Digital by default? Why the NHS App must work for everyone

“The ambition set out at the recent ‘Future Ready: Digital Health for Tomorrow’s NHS’ digital symposium at the Catalyst was clear”, writes our Head of Digital Systems Sonia Townend - “…a health system in which digital access is the default, not the exception.”

“Central to that ambition is the continued scaling of the NHS App, positioning it as the front door to healthcare for millions of people.

“For many, this ‘Digital First’ approach presents a significant opportunity. Faster access to services, greater visibility of health information, and more control over their experience and outcomes. But for those of us working to reduce health inequalities, it also raises a critical question. What happens to the people who are not yet ready for a digital-first NHS?”

Digital transformation risks widening existing inequalities

“At Ways to Wellness, we test non-medical interventions that support people living with long-term health conditions, many of whom are also experiencing financial hardship, social isolation, and multiple barriers to accessing care. A significant number of the people we work with do not have access to a suitable device. Others lack the skills or confidence to navigate digital services. Some have concerns about trust, privacy, or data sharing.

“These are not cases of people on the fringes. They represent a significant proportion of the North East population, where levels of deprivation and poor health remain persistently high. If digital becomes the default without the right support in place, there is a real risk that existing inequalities will deepen. Access to healthcare could become easier for some, but more complex for others. Inadvertently therefore, we could see the drive towards ‘Digital First’ reinforcing, in new and less visible ways, the inverse care law, which states that the availability of good medical care tends to vary in an opposite or contrary way with the need for it in the population served.”

Digital inclusion is preventative health infrastructure

“The response to this challenge cannot sit solely with digital teams or technology providers. It must be seen as a core part of the prevention agenda that is such a core part of the 10-year plan for the NHS. As highlighted at the event by Dr Karen Connelly, Chief Clinical Information Officer for Northumbria Healthcare NHS Foundation Trust, one of the main reasons digital transformation initiatives fail is the lack of engagement by intended users. And not because of technology, but because of how it is implemented.

“At Ways to Wellness, our link workers test a relational model of working, providing personalised, one-to-one support to help people manage their health and wellbeing in ways that are meaningful to them. As digital access becomes more central to the NHS, this support will increasingly include helping people to engage with tools like the NHS App.

“This means sitting alongside someone to help them set up an account. It means building confidence step by step. It means explaining how and when to use digital services safely. And it means recognising when digital is not the right option for an individual at a particular point in time. 

“Ways to Wellness is also part of a wider digital inclusion ecosystem. Through partnerships with local organisations, we are able to connect people to devices, data, and affordable broadband. We can support access to training and ongoing skills development. These practical interventions are not peripheral. They enable access to care.

Digital transformation succeeds or fails on people, not technology

“During the panel discussion, ‘Should patients have full access to their digital health record?’, there were strong and valid provocateurs on both sides of the debate who covered issues such as awareness of domestic abuse, safeguarding, and empowering patients to have more agency in their healthcare. But it took an audience member to raise the issue of digital exclusion. 

“Greater transparency can support shared decision-making, and empower people to manage their own health. But without careful design, it can also create confusion, anxiety, or even unintended harm. The answer is not to slow progress down. It is to change how we design and implement it.

“Too often, digital solutions are built around assumptions about how people behave, what they understand, and what they have access to. Consultation alone is not enough to address this. We need genuine co-design, which means involving people experiencing barriers from the outset, testing solutions in real-world contexts, listening to feedback, and adapting accordingly. At Ways to Wellness, co-production is central to how we work. As digital transformation accelerates, there is an opportunity to extend this approach to ensure it can influence the design of national tools and services. If people are part of shaping the systems they use, those systems are far more likely to work for them.

“Barriers such as cultural resistance, lack of a clear strategy, and insufficient engagement with end users continue to undermine well-intentioned programmes. Communication is often an afterthought, rather than a core component of delivery.

“For organisations like Ways to Wellness, this resonates strongly. We see every day that change only works when people are supported through it.

“The scaling of the NHS App will not succeed based on functionality alone. It will depend on how well it is introduced, how clearly it is explained, and how effectively people are supported to use it in a way that works for them. This includes staff as well as patients. Confidence, understanding, and buy-in at every level are essential.”

Designing for those most often excluded

“A session on the day about how digital transformation can support neurodivergent children and young people’s mental health and wellbeing, chaired by Professor Abigail Durant, highlighted the importance of designing with diversity in mind. Digital tools have the potential to offer more flexible, personalised, and accessible forms of support. But this only happens when design reflects the needs of different groups.

“This principle applies far beyond children and young people. It is relevant to older adults, people with disabilities, those with limited digital literacy, and those navigating multiple disadvantages. Designing for inclusion does not mean creating a single solution that works for everyone. It means creating systems that are adaptable, responsive, and grounded in real experiences.

“For the NHS App and wider digital services, this presents both a challenge and an opportunity. If inclusion is built in from the start, digital transformation can reduce inequalities rather than reinforce them.

“The voluntary, community and social enterprise (VCSE) sector has a critical role to play in this transition.”

A shared responsibility

“Organisations like Ways to Wellness, which are embedded in the communities most impacted by health inequalities, are therefore often closest to the people facing the greatest barriers. We build trusting relationships. We understand the complexity of people’s lives, and are able to respond flexibly to individual needs. This places the VCSE sector in a unique position, not only to support implementation, but to help shape it.

“We can act as a bridge between systems and communities. We can surface insights that might otherwise be missed. And we can test and evidence approaches that work in practice.

“As the NHS continues to implement its 10-year plan, there is an opportunity to recognise this role more formally. Digital transformation will be more effective, more equitable, and more sustainable if it is delivered in partnership with the VCSE sector.

“The move towards a ‘Digital First’ NHS is already underway, but how that transition is managed will be crucial to its success. If we focus only on the technology, we risk leaving people behind. If we focus on people, we create the conditions for success. At Ways to Wellness, we will continue to develop prototypes that support individuals to build the skills, confidence, and access they need to engage with digital healthcare. We will continue to work with partners to strengthen the local infrastructure for digital inclusion, and we will continue to advocate for co-design, ensuring the voices of those most often excluded are heard.

“Digital by default must not mean digital only. A truly inclusive health system is one that meets people where they are, and supports them to move forward at their own pace, providing non-digital alternatives for those that need them as outlined in the NHS Patient Charter. Crucially, we believe non-digital routes to care must remain accessible, well-communicated, and of equal quality as their digital counterparts.

“The opportunity is significant, but so is the responsibility. Get in touch with us if you’d like to help us take it on.”