Digital Health Success Requires More Than System Capability

Successive government policies are increasingly positioning equitable health, care, and service delivery as central to NHS reform. Data from the Office for Health Improvement and Disparities continues to highlight stark and persistent inequalities across income, ethnicity, geography, and disability. The need to address this, once an ambition, is now a policy and regulatory requirement, which has been translated into statutory duties within the Health and Care Act 2022, reflected in the design of frameworks like Core20PLUS5, which targets the most deprived 20% of the population and in the expanded role of the Care Quality Commission to evaluate the NHS delivery of equitable service access and digital inclusion.

There is a growing consensus that tackling inequalities is important and must be woven through every dimension of care. At the same time, increasing the digital maturity of the NHS has become a central focus of this Government's plans for reform. Positioned as both a lever for productivity and an improved patient experience, digitisation is no longer just an enabler of transformation; it is increasingly seen as the ultimate end goal. This week's Spending Review reinforces this direction, with a planned £10 Billion of funding, representing a 50% increase in NHS technology investment over the next 3 years. This funding announcement included several high-profile and ambitious objectives, including the transformation of the NHS App into a national digital front door and the creation of a unified patient record and an expansion in the use of patient-facing technologies. Together, these initiatives are expected to accelerate the rollout of digital services across the system.

However, without a deliberate equity focus, the NHS's ambitions risk exacerbating the very disparities the health system is tasked with closing. The risk here is that we digitise our services without redesigning them to account for unequal access, skills, or trust. Innovation, without inclusion, risks embedding structural inequalities.

Take, for instance, the NHS App. Despite over 30 million registrations and growing functionality, usage remains unevenly distributed. A large-scale analysis of app activity found that GP practices in deprived areas had significantly lower uptake including 35% fewer log-ins, 40% fewer appointment bookings, compared to the least deprived areas. Ethnic disparities, were even greater, practices serving predominantly White populations had 130% higher prescription ordering than more ethnically diverse ones. The data also suggests lower engagement among older adults. We see here long-standing patterns of exclusion which reflect a modern "digital inverse care law" where those most in need of accessible, efficient health technologies, are the least likely to benefit. While the NHS app offers clear benefits, they are disproportionately used by those who are already well served. People facing the most complex health needs or digital exclusion are not just underrepresented, they will be marginalised by a system that increasingly delivers digital-first pathways.

Current NHS digital maturity frameworks do little to guard against this risk. Progress with digital maturity is measured more in terms of deployment, rollout, and scale, rather than inclusion, reach, and equity.

Most digital maturity frameworks used in the NHS assess infrastructure, deployment, and staff capability, but stop short of asking whether patients actually use digital tools, or whether that usage is equitable across age, ethnicity, language or deprivation. As a result, an NHS organisation can score highly on digital maturity while large sections of its population remain digitally excluded or underserved. This creates a false proxy for progress at a time when equity is increasingly a statutory obligation. As the NHS continues to scale up digital, equity must be placed at the centre of design and delivery.

This disconnect between policy ambition and the delivery of outcomes is not unique to the NHS. A recent global scoping review of digital health equity frameworks identified a persistent gap between high-level policy goals and a lack of the on-the-ground mechanisms to deliver them. Current frameworks targeting digital health equity were found to be theoretical and lacking in the operational detail required for implementation.

"Digital transformation without inclusion is the digitisation of inequality."

To translate policy into action, we need tools that help systems to understand how to deliver, progress and track equity impact as a core part of digital transformation. This requires greater emphasis on strategic oversight, a workforce with the capacity, capability and an understanding of inclusive design, and finally the need for ongoing monitoring and evaluation.

The EquiIndex Digital Health Equity Maturity Framework supports organisations to do exactly that. This structured self-assessment tool enables health and care providers to evaluate how well digital transformation efforts are advancing equity. It helps identify gaps, assess current maturity, and develop targeted improvement plans across seven key domains which include leadership and governance, community engagement, digital literacy, workforce capability, infrastructure and inclusion, ethical technology, and evaluation and learning.

As the NHS continues its digital evolution, equity must become the core measure of progress, and digital transformation success judged by the outcomes they enable and the people they reach. Initiatives like the Widening Digital Participation programme have already shown what is possible, delivering £6 in health system savings for every £1 invested. By aligning technology with inclusion, we can ensure that digital health not only drives efficiency and more affordable care, but also delivers fairness, reach, and meaningful impact for all.

Get in touch for more information on the EquiIndex and how it can help your organisation progress towards greater Digital Health Equity.