The "doctor in your pocket" vision only succeeds if it works for everyone. Building truly inclusive digital health services demands co-creation, universal design principles, and community support from the outset.
Margaret, 73, hasn't seen her GP in eight months. Not because she doesn't need to—her diabetes requires regular monitoring—but because she is unable to navigate the online appointment system. The phone lines are constantly engaged, and the practice no longer accepts walk-ins. She's one of millions caught in a widening gap between digital-first healthcare and the people who need it most.
The "doctor in your pocket" vision becomes reality when that pocket belongs to anyone who needs it, regardless of their digital confidence, device ownership, or life circumstances. That's when the architectural possibility outlined in this series transforms into sustained health improvement across the entire population the NHS serves, cementing Britain's position at the forefront of inclusive, preventive, community-based digital healthcare.
A Digital Poverty Alliance research found that 25,000 lives among over-65s could be saved each year if they had the digital skills needed to access health information. Not through new treatments or medical breakthroughs, but simply by ensuring people can access the health guidance already available online.
Since the pandemic, many more services have transitioned online, bringing increased convenience and efficiency to many, but creating a divide between essential support and those who are digitally excluded. Eliminating digital poverty has never been more critical, particularly as the NHS 10-Year Health Plan sets out its three fundamental shifts: from analogue to digital, from hospital to community, and from sickness to prevention.
The DPA defines digital poverty as the inability of an individual to access online services when, where and how they need. One in seven adults and one in five children currently live without either the device, connection or skills they need, and one in 17 adults live without all three. This rises sharply in specific communities. One in two older people is digitally excluded, as well as one in two adults facing unemployment or in lower socioeconomic bands. Approximately eight million adults lack basic digital skills, including changing passwords and setting up email accounts.
Understanding the barriers
Digital poverty isn't simply about money. Multiple intersecting factors keep people from accessing the digital world, and as we age, these barriers often intensify. Fear plays a huge role: fear of breaking technology, fear of scams or data loss, fear of isolation without human contact. Physical impairments make holding a smartphone or reading small text challenging. Cognitive decline affects how we process information. Technology advances faster than many people can keep up. For some, there's simply no motivation or desire to use digital services at all. Insufficient digital skills and confidence often accompany a lack of reliable devices or connectivity.
Any factors that prevent people from being in work contribute to poverty, which in turn leads to digital exclusion. Nowhere is this more obvious than in households including a disabled adult; almost a third of such households are in poverty, according to Trust for London data. It creates a vicious circle, as digital access is now crucial to accessing education and training, applying for jobs, and finding healthcare.
The economic cost is substantial. The NHS App has already avoided 1.5 million missed appointments and saved 50 million paper letters, demonstrating the efficiency gains possible. Yet these benefits only reach those who can access digital services. For the millions who cannot, the gap between available support and their ability to access it widens with each digital transformation, creating inefficiencies, missed preventive opportunities, and worse health outcomes.
Building inclusion from the ground up
The NHS 10-Year Health Plan positions the NHS App as central to delivering the shift from analogue to digital. A "doctor in your pocket" is exciting for those who are digitally confident, but unless carefully designed from the outset, it risks leaving behind those who most need healthcare support. It also requires the creation of training mechanisms that can scale at pace – something that will likely fall to communities.
In creating new digital health services, it's vital that designing for the most vulnerable users, those with the least digital intuition, is at its heart. Many of us are familiar with platforms designed for an "ideal" user, one who is confident, follows instructions, and uses them as intended. As technology becomes more capable, it becomes easier to add layers of complexity that are well-intentioned but create a heavier interface for the end user.
Building inclusive digital health services is a genuinely complex endeavour. You're designing for Marcus, the construction worker checking his blood pressure through the app, while simultaneously serving an 80-year-old with arthritis who struggles to hold a smartphone, a young parent managing childcare who fears making mistakes with technology, and a rural resident with patchy connectivity. The challenge lies in what to anchor on: simple principles, access beyond the obvious digital touchpoints and personal devices, and leveraging the community.
This is why it's crucial to involve a wide range of those with lived experience of digital exclusion in the creation of these services. Listening to the real needs of users, gaining their feedback at the start, and placing their needs at the centre of the design and requirements process is vital to true co-creation. Focus groups with a finished product, aiming to find ways to train users, can never be as effective as starting where they are. This must also align with globally accepted accessibility standards. An accessible service for some is often the most intuitive and helpful design for the many.
Combining digital and human support
Technology alone cannot solve digital exclusion. Non-technical solutions are equally vital to delivering the 10-Year Health Plan's vision of community-based care. Co-locating digital services within the Neighbourhood Health Service, where real people can help and support, will be a key element of an equal and accessible health service of the future. This approach recognises that many people will always prefer, or require, human interaction alongside digital tools.
Community infrastructure matters: libraries offering assisted digital access, local health services providing human support, trusted community organisations helping people navigate systems, and family members or friends who can support when needed. The NHS App must integrate with these touchpoints, enabling care rather than becoming a mandatory gatekeeper.
Measuring success requires looking beyond adoption statistics. The government has a unique ability to direct both policy and funding towards strategic methodologies that drive digital inclusion alongside traditional health outcomes. This means monitoring engagement patterns across demographic groups, identifying where lack of participation correlates with health outcomes, understanding reasons behind non-engagement, and evidencing whether digital exclusion factors into health inequalities. This avoids an outdated belief that simply moving services online will force uptake.
World-leading inclusive healthcare
As the NHS digital transformation continues into the AI era, for many, using basic digital tools remains a challenge. The opportunity here is profound. By co-creating genuinely inclusive tools that serve the goal of equity, with large-scale reach and that doctor in your pocket available to all, not just ideal users, the NHS can position itself as a world-leading provider of inclusive digital healthcare.
This isn't just about avoiding a two-tier system that inadvertently misses those who most need health support. It's about demonstrating that population-scale digital health transformation can work for entire populations, not just those who are digitally confident. If the NHS achieves this, it will provide a blueprint for other health systems globally, proving that prevention at scale and digital inclusion are not competing priorities but mutually dependent goals.
Our healthcare series continues with an examination of the technical foundations that enable comprehensive digital health services at a population scale, exploring how interoperability creates the invisible infrastructure that makes prevention possible across interconnected systems.
