Digital Inclusion is a Strategic Imperative for the NHS

Digital inclusion is often framed in moral terms as the right thing to do for our communities and the people who are at risk of being left behind. But increasingly, the imperative to act is also economic, operational, and strategic. As we move to digitise our healthcare systems, where digital tools are central to service access and care delivery, digital exclusion is increasingly inefficient and unsustainable and the consequences of exclusion ripple across the system. 

Exclusion Wastes Resources and Reduces Outcomes

One of the most immediate impacts of digital exclusion is operational inefficiency. Digital exclusion leads to missed appointments, duplicated effort, and poorer health outcomes, all of which serve to escalate costs. As more services shift to “digital by default,” the risks of inequitable access compound, affecting everything from return on investment to regulatory compliance.

Individuals who are excluded for whatever reason, will struggle to book appointments online, will miss follow-ups because they don’t understand how to access a virtual consultation, will not understand how to review and interpret their digital test results and will call up busy GP practices to request prescriptions instead of via the NHS app. 

There will be those who distrust digital channels altogether. People who are unable or unwilling to access digital services are more likely to disengage from care or fall through the cracks. Digital exclusion means failure to access timely care, which in turn increases their reliance on emergency and unplanned services. It can also prevent individuals from managing long-term conditions proactively, leading to avoidable deterioration, preventable hospital admissions and escalating cost of care.

Studies have shown that patients who miss outpatient appointments (DNAs) tend to be older, from more deprived backgrounds, and are less digitally engaged, all of which are factors that are closely linked to worse long-term health outcomes and higher health system costs. 

As Health systems invest in its digital infrastructure, such as patient portals, online booking, virtual consultations, AI triage and remote monitoring, these investments will only deliver value if they are used. When uptake is concentrated among younger, more affluent, and more digitally literate groups, the benefits of transformation are distributed unevenly, undermining both clinical and financial returns. For example, data from NHS Digital showed that NHS App usage is significantly higher in less deprived areas and among working-age adults 

Meanwhile, those with the greatest health needs, including older people, people living in poverty, and ethnic minority groups, are less likely to register, download, or engage with digital health services. This pattern creates a double loss: it widens the inequality gap, and it reduces the system’s return on digital investment.

Increasing Regulatory and Operational Risks 

Ensuring equitable access to care, including digital care is increasingly a legal and regulatory obligation. The Health and Care Act 2022 places a statutory duty on NHS bodies to address health inequalities as a core part of service planning and delivery. Central to this is the Triple Aim Duty, which requires decision-makers to consider the impact of their actions on, health and wellbeing, quality of services, and the sustainable use of NHS resources. The Act mandates that inequalities be addressed across all three dimensions.

In addition to the triple aim, the Act introduces a Health Inequalities Duty that places a direct responsibility on NHS England and Integrated Care Boards (ICBs) to actively reduce disparities in health outcomes. This means that digital transformation efforts, must be designed and implemented with inclusion at their core.

The Care Quality Commission (CQC) has also strengthened its focus on health equity. It increasingly evaluates whether services are accessible to all segments of the population, including those who may face barriers to digital engagement. Trusts and providers that cannot demonstrate proactive efforts to enable inclusive access may face reputational damage, poorer inspection ratings, or even financial penalties.

National guidance reinforces this. NHS England’s “What Good Looks Like” framework recognises digital inclusion as a key pillar of equitable, high-quality care. It sets out expectations that digital services should be accessible, inclusive, and tailored to meet diverse user needs, regardless of age, literacy, language, or connectivity barriers.

Similarly, the Core20PLUS5 strategy identifies digital inclusion as a critical enabler of system improvement. It highlights how disparities in digital access and skills can exacerbate existing health inequalities and limit

engagement. Embedding digital inclusion into mainstream service planning is a requirement for meeting national equity targets but will also strengthen public trust and future-proof their digital ambitions.

Despite these risks, digital inclusion remains under-discussed at board level. The focus on the success of digital implementation efforts are more likely to be measured in user numbers or implementation milestones, rather than equity of access. Can all

NHS organisations say with confidence they know who is not engaging with their digital services, why, and what is being done about it?

Leadership teams need to be asking who is being left behind in our digital transformation efforts? Are we collecting and analysing demographic data on digital access and usage? Are we co-designing services with those who are most likely to face barriers? Are inclusion risks being logged, managed, and mitigated in the same way as other strategic risks?

Digital inclusion will drive more cost-effective use of the resources already invested. Inclusion also supports delivery of national priorities such as reducing waiting lists, enabling elective recovery, improving long-term condition management, and reducing health inequalities.

The Good Things Foundation, in partnership with the NHS, found that investing in digital inclusion could save the health and care system hundreds of millions of pounds annually by reducing appointment no-shows, enabling earlier intervention, and increasing efficiency. Evidence from the NHS Widening Digital Participation Programme, found that targeted digital inclusion interventions significantly improved health outcomes and reduced NHS demand. Co-designed local ‘digital health hubs’, supported over 285,000 people, with 53,000 people experiencing improved digital health literacy. And increased confidence in managing their health. Follow-up surveys found that 33% made fewer GP visits and 14% used A&E services less. A return-on-investment analysis from Phase 1 estimated £6 in NHS savings for every £1 spent.

Digital Health Equity Requires Strategic Oversight

Having inclusive digital health services is fundamental to building a resilient, cost-effective, and equitable health system. As healthcare delivery becomes increasingly reliant on digital access, those excluded will face greater risks of delayed care, worse outcomes, and disengagement, which won’t just impact individuals; they will increase system-wide inefficiencies and drive-up avoidable costs, challenges that the NHS can’t ignore in the current economic climate. On the other hand, achieving greater digital health equity will improve organisational performance, enhance value for money, and strengthen public trust.

To achieve this, digital inclusion requires greater focus within strategic planning and oversight. Boards and senior leaders have an important role to play in embedding it into organisational governance, investment decisions, and performance and risk frameworks. In this way the full benefits of digital transformation be realised across the entire population.

This requirement forms part of the Leadership and Governance domain of  EquitiHealth's EquiIndex, a self-assessment tool designed to help organisations evaluate and progress toward digital health equity.  The Framework includes assessing for senior-level accountability, strategic alignment, and oversight in embedding inclusion within digital strategies. This includes integration into risk management processes, investment and funding decisions, and the routine collection and review of access and uptake data. Strengthening governance is an essential foundation of ensuring that digital transformation delivers equitable outcomes for all.

“Digital transformation without inclusion is the digitisation of inequality.”

Get in touch for more information on the EquiIndex Maturity Assessment and how it can help your organisation progress towards greater Digital Health Equity.