Could more digital services actually create more time for human care?
It might sound counterintuitive. But when people who can confidently use digital services are given simpler ways to book appointments, manage their health proactively, access advice or receive care remotely, it can free up valuable clinical and administrative capacity.
That freed capacity can then be focused where it is needed most, including on people who need more time, more support or a non-digital route into care.
Realising this opportunity requires health and care organisations to address an important challenge. Digital exclusion persists, and some of the people who rely most heavily on health and care services are also among those most likely to experience it.
“There’s a risk that when an organisation kicks off a big piece of digital transformation. If the programme doesn't properly consider digital exclusion, they end up with shiny new digital solutions that a significant number of patients can’t use, so they’re in a worse place than they were before the digital solution came in.” - Dr Simon Berman, CTO, Health and Care, CGI in the UK.
Realistically, it is unlikely the digital divide will ever be entirely overcome, so health and care leaders must design services with that reality in mind. Digital-first services must never mean digital-only.
Digital exclusion is a complex issue
As a starting point for understanding the scale of digital exclusion, the Good Things Foundation found that nearly half of UK families did not meet the minimum digital living standards in 2024. Poor digital literacy, connectivity difficulties, lack of an appropriate device, inaccessible platform design or concerns about privacy and security can all contribute to the digital divide.
But there are further dimensions to this challenge because there is no single digitally excluded population. Age, income, geography, language, attitude and disability can all affect someone's ability to access digital services, and these factors often overlap.
The consequences can be significant. Digital exclusion can contribute to missed appointments, delayed diagnosis, poorer management of long-term conditions and increased isolation. It can also place additional pressure on carers and health and care services.
This is particularly important because most large NHS Trusts incur the vast majority of their spending on a relatively small proportion of the population. Many of these patients are likely to be at greater risk of digital exclusion, making it essential that digital transformation does not create additional barriers to accessing care. So, should health and care organisations slow the pace of digital engineering?
Digital inclusion and transformation must progress together
There is an understandable concern that accelerating the adoption of digital services could deepen inequalities in access to health and care. But slowing digital transformation is not the answer.
Digital services have an important role to play in addressing some of the significant challenges facing health and care systems, from demographic change to rising levels of comorbidity and growing public expectations. Alongside this, organisations need to tackle waiting lists, improve productivity and shift more care towards prevention and earlier intervention.
Remote consultations can save patients long journeys. Digital monitoring can help people manage long-term conditions from home. Digital tools can provide new routes into services for people who may otherwise be reluctant to engage. Automation and AI can reduce administrative workloads, giving clinicians more time to focus on the people who need face-to-face care.
The goal, therefore, should be to accelerate both digital transformation and digital inclusion. Health and care organisations can then enable more people to benefit from digital services while ensuring those who cannot access them have equal and appropriate routes to care.
“The key here is awareness of the risk of excluding people. If anything, the pace of digital transformation needs to accelerate. But alongside that, so must the awareness and action to ensure that those potentially at risk of exclusion are included.” - John Matheson, Former Director of Finance and E-Health at NHS Scotland; Chair of the Health Advisory Board at CGI in the UK.
Make inclusion an enabler of transformation
The key is to consider inclusion from the planning stage of any digital initiative. Designing around the true diversity of the relevant populations, rather than a generic definition of the "digital user", can increase adoption, improve outcomes and ultimately strengthen the return on digital investment.
“Co-production is crucial to digital inclusion in health and care—large digital initiatives must listen to citizen voices and involve patient user groups in working out how everyone can be part of this journey.” - Dr Simon Berman, CTO, Health and Care, CGI in the UK.
Technology can widen access when a service is designed around people's circumstances rather than expecting people to adapt to the technology.
Success should therefore be measured not simply by how many services offer digital access, but by whether transformation improves access, experiences and outcomes for the people those services exist to support.
The starting point for inclusive transformation is simple: who could this service exclude, and why?
Tools such as Greater Manchester’s Digital Exclusion Risk Index can help health and care organisations understand where exclusion is most likely at a local level so they can target support accordingly. But data alone is not enough. Organisations also need to engage directly with patients, communities, carers and the people delivering services to understand the barriers they experience.
“Leaders need to recognise that digital first is as much about culture as it is about technology, and that digital delivery isn’t just about technical accessibility—services also need to be usable, understandable and designed around people's needs.” - John Matheson, Former Director of Finance and E-Health at NHS Scotland; Chair of the Health Advisory Board at CGI in the UK.
Design with people, rather than for them
Once the barriers are understood, health and care organisations can take practical steps to address them.
Scotland's approach to digital inclusion provides useful lessons. Its digital inclusion programme has focused on five interconnected areas: motivation, access to appropriate devices and connectivity, skills and confidence, inclusive design and trust around data security and privacy.
The Connecting Scotland programme demonstrates what this can mean in practice. Working with third-sector organisations, it has provided devices and connectivity to people experiencing digital poverty. Crucially, technology is combined with human support, including digital champions who can provide sustained one-to-one help. Libraries, community centres, GP surgeries and other familiar places can also provide supported access for people who lack either technology or confidence at home.
Scotland's Near Me video consultation service provides another example. It enables people to attend appointments remotely, reducing the need for long and potentially stressful journeys. Patients can connect from home, while those who cannot do that can access the service through local community facilities.
Both demonstrate an important principle: technology alone does not create inclusion. The services, support and choices surrounding it matter too.
Put user-centred design into practice
Creating technology that works for as much of the target audience as possible can start with a simple conversation.
When young people in Scotland were asked about accessing mental health services, they described how having to speak to an adult at the end of a telephone line could be a barrier to seeking help. Working with young people to understand that experience enabled the development of digital access points that provided a route into services they felt more confident using.
Similarly, Scotland’s Digi Lifelines programme was co-designed with people affected by drug use to develop digital approaches that suited their particular needs and reduce exclusion. Meanwhile, digital consultations and devices, such as iPads, have been introduced into care homes to improve older residents’ access to health and care, with human support available if needed.
These examples show the value of involving people directly in designing the services they will use. Co-creation can uncover barriers that might otherwise be missed and help organisations develop services that are more accessible, relevant and trusted.
Digital-first, with other routes built in
Even with the best support and most inclusive design, there will continue to be people who cannot or do not want to access health and care digitally. Multi-channel delivery therefore remains essential.
NHS Notify provides a simple example of how this can work. Communications can be sent digitally first, but if a patient does not interact digitally, the service falls back to another means of contact, ultimately including a traditional letter.
The same principle can be applied more broadly. Digital channels can sit alongside telephone, face-to-face and other appropriate contact methods, enabling people to access services in ways that reflect their circumstances and needs.
Importantly, digital transformation can help make this possible. Greater digital adoption among those who are able and willing to use these services can free up capacity to provide more personalised support for those who need alternative routes into care.
“While we are all determined to do the best for the populations that need health and social care and meet their needs in the best way we can, we must ensure that nobody is left behind.” - Peter McLeod, Director of Social Services and CEO, Care Inspectorate, Scotland.
Creating a more inclusive healthcare future
Health and care leaders need to design for the reality that the digital divide is unlikely to disappear entirely. But that should not temper their ambition for digital health and care.
“The final reality check for leaders is that we should talk about closing, not eliminating, the digital divide. Therefore, the message of digital first, not digital only is critical, and the NHS does need to maintain multi-channel delivery.” - John Matheson, Former Director of Finance and E-Health at NHS Scotland; Chair of the Health Advisory Board at CGI in the UK.
“There’s a strong sense of optimism and possibility about keeping populations well—but there’s also the leadership challenge of ensuring that every action includes as many people as possible.” - Peter McLeod, Director of Social Services and CEO, Care Inspectorate, Scotland.
By designing inclusion into transformation from the beginning, health and care organisations can create digital services that more people trust, adopt and benefit from. At the same time, they can use the capacity those services create to provide more personalised support for people who continue to need non-digital care.
That is why digital inclusion should not be viewed as a constraint on transformation. When done well, it is an enabler, helping to increase adoption, improve outcomes and strengthen the value organisations realise from their digital investment.
The ambition should be digital-first health and care that works for everyone, without ever assuming that digital must be the only way in.
To find out more, please contact our health and care expert Simon Berman.
