Keeping the digital front door to healthcare open to everyone

The NHS undoubtedly remains one of the great achievements of the British welfare state: a system built on the idea that everyone, regardless of income, background or circumstance, should be able to get medical support when they need it. Nye Bevan’s vision that “no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means” is as profound today as it was in 1952.

As healthcare becomes increasingly digital, though, that founding principle raises a new question: what counts as “lack of means” in a digital age?

Booking an appointment, ordering a repeat prescription, receiving test results, reading maternity notes or attending a remote consultation can all now involve going online. For many people, this is convenient and empowering. Digital health can make services easier to reach, help people manage their care and free up capacity in a system under huge pressure.

But for the more than 8 million people in the UK who are digitally excluded today, the shift to digital can create a barrier that feels very different from the NHS’s founding promise. It is not a formal charge at the point of care, but when reaching services depends on internet access, a suitable device, digital confidence, accessibility, language support or trust, digital exclusion can become a de facto paywall.

The answer is not to resist digital healthcare. Done well, digital can improve access, prevention, communication and patient experience. But we have to be honest about who digital works for, who it leaves out, and what happens when the online route becomes the only route that really functions.

Digital inclusion needs to be baked into healthcare, not bolted on afterwards

At Good Things, we believe digital exclusion has to be treated as a barrier to healthcare access, not as a separate “digital skills” problem sitting somewhere outside the system.

Digital exclusion rarely appears in isolation. It intersects with poverty, disability, language barriers, low confidence, social isolation, caring responsibilities, poor health, insecure housing and lack of trust in public services - the same factors that can already make it harder for people to access timely, appropriate care.

Too often, inclusion is considered after the service has already been designed. By then, the assumptions have already been made: that people have a device, can afford data, understand the message, trust the link and know what to do next.

A more inclusive approach starts earlier. It asks who might struggle to use a service, why, what happens when the digital route does not work, and where someone can get trusted support before a missed message becomes a delay in care.

Digital Midwives: shifting the dial

The Digital Midwives programme is a pioneering partnership between Good Things and NHS England, now expanded into 87 maternity services across England and Wales. It identifies and addresses digital exclusion as part of maternity care, so that women and families are not shut out of vital information, communication and support because they lack connectivity, confidence or access to a suitable device.

Maternity care is just one example of why this matters, but it is a particularly urgent one. Pregnancy is a time when communication with health services can be frequent, important and emotionally charged. As a parent of a two-year-old, I remember that feeling clearly: the practical updates mattered, but so did the reassurance that if something changed, someone was there and you knew how to reach them.

For families with reliable connectivity, confidence and the right device, digital tools can make maternity care feel more accessible and joined up. But for families experiencing digital poverty, the digital route into care can become fragile, confusing or closed altogether.

One of the programme’s most important innovations is deceptively simple: expectant parents are now asked three questions during their first pregnancy screening. Do they have access to a device? Do they have enough connectivity? Do they feel able to use the digital tools and communications that maternity care now depends on?

Those questions change what the system can see. They make digital exclusion visible early, before it shows up as a missed message, a missed appointment or a delayed response to a concern. They also give staff a practical way to address the barrier.

Through the programme, participating maternity teams are gifting SIM cards provided by Good Things’ National Databank and, where possible, devices to women and families in need. That support may be simple, but its impact can be profound: keeping people connected to the information, advice and clinical support they may need throughout pregnancy.

But Digital Midwives is not only changing what support is offered. It is changing how staff understand patient engagement.

In one reported case, a woman missed an appointment. Historically, that might simply have been recorded as a “did not attend”, but because the team knew she was struggling to afford connectivity, they considered whether she may have been unable to get in touch.

Rather than assuming she had disengaged, they visited her at home. They found her in serious distress and unable to contact the maternity unit for help. She was brought in for emergency care - an intervention that may have saved both her life and her baby’s.

Stories like these capture the wider point: what can look to the system like non-engagement, non-compliance or lack of interest may in reality be a person struggling to access support through a route that does not work for them. Digital Midwives shows that when staff are equipped to spot those barriers, they can ask better questions, offer practical support, prevent avoidable escalation and see the person behind the missed appointment.

Five ways health services can build digital inclusion into care

The lesson from Digital Midwives is not limited to maternity care. Participating midwives and maternity teams have shown that digital inclusion becomes much more achievable when it is built into everyday practice. Their experience points to five practical steps that could help other health services make digital access more inclusive, reliable and safe.

1. Ask about digital access early and routinely.

Good Things’ Indicators of Digital Inclusion provide a practical way to understand the barriers someone may face. Questions about device access, connectivity, confidence, skills, affordability and support can be built into registration, assessment, screening, care planning and discharge conversations. The aim is not to create another administrative burden, but to make digital exclusion visible early enough to respond.

2. Treat digital exclusion as a possible access and safety risk.

When a patient does not respond to a message, misses an appointment, does not complete an online form, or fails to use a digital service, staff should be supported to ask whether a digital barrier may be part of the reason. That small shift in thinking can change what happens next. If patients are worried about using digital health services, Good Things developed this handy resource that explores people’s beliefs and trust, and answers any common worries they may have.

3. Design for what happens when the digital route does not work.

Inclusive digital healthcare is not about forcing everyone online, but nor is it about relying on poor analogue fallbacks that exist on paper but fail in practice. Health services need a clear, reliable route to support when someone cannot use an app, complete an online form or respond to a digital message.

4. Work with trusted community partners.

Health services do not have to solve digital exclusion alone. The National Digital Inclusion Network brings together more than 8,700 registered community organisations across the UK, many already helping people build confidence, access devices, get connected and navigate the digital world safely.

5. Build lived experience into service design.

The best way to understand digital exclusion is to listen to the people experiencing it. Health services should capture insight from patients, carers, frontline staff and community partners about where digital routes are helping, where they are creating barriers, and what support people actually need. Inclusive digital healthcare starts by designing with people who face the greatest barriers, not around them.

Designing the future NHS around inclusion

These steps cannot sit only with individual frontline professionals or civil society. Staff can ask better questions, spot barriers and offer support, but they need systems around them that make this possible.

Digital inclusion has to be built into the way health services are designed, funded, delivered and evaluated. It should be part of the operating model for modern healthcare, not an optional addition to digital transformation.

Every major digital health programme should be able to show how it will identify people at risk of digital exclusion, respond when digital routes do not work, and use patient insight and community partnerships to improve access over time.

As healthcare shifts towards remote monitoring, automation, artificial intelligence and more personalised digital services, this will only become more important. Digital inclusion should be treated as infrastructure for modern healthcare: not just platforms and apps, but the human infrastructure that allows people to use digital services safely and confidently.

Keeping the NHS open to everyone

The NHS was built on a simple but radical promise: that healthcare should be there for everyone who needs it. As more of healthcare becomes digital, that promise does not change, but the conditions for protecting it do. 

If healthcare is becoming digital, then digital inclusion has to become part of how healthcare is delivered. That means designing services around the reality of people’s lives, identifying barriers early, working with trusted community partners, and making sure people have the support they need to use digital routes safely and confidently. 

Done well, digital health can strengthen the NHS’s founding promise. It can help more people access care earlier, communicate more confidently, and manage their health more effectively. But that will only happen if inclusion is built in from the start. 

The opportunity now is to make digital healthcare not only more efficient, but more human, more responsive and more open to everyone.