Digital inclusion and exclusion


The NHS, and the wider health and care system, is committed to delivering information and services digitally wherever appropriate. For patients, digital health can mean better access to information and care, increased convenience, and more opportunities for greater control of their own health and shared care. For the health and care system digital health can mean more effective delivery of care, better outcomes and reduced costs.

The COVID-19 pandemic has placed greater importance on digital connections due to the rapid transition to online services – including IAPT therapy. However, connecting and accessing services online is not an option for all Londoners. Digital exclusion can have many causes including an absence of devices, connectivity limitations and inability to afford data, a lack of digital skills and confidence and a lack of close at hand support.

11 million people (20% of the population of the UK) are known to lack basic digital skills, or do not use digital technology at all and 4.8 million people never go online at all. These are likely to be older, less educated and in poorer health than the rest of the population.

Londoners who are more likely to be digitally excluded include older Londoners, asylum seekers, disabled people, low-income young Londoners and low-income families. The public health crisis and rapid digital transformation risks exacerbating existing healthcare inequalities further, as those who lack the skills, means or confidence to use digital services are more likely to become digitally isolated. This gives rise to inequalities in access to opportunities, services, knowledge and goods which can have a detrimental impact on mental health.


NHS Digital in its digital inclusion for health and social care guide, advises local health and care services to take into consideration the needs of people who may be digitally excluded and work with a range of community partners to improve digital inclusion.

Furthermore, the Association of Mental Health Providers in partnership with the Mental Health Network’s Digital Mental Health Forum, have co-produced a mental health digital inclusion guide outlining practical tips, case studies and examples, which can be used by mental health providers to make their digital mental health services more inclusive. From the mental health digital inclusion guide, four common principles and essential foundations for digitally inclusive mental health services are to:

  • Understand the needs of people who use your services
  • Provide a personalised approach
  • Prioritise flexibility and adaptability
  • Ensure ongoing communication and feedback.

IAPT service examples

Some London IAPT services have collaborated with other partners to ensure digital inclusion in the provision of services to the populations they serve, please see below for some examples.

ELFT – (Newham, Tower Hamlets and Richmond) and Kingston

IAPT services noticed that referrals from disadvantaged population groups decreased following Covid-19, possibly due to lack of access to digital technology for remote therapy. Therefore, the service opened up clinical spaces by setting up IT ‘pods’, with a computer in therapy rooms so patients can come into the service and are able to access remote therapy via that computer.

City & Hackney

During the COVID-19 pandemic, partnered with third sector partners and personal health budgets (PHB) and used its digitalised system to fast track a ‘Stay Connected’ PHB offer focused on improving digital inclusion for those with a lack of access to equipment. This facilitated quick access to a choice of mobile phones and/or sim cards. Since May 2020 this has enabled 120 people to access and take part in remote support services, join online community activities, access resources and support online, and stay in touch with family and friends during lockdown and beyond. Please see page 16 of the mental health digital inclusion guide for the City & Hackney case study.

IAPT protocol examples

In order to ensure inclusion for all service users so no one is left out and can access psychological therapies when needed, some IAPT services have developed protocols and guidelines for return to face-to-face provision. Below are some of these protocols as examples for other services who are considering return to face-to-face provision.