Analysis reviewing evidence and practice cases on how community co-design can improve the inclusivity and trustworthiness of digital health services.
Key messages
Policy implications
Gaps
Commentary
This analysis argues that the use of technology in care often falls short when digital services are designed without the active involvement of the communities they aim to serve. It highlights how exclusion can be embedded through design choices that assume access, confidence and trust.
In terms of care equity, the emphasis on ‘margins-first’ co-design is significant. By centring people most at risk of exclusion, digital services are more likely to address structural barriers rather than reproduce them.
The report reframes success in digital health away from simple uptake metrics. Confidence, trust and perceived usefulness are presented as equally important indicators of whether technology supports equitable access to care.
Overall, the analysis reinforces that inclusive digital health requires cultural and organisational change, not just better technology. Without genuine community involvement and power-sharing, digital transformation risks widening inequalities rather than reducing them.
A public data tool and methodology designed to identify areas and populations at highest risk of digital exclusion to support targeted inclusion investment.
Key messages
Policy implications
Gaps
Commentary
The Digital Exclusion Risk Index (DERI) provides a practical way to make digital exclusion visible at place level. By combining multiple indicators into a single framework, it enables decision-makers to move beyond assumptions and identify where exclusion is most likely to affect access to services.
In the context of technology-enabled care, this kind of tool supports more deliberate targeting of support. Rather than distributing resources evenly or reactively, DERI allows local systems to prioritise areas where lack of access, skills or connectivity is most acute.
The emphasis on publishing metrics is particularly important. Making digital exclusion risk transparent creates a basis for accountability and supports alignment between digital strategies and wider work on inequality across health and social care.
Overall, DERI shows how data infrastructure can underpin more equitable use of technology in care. Its value lies not in replacing local knowledge, but in strengthening the evidence base for place-based action on digital inclusion.
A study examining the association between local authority digital front doors and social care service uptake among adults in England.
Key statistics
Key messages
Policy implications
Gaps
Commentary
This study offers early quantitative insight into how digital front doors may shape access to social care. By analysing patterns of uptake across local authorities, it highlights that digital access points are not neutral tools and may influence who comes forward for support.
Variation by age group suggests that digital routes may work better for some populations than for others. Without accompanying qualitative evidence, it remains unclear whether observed differences reflect convenience, exclusion, confidence or awareness.
The short timeframe is also important. Digital front doors were widely introduced during and shortly after the COVID-19 pandemic, a period of rapid service change. Their longer-term effects on access, prevention and unmet need remain uncertain.
Overall, the study highlights the importance of treating digital front doors as part of a broader access system. Understanding how different groups experience and navigate these tools will be essential if technology is to support fair and effective access to social care.
A qualitative study examining how the digitalisation of social care affects older unpaid carers, focusing on choice, coercion and exclusion.
Key messages
Policy implications
Gaps
Commentary
This study shows how the digitalisation of social care reshapes everyday caring work for older unpaid carers. While digital tools were sometimes seen as useful, many carers described a loss of choice as non-digital routes were reduced or removed.
Affordability and skills gaps emerged as central barriers. For carers already managing significant responsibilities, the need to pay for devices or data and to develop digital confidence added pressure rather than relief. These constraints meant that digital systems often worked better for those with existing resources, leaving others struggling to engage.
The findings also highlight the importance of how digital change is implemented. Where carers were not involved in design decisions, digital services were more likely to feel imposed and poorly aligned with real-world caring contexts. In contrast, co-produced approaches were seen as more responsive and respectful of carers’ needs.
Overall, the study illustrates that digital social care can either support or undermine access depending on the choices made around funding, design and delivery. Retaining offline options and providing practical support for connectivity and skills are not transitional measures, but essential conditions for fair and workable digital care.
A qualitative study examining how digital-by-default primary care affects access for adults from minoritised ethnic communities in England.
Key messages
Policy implications
Gaps
Commentary
This study highlights how the use of technology in care can deepen inequalities when digital systems become the default route for access. For adults from minoritised ethnic communities, barriers linked to device access, data affordability and language support intersect with existing structural disadvantages.
The findings challenge assumptions that digital access is inherently efficient or inclusive. Where systems are designed without consideration of lived experience, technology can displace barriers rather than remove them. From an equity perspective, this raises concerns about who digital transformation is designed for and who it leaves behind.
The reliance on informal staff workarounds illustrates the strain placed on frontline services. While these adaptations may help individual patients, they are inconsistent and fragile, masking systemic exclusion rather than addressing it.
Overall, the study highlights that the use of technology in care must be accompanied by inclusive design, meaningful alternatives and organisational support. Without this, digital-by-default models risk reinforcing inequities in access to primary care rather than reducing them.
A qualitative evaluation of a trust-wide digital inclusion programme supporting digitally excluded people using mental health services.
Key messages
Policy implications
Gaps
Commentary
This study demonstrates how targeted digital inclusion support can improve access and engagement for mental health service users who are otherwise excluded from digital care. By combining devices, connectivity and one-to-one support, the intervention addressed multiple barriers simultaneously.
From a care equity perspective, the findings highlight that digital exclusion is not simply a technical issue but one linked to confidence, skills and control. Supporting people to use technology on their own terms can enhance autonomy and participation in care.
The emphasis on personalised support is particularly important. Standardised digital roll-outs are unlikely to meet the needs of people facing multiple disadvantages, whereas tailored approaches may help reduce inequities in access to mental health services.
However, the study also points to evidence gaps. Without data on long-term outcomes, cost-effectiveness and scalability, it remains unclear how such programmes can be embedded sustainably across systems. Even so, the findings provide useful practice-based evidence for designing more inclusive uses of technology in care.
National guidance setting out actions for the NHS to design and deliver digital health services that are inclusive and equitable.
Key messages
Policy implications
Gaps
Commentary
This framework provides a clear policy position on the use of technology in care, emphasising that digital transformation must not replace non-digital access routes. It recognises digital exclusion as a structural issue rather than an individual failing.
The focus on proactive identification of excluded groups is significant in terms of achieving care equity. Rather than relying on uptake data, the framework encourages services to understand who is missing and why.
The emphasis on partnership working reflects an understanding that digital inclusion cannot be delivered by the NHS alone. Local authorities, voluntary organisations and community groups play a central role in supporting access, skills and trust.
However, as a guidance document, the framework stops short of providing evidence on impact. Its contribution lies in setting expectations and principles. Ensuring these are translated into practice, and evaluated for their effect on inequalities, remains a key challenge for the NHS.
Analysis examining how technology and care are represented in English government policy texts.
Key messages
Policy implications
Commentary
This paper draws attention to the way technology is positioned within English care policy, not through outcomes or implementation, but through language. By framing technology as a solution to the challenges of ageing and care, policy discourse promotes ideas of independence, efficiency and innovation as dominant goals.
These narratives matter because they shape how problems and solutions are understood. When technology is consistently presented as enabling older people to live independently, the relational, social and material aspects of care risk being sidelined. The analysis suggests that care is often depicted as something that can be optimised or substituted, rather than supported.
From a care equity perspective, the discourse identified in this study raises concerns about who is implicitly included or excluded. Policy language frequently assumes access to technology, digital confidence and supportive environments. This can obscure the realities faced by people with limited resources, lower digital literacy, cognitive impairment or unstable support networks. When these assumptions go unchallenged, inequities in access to care can become normalised rather than addressed.
The study also highlights how equity considerations are rarely made explicit in policy narratives. By focusing on independence and innovation, less attention is given to structural barriers, unequal access to technology, or the additional support required by some groups if they are to benefit from digital care.
Overall, the paper demonstrates that equity in the use of technology in care is shaped not only by implementation, but by the stories policymakers tell about what technology is for and who it serves. Making care equity explicit within policy discourse is therefore a necessary step toward more inclusive and realistic digital care strategies.
An analysis of patient safety risks associated with remote consultations in UK primary care and strategies to mitigate harm.
Key messages
Policy implications
Gaps
Commentary
This paper highlights that the use of technology in care brings distinct patient safety challenges, particularly in remote primary care consultations. While remote access can improve convenience, it can also reduce clinicians’ ability to assess subtle cues or conduct physical examinations.
In terms of care equity, these risks are not evenly distributed. Patients with communication difficulties, language barriers or complex needs may be more vulnerable to harm in remote settings, especially if digital consultations become routine.
The study highlights the importance of mitigation strategies such as clear safety-netting and the option of in-person review. These approaches recognise that remote care should be adaptive rather than uniform.
Overall, the findings reinforce the need for balanced digital strategies. The use of technology in care must carefully weigh safety and equity alongside access, ensuring that digital delivery enhances care without increasing risk for already underserved groups.
Survey analysis from the State of Caring 2025 report examining how unpaid carers use digital technology and online resources to access information, support services and manage caring responsibilities.
Key messages
Policy implications
Gaps
Commentary
The State of Caring 2025 report highlights the increasing importance of digital information and technology in supporting unpaid carers. Online platforms are widely used to access guidance on benefits, services and caring responsibilities. This reflects broader shifts in health and social care systems, where information and service navigation increasingly take place through digital channels.
However, the report also suggests that digital access alone cannot address the practical and emotional challenges carers face. Technology may support information access, but carers continue to rely on professional advice, community services and peer support to manage complex caring responsibilities.
The findings also raise important issues relating to care equity. When support systems rely heavily on digital access, carers who lack reliable internet access, digital skills or confidence may struggle to obtain the information and assistance they need. This can create uneven access to support, particularly for older carers or those experiencing financial disadvantage.
Overall, the report reinforces the role of digital information as an important component of support for carers, while highlighting the need for inclusive design and multiple routes to assistance to ensure carers are not excluded from essential services.
