NHS Online must not become another silo if it is to succeed

An NHS ‘online hospital’ can only succeed if it strengthens existing services rather than competes with them, writes John Mitchell, chair of the Digital Health Networks Integrated Care System (ICS) Digital Council

When NHS England announced plans for NHS Online, promising the equivalent of up to 8.5 million appointments and assessments in its first three years, I saw an important message: Digital care is moving further to the forefront as a way to create additional capacity across the system through empowerment, efficiency, and smarter use of clinical time.

The challenges that we’re all grappling with every day are how to use digital tools where they are best placed and how new models of care can relieve pressure not just recreate analogue pathways on digital tools.

This new model promises faster access, shorter waits, and the ability for patients to connect with specialists anywhere in the country – removing the dependency on any four walls.

For many of us in digital leadership, this ambition has been a long time coming.

If done well, NHS Online could reshape access to care by letting patients book tests, scans and specialist appointments through the NHS App, supported by community diagnostic centres and virtual consultations.

The scale of ambition isn’t new, although the renewed momentum in discussion is welcome. But the real test will be how it works for patients and the people delivering care.

Laying the groundwork

Across the NHS, we’ve already been laying the groundwork: virtual wards, remote outpatient models, digital front doors, and home monitoring, albeit sometimes lacking focus.

The challenge now isn’t invention; it’s connection and momentum.

If NHS Online sits outside the ecosystem, it risks becoming another silo

As we said in the ICS Digital Council’s ‘System digital leadership in the new world’ report earlier this year, digital success depends on clarity and shared ownership. National bodies should set direction, providers should lead delivery, and local systems must have the freedom to adapt and integrate.

If NHS Online sits outside that ecosystem, it risks becoming another silo. It should strengthen existing services, not compete with them.

When it connects the dots between digital and physical care, it could finally start to remove the dependency on four walls that has defined healthcare delivery for decades.

The same principles could also be applied to primary care access – using digital triage, remote consultation, and joined-up referral models to improve consistency, free up capacity, and make it easier for patients to get the right help first time, avoiding the 8am phone scramble.

Address digital exclusion

The NHS England announcement rightly commits to patient partnership and learning from five years of research into online care. That’s the right starting point – but it has to go further.

If NHS Online doesn’t actively address digital exclusion – poor connectivity, limited confidence, lack of access or language barriers – it could deepen inequality rather than reduce it.

Digital inclusion needs to be treated as a clinical safety issue, not a communications project – with continuous assessment of assisted options, accessible design, and testing of who’s being left behind.

Ethical procurement cannot be ignored. The technologies and partners we choose will shape patient experience, workforce morale and public trust.

We should prioritise suppliers who are transparent, evidence-led, and aligned with NHS values – not just those who can deliver at speed. If we want public confidence in NHS Online, inclusion and ethics can’t sit in the margins, they need to be the foundation.

Technology isn’t the difficult bit. People, capability, culture and transformation need to be addressed.

Clinical leadership 

As our leadership work at Digital Health Summer Schools 2025 highlighted, the NHS still needs stronger digital capacity and clearer career pathways if we want this kind of transformation to embed and last.

Simply moving the same workforce into new virtual clinics will only shift pressure around the system

Progress is also constrained by funding process challenges, particularly the divide between capital and revenue funding.

Until we find a more flexible, sustainable approach that reflects the reality of modern digital services, transformation will remain stop-start and dependent on short-term investment cycles rather than long-term planning.

Simply moving the same workforce into new virtual clinics will only shift pressure around the system.

Digitally led projects don’t always go well. We can’t talk about a new hospital model without addressing end-to-end clinical governance and responsibility.

When a patient starts their journey online, moves through diagnostic centres, and ends up with in-person care, who owns that journey? Who’s accountable for escalation, handovers and follow-up? Who has the trust of the patient?

Those aren’t minor details; they define whether patients and clinicians will trust the model.

Clinical leadership must be visible from day one. If clinicians don’t take ownership of clinical change, it will be difficult to make a lasting difference.

We don’t need perfection on day one. We need clarity about what NHS Online is trying to achieve, openness about what’s working, and honesty about what isn’t.

Transformation works best when it’s built with people, not done to them. Let’s test, iterate and share openly. Measure outcomes, access and experience – not just activity.

If we get the purpose, ethics, inclusion, governance and workforce right, this could finally be the moment we remove the dependency on any four walls and make care truly responsive to people’s lives.

This might be a significant change that brings real benefit, but it has to be built from the ground up – not from a press release down.