In the digitalisation of the NHS, leave no patient behind

Global Accessibility Awareness Day highlights the importance of inclusion and co-design, writes patient liaison group chair Chrissie Douglass

Location: UK
Published: Thursday 16 May 2024

Today is the UN’s Global Accessibility Awareness Day. The purpose of the day is to get everyone talking, thinking and learning about digital access and inclusion. As digitalisation in the NHS advances, this is a vital conversation in the context of healthcare.

Digitalisation in the NHS has the potential to positively impact patients for whom digital services are more accessible – for example, individuals with reduced mobility, caring responsibilities and those who are immunosuppressed or shielding. It also has the potential to improve the efficiency and sustainability of the medical workforce.

However, digitalisation that is not meaningfully informed by people’s needs and delivered with a focus on equitable impact has the potential to both re-entrench existing biases and barriers to accessing healthcare, and to create new ones for those who are digitally excluded. This risks widening health inequalities and adding pressure to healthcare services that are already stretched beyond capacity.

Understanding root causes

Digital poverty and poor digital literacy remain stubbornly persistent for some population groups. In the UK, around one in seven adults and one in five children are classed as being in digital poverty, which is often defined as ‘the inability to interact with the online world fully; when, where and how an individual needs to’.

But how we understand ‘inability’ is important here. As with disability more widely, inability is too often assumed to be a fixed state. Older people and disabled people, in particular, become labelled as groups who are fundamentally less competent to manage a shift to digital services, without interrogating the root causes for their current exclusion, such as higher living costs or digital solutions that are not designed with and for a diverse user base.

There is also a tendency to assume this apparent deficit is all on the patient’s side, and that the healthcare workforce can seamlessly adapt to digitalised services without the necessary support to ensure confidence in managing these systems. There must be ongoing, adequate and appropriately targeted support and training for both the public and healthcare workers that keeps up with the rate of digitalisation in the NHS so nobody gets left behind.

Back to basics

For the digital revolution to truly benefit everyone in society, we need to go back to the first principles of design – breaking down complexity into its basic elements and working from the ground up.

This means committing to meaningful co-design with patients from all backgrounds and the medical workforce, to ensure digital innovation embeds universal accessibility from the outset. To do this, we have to recognise that accessibility is an attitude as well as an action; we have to make space to learn about the diverse needs of digital service users; and we have to commit to acting on what they tell us.

Failing to consider the needs of the most marginalised groups in society when implementing digital change will perpetuate mistrust in healthcare professionals and push those who need care the most, further from services. As the NHS evolves and digital options become more available, patients must be supported to retain control over their own care and the right to choose what their care looks like.


Chrissie Douglass is chair of the BMA patient liaison group