NHS digital plans risk worsening health inequalities, say academics

The overhaul of the NHS App, announced in the government’s 10 year health plan, could worsen health inequalities, according to academics from Brunel University of London.

In a blog post, published on The Conversation, Catia Nicodemo, professor of health economics at Brunel, raised concerns that making the app the front door to the NHS risks “leaving behind anyone who struggles with an increasingly digital world”.

Wes Streeting, health secretary, has claimed that new AI tools on the app, announced in the 10 year health plan, will “democratise healthcare in a way never before possible” by providing NHS patients “with the same ease and convenience that’s afforded to private patients”.

However Nicodemo said that the plans could “exacerbate health inequalities which already exist – and increase pressure on some areas of already strained services”.

“In particular, a digital-first approach to healthcare risks excluding older adults, who may lack the skills or resources to confidently navigate the necessary software,” she added.

Nicodemo believes that the NHS needs to maintain traditional communication options, such as telephone and in-person services, so that the 10 year plan’s focus on ‘digital by default’ does not become “digital only”.

Dr Bryan McIntosh, reader in healthcare management at Brunel, said: “Ultimately it is the poor and marginalised who are forgotten. Always.

“Technology doesn’t have to be dehumanising, but if it’s to avoid that outcome it must be human-focused, not just consumer-focused, and not just digital-consumer-focused.”

Media regulator Ofcom estimates that around 6% of UK households lack internet access at home and figures from the charity Age UK suggest that 33% of people over 75 in the UK lack basic digital skills.

Elizabeth Anderson, chief executive at the Digital Poverty Alliance, which has launched an inquiry into digital inclusion in healthcare, said: “Digital innovation in healthcare holds huge promise, but only if inclusive by design.

“While modernising the NHS App can improve access for many, we can’t overlook the 19 million people across the UK who still face barriers to digital access, whether through a lack of devices, connectivity or digital skills.

“Without targeted support, these upgrades risk deepening existing health inequalities and placing further strain on offline services. With increasingly more health services being moved online, it’s crucial that we have the digital infrastructure to support this transformation.

“Any digital first strategy must be backed by a comprehensive plan to address digital poverty, so no one is left behind in their time of need.”

In response, a Department of Health and Social Care spokesperson told Digital Health News that it is developing a Digital Inclusion Action Plan which includes maintaining non-digital communication options.

“Our digital transformation will modernise the NHS and make it fit for the future – but a digital NHS must be a force for inclusion.

“We are working closely with patient groups and community partners to co-develop and test the NHS App, we have appointed more than 2,000 NHS App ambassadors across the country and we are partnering with over 1,400 libraries and community organisations – which offer free access to one-to-one digital skills support,” they said.