Digital Exclusion and Transformation

12th September 2024

**Safeera Ahmed, Managing Consultant at NHS TU and NHSE Core20PLUS Ambassador**

Thursday 12 September marks the second annual ‘End Digital Poverty Day’, a day of awareness for digital exclusion and poverty initiated and hosted by the Digital Poverty Alliance (DPA). Established in September 2023, the day sees individuals and organisations come together to provide support and solutions to ultimately improve the digital access gap for all communities across the UK.

What is Digital Exclusion?

Over the past decade we have seen a rapid acceleration in the adoption of digital health technologies, such as telehealth and online health services. The COVID-19 pandemic further expedited this shift where meetings and consultations moved online, more information was accessed via online websites and repositories, and the use of health applications became the way we receive and understand our own health information. These technological advancements have been innovative, modernising the provision of our NHS services and particularly allowed services to continue operating at a time when contact had to be limited. However, there is a cost to these digital advancements – digital exclusion.

Digital exclusion refers to the increasing challenges people face when engaging with or accessing digital services and technologies that allows and enables them to participate in an ever-changing online world. The COVID-19 pandemic highlighted and often exacerbated existing digital health inequalities. The rapid shift in 2020 saw a deepening divide between those who had the resources to be digitally independent, and those individuals and communities without reliable internet access or the ability to access the help when they needed it the most.

Millions of people across the UK are impacted by digital exclusion. The Digital Poverty Alliance (DPA) predicts that approximately 13-19 million people over the age of 16 are experiencing some form of digital exclusion. Breaking this down by age and socio-economic circumstances, they estimate that this equates to 1 in 2 older adults and a startling 20% of all children. People who are unemployed are estimated to be 2-3 times more likely to experience some form of challenge, as well as people living in rural areas, people with disabilities and ethnic minorities. For those affected, it isn’t just about seeking information through a different route, it is a very real barrier to accessing the right help, looking for employment, accessing resources, getting timely health advice when needed and even for making or maintaining important social connections.

Why does the NHS need to narrow the gap?

Improving access to digital resources and platforms allows everyone to equally engage with all public services, including health and social care services. As the NHS continues with the improvement and transformation of its services, it is vital that programmes of recovery deliver equitable, fair and accessible outcomes. Achieving true digital inclusion is not solely the responsibility of the NHS, but alongside social care, business, civil society and wider communities – the NHS, Integrated Care Boards (ICB), hospitals, GPs and others all have a part to play in achieving fair access to all the communities they serve.

The NHS 10-Year Plan sets out a bold vision for a digitally enabled health service, with ambitions to expand virtual hospitals, streamline communication through digital-first channels, and embed inclusive design across all digital services. While these innovations promise improved efficiency and access, they also risk deepening health inequalities if digital exclusion is not addressed in parallel. To align with this national direction, we must ensure that digital transformation efforts are inclusive by design, embedding accessibility standards, co-producing solutions with groups who face barriers to digital access, and investing in support for digital skills and connectivity. By aligning our local strategies with this national direction, we can help ensure that everyone benefits from the digital evolution of the NHS.

Having digitally inclusive services leads to improvements in enhanced and timely communication between staff and users, improved health access and outcomes, efficient use of vital resources and ultimately improves the quality and experience of care. If services are not designed with the end users in mind or without consideration of the barriers some people may face, communities can be left without access to the right help.

Transformation programmes need to prioritise addressing the barriers to digital inclusion to develop services and solutions that are responsive and accessible for the people who will need and use them. Health systems have a statutory duty to consider how digital solutions will impact their populations, and are also bound by the public sector equality duty to understand and actively reduce barriers and health inequalities.

In September 2023, NHS England published ‘Inclusive Digital Healthcare: a framework for NHS action on digital inclusion’, setting out how the NHS can enable greater access to, and improved experiences of, healthcare through inclusive digital transformation. The framework aligns with the Health and Care Act 2022, which requires NHS England and Integrated Care Boards to actively reduce inequalities in access and outcomes.

It identifies five domains for action – ensuring access to devices and data, designing accessible technology, building digital skills, fostering trust and confidence, and strengthening leadership and partnerships. Central to the framework is the belief that digital inclusion is a shared societal responsibility, demanding meaningful collaboration with professionals, partners and service users to design services that are equitable, inclusive and effective.

The Government’s Digital Inclusion Action Plan: First Steps (2025) reinforces this vision with a coordinated, long-term approach to tackling digital exclusion. It prioritises local initiatives, digital skills, access to devices, service accessibility, and evidence-based planning, supported by four strategic themes: opening up opportunity through skills, addressing data and device poverty, removing barriers to digital services, and building public confidence.

The plan emphasises the importance of cross-sector collaboration with local authorities and charities, with a particular focus on young people, older adults, those with disabilities, those out of work, and low-income households. Incorporating these principles into NHS digital transformation efforts can help ensure that national ambitions are grounded in practical inclusive delivery.

These key documents emphasise the need for inclusive, accessible digital transformation that leaves no one behind. By embedding these national frameworks into local practice, targeted support can be provided for those facing digital barriers.

The TU can play a pivotal role in ensuring digital innovation enhances, rather than exacerbates, health equity through our projects. We can:

Use data and mapping to understand people’s health needs and predict future demand. This helps identify and tackle unfair differences between communities.
Help clients meet their legal equality duties and build fair, inclusive services through tools like Equality Impact Assessments.
Support long-term planning for the health and care workforce, helping to design systems that work for everyone and reflect the communities they serve.

Below is a suite of resources to support you and your organisation in delivering equitable services:

How we can support you

If you’re planning or delivering a transformation programme and would like to explore how our services could help you, please get in touch. Our team brings a broad range of expertise, from strategic planning and business case development to clinical redesign and complex programme management.