Excellent digital services, innovations, IT systems and access to shared records will be required to enable this way of working and multidisciplinary models of care. 
 
However, as the NHS moves towards a more digitally-integrated future, there is an increased risk of excluding and disadvantaging patients who are not sufficiently skilled, confident or equipped to access digital communications or services. While the scale of potential digital benefits has been made clear, it is imperative not to leave any patients behind, particularly those most in need of healthcare services. Groups at a higher risk of this include older people, those more economically deprived, socially excluded groups such as people experiencing homelessness, disabled people, communities with inadequate internet access and non-English speakers. 

Improving technical literacy and access to patients, and ensuring that non-digital traditional pathways are still operational and accessible to patients who require them, will help mitigate digital exclusion.  

Engagement with patients and service users is needed to inform the formats for healthcare information and identify where analogue adjustments or alternatives will still be needed. These could include easy read and translated patient information on accessing and use digital options, as well as the continuation of non-digital options including walk-ins and phone calls. 

Moving from hospital to community-based care and driving productivity improvements is heavily reliant on digital advancements, particularly outside of hospitals. This is an area where TPHC has significant expertise and a proven track record, including our engagement and training with client teams to improve their digital literacy. 

Embedding inclusion into the digital roadmap 

The massive scale of transformation required to boost productivity and secure the NHS’s future means that there is work to be done across all levels of the service. To deliver a neighbourhood NHS, all providers and ICBs must work collaboratively to unlock each potential benefit. 

Finding the balance between implementing digital innovation and providing traditional care pathways for those who need them will be paramount to the success of a neighbourhood NHS in the future.  

TPHC’s digital and analytics expertise  

The success of the Digital First Programme in NCL over several years was enabled by TPHC’s ability to scale teams up and down based on demand and its pool of experts. They include project management, business analysts, data analysts and digital specialists. Digitisation is an area of vast potential benefit for the NHS that TPHC is ideally equipped to facilitate.  

To find out more about how we can help in this area, visit our consultancy services page.