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Community digital inclusion and access to services

An evaluation of a city-wide, voluntary sector-led digital inclusion programme examining impacts on digital health service use.

Key messages

  • a city-wide digital inclusion programme delivered through voluntary and community sector organisations improved use of digital health services
  • partnership working with local voluntary organisations was central to engagement
  • place-based delivery helped reach residents facing digital exclusion
  • digital inclusion support extended beyond skills to include confidence and trust
  • findings suggest that local context shapes the effectiveness of digital interventions.

Policy implications

  • digital inclusion strategies should be delivered through trusted community organisations
  • place-based approaches may be more effective than generic national programmes
  • integration between health services and voluntary sector partners can support equitable digital access
  • future programmes should build evaluation into design from the outset.

Gaps

  • lack of controlled study design limits causal inference
  • limited analysis by age, ethnicity or deprivation
  • uncertainty about which population groups benefit most
  • need for longer-term follow-up on health outcomes.

Commentary
This study provides evidence that community-led digital inclusion initiatives can improve engagement with digital health services. By working through voluntary and community sector organisations, the programme was able to reach residents who might otherwise remain excluded from digital care.

Considering care equity, the findings reinforce the importance of place-based delivery. Digital exclusion is shaped by local factors, including trust, social networks and access to support, which community organisations are often well placed to address.

The emphasis on partnership working highlights that digital inclusion is not solely a technical challenge. Social relationships and local infrastructure play a key role in enabling people to engage with digital health services.

However, the study also highlights evidence gaps. Without controlled designs and analysis, it remains unclear which groups benefit most and whether digital inclusion reduces or widens inequalities. Strengthening evaluation methods will be important to guide future use of technology in care.

Designing inclusive and trusted digital health services

Analysis reviewing evidence and practice cases on how community co-design can improve the inclusivity and trustworthiness of digital health services.

Key messages

  • many digital health services fail to meet needs when communities are not meaningfully involved in design
  • lack of trust and relevance contributes to low uptake among underserved groups
  • community co-design improves usefulness, accessibility and legitimacy of digital services
  • ‘margins-first’ approaches prioritise people most likely to be excluded
  • measuring success should go beyond uptake to include confidence, access and trust.

Policy implications

  • digital health programmes should embed community co-design from the outset
  • power-sharing with communities is central to building trust
  • evaluation frameworks should include equity-relevant outcomes, not just usage metrics
  • commissioners and designers should resource sustained engagement rather than one-off consultation.

Gaps

  • limited empirical evaluation of long-term impacts of co-designed digital services
  • challenges in scaling community-led approaches within national programmes
  • need for clearer guidance on measuring trust and confidence outcomes.

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.

Digital Exclusion Risk Index (DERI)

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

  • Digital Exclusion Risk Index (DERI) is a composite index combining multiple indicators of digital exclusion risk
  • the tool supports identification of places and groups most likely to lack access, skills or connectivity
  • it is intended to inform targeting of devices, data and digital skills support
  • the index can be used by integrated care systems and local authorities
  • publishing metrics enables transparency and accountability in digital inclusion work.

Policy implications

  • digital inclusion investment can be targeted more effectively using place-based risk data
  • routine publication of digital exclusion metrics supports equitable resource allocation
  • Integrated Care Systems (ICSs) and local authorities can integrate DERI into needs’ assessment and planning
  • data-led approaches may help align digital strategies with wider inequality priorities.

Gaps

  • the index does not directly measure health or social care outcomes
  • risk indicators rely on available public data, which may lag behind change
  • further work is needed to link exclusion risk to service use and outcomes.

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.

Digital front doors and social care use

A study examining the association between local authority digital front doors and social care service uptake among adults in England.

Key statistics

  • less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system
  • about 25% (37/147) adopt digital self-assessment within their system. 

Key messages

  • digital front doors are increasingly used by local authorities to manage access to social care
  • associations were identified between the presence of digital front doors and patterns of social care uptake
  • impacts varied across age groups
  • findings suggest digital access routes may influence who engages with social care services
  • evidence reflects early implementation rather than long-term effects.

Policy implications

  • digital front doors should be implemented alongside non-digital access routes
  • monitoring of service uptake by age and other characteristics is important
  • local authorities may need to assess how digital access shapes demand and equity
  • digital access strategies should be integrated with wider access and prevention planning.

Gaps

  • lack of qualitative data explaining why digital front doors are effective or ineffective
  • limited insight into user experiences and barriers
  • most data relate to 2021 or within two years of implementation
  • long-term impacts on access and outcomes are not yet evidenced.

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.

Digital poverty in the UK

A national assessment examining the scale, drivers and impacts of digital poverty in the UK, with implications for health and social care access.

Key statistics

  • an estimated 13-19 million people aged 16 and over in the UK experience digital poverty
  • digital poverty is driven by income constraints, infrastructure gaps and limited digital skills
  • significant regional variation exists in levels of digital poverty
  • modelling suggests substantial social and economic benefits from reducing digital poverty.

Key messages

  • digital poverty affects a large proportion of the UK population
  • lack of access to devices, connectivity and skills is unevenly distributed
  • digital access is closely linked to income, geography and education
  • reducing digital poverty delivers wider social and economic benefits
  • digital access functions as a determinant of health and social care inequality.

Policy implications

  • funding for devices and connectivity is needed at population scale
  • digital skills support should be embedded within public services
  • national and local strategies must address infrastructure and affordability
  • tackling digital poverty is integral to reducing inequalities in health and social care.

Gaps

  • need for more granular data on impacts for specific population groups
  • challenges in evaluating long-term effects of large-scale digital inclusion programmes.

Commentary
This report positions digital access as a foundational condition for participation in modern health and social care systems. By quantifying the scale of digital poverty and its underlying drivers, it shows that exclusion from digital services is not marginal but widespread.

The findings highlight how digital poverty maps onto existing patterns of disadvantage. People with lower incomes, weaker infrastructure and fewer digital skills are more likely to face barriers to online health information, digital appointments and technology-enabled care. As digital routes become increasingly embedded in service delivery, these gaps translate directly into unequal access.

Rather than framing digital exclusion as an individual deficit, the report emphasises its structural nature. Access to devices, affordable connectivity and skills support emerges as a prerequisite for fair access to care, not an optional add-on.

Overall, the analysis supports that efforts to expand digital health and care must be accompanied by large-scale investment in inclusion. Without addressing digital poverty directly, the use of technology in care risks reinforcing existing social and care inequalities rather than helping to reduce them.

Digitalisation of financial management in dementia care

A qualitative study exploring how digital financial systems have changed money management for people living with dementia and their family carers since the COVID-19 pandemic.

Key messages

  • digitalisation has transformed how finances are managed for people living with dementia
  • tools such as direct debits and debit cards can simplify routine payments
  • digital finance systems can also increase complexity and risk for some individuals
  • older people living with dementia face barriers related to usability and digital confidence
  • unpaid carers often take on additional financial management responsibilities as a result.

Policy implications

  • digital financial systems should be designed with cognitive accessibility in mind
  • clearer safeguards are needed to support people living with dementia
  • digital literacy training could support both people with dementia and carers
  • access to appropriate devices and support is necessary to prevent exclusion.

Gaps

  • evidence is qualitative and based on lived experience
  • limited evaluation of specific interventions to support digital financial inclusion
  • lack of research on how financial digitalisation affects different socioeconomic groups.

Commentary
This study illustrates how the digitalisation of financial management brings mixed consequences for people living with dementia and those who support them. While automated payments and card-based systems can reduce day-to-day burden, they can also obscure oversight and increase dependence on others.

The findings show that digital change often shifts responsibility rather than removing it. As systems become harder to navigate, unpaid carers frequently absorb additional financial tasks, adding to existing caring pressures. These dynamics are particularly pronounced where platforms are not designed with cognitive impairment in mind.

Usability emerges as a central issue. Digital finance tools that assume high levels of confidence, memory and comprehension can inadvertently exclude people living with dementia, even when intended to simplify processes.

Overall, the study highlights the need to treat financial digitalisation as part of care infrastructure. Ensuring that systems are accessible, supported and adaptable is essential if technology is to reduce burden rather than redistribute it onto carers.

Equity impacts of digital-by-default primary care in minoritised ethnic communities

A qualitative study examining how digital-by-default primary care affects access for adults from minoritised ethnic communities in England.

Key messages

  • digital access routes such as e-consultations and online triage often replicate or worsen existing access barriers
  • limited access to devices, data and reliable internet inhibits use of digital primary care
  • lack of language support and English-only digital interfaces reduce accessibility
  • digital systems are frequently poorly aligned with users’ needs and circumstances
  • GP staff often rely on informal, ad-hoc workarounds to support patients excluded by digital systems.

Policy implications

  • digital-by-default approaches risk widening inequalities if alternative access routes are not protected
  • primary care digital systems should be designed with language support and accessibility in mind
  • investment in digital inclusion alone may be insufficient without service design changes
  • practices may need clear guidance and resources to support equitable access rather than relying on informal workarounds.

Gaps

  • limited evidence on long-term impacts of digital-by-default models on health outcomes
  • lack of quantitative assessment of exclusion at population level
  • limited evaluation of which design changes most effectively reduce digital barriers.

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.

Improving access for digitally excluded people using mental health services

A qualitative evaluation of a trust-wide digital inclusion programme supporting digitally excluded people using mental health services.

Key messages

  • digitally excluded people using mental health services face barriers related to device access, connectivity and digital skills
  • a trust-wide offer providing devices, data connectivity and one-to-one digital skills support improved access to digital care
  • participants reported increased engagement with services and greater perceived control over their care
  • tailored, individual support was central to building confidence and digital capability
  • digital inclusion was viewed as enabling participation rather than replacing non-digital care options.

Policy implications

  • digital inclusion support should be treated as a core component of digital mental health strategies
  • investment in devices and connectivity needs to be accompanied by personalised skills support
  • mental health providers may need dedicated roles or teams to deliver digital inclusion at scale
  • hybrid models should remain available to avoid excluding those unable or unwilling to use digital tools.

Gaps

  • limited evidence on longer-term outcomes and sustainability
  • no assessment of cost-effectiveness
  • potential selection bias due to voluntary participation
  • uncertainty about scalability beyond a single NHS trust.

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.

Inclusive digital healthcare: a framework for NHS action

National guidance setting out actions for the NHS to design and deliver digital health services that are inclusive and equitable.

Key messages

  • digital healthcare should be inclusive by design rather than assuming universal access
  • digital services must remain complementary to non-digital routes
  • proactive identification of digitally excluded groups is essential
  • partnerships with local authorities and voluntary organisations can support access
  • support for devices, connectivity and digital skills is a core component of inclusion.

Policy implications

  • NHS organisations should assess digital exclusion risks when implementing digital services
  • offline access routes should be maintained and protected
  • local partnerships are key to delivering practical digital inclusion support
  • inclusion should be embedded in governance, commissioning and service assurance processes.

Gaps

  • framework guidance is not accompanied by outcome evaluation
  • limited evidence on how consistently the framework is implemented across the NHS
  • need for monitoring of equity impacts over time.

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.

Liverpool 5G health and social care testbed

A programme evaluation examining the benefits and outcomes of a community 5G network supporting connected health and social care services in Liverpool.

Key messages

  • the testbed combined community 5G connectivity with connected health and social care services
  • reported outcomes included reductions in GP visits and telecare costs
  • improved connectivity supported access to digital health and care services
  • the programme focused on deployment in disadvantaged areas
  • infrastructure investment was central to enabling service use.

Policy implications

  • investment in free or low-cost connectivity can support access to technology-enabled care
  • connectivity infrastructure should be considered part of health and social care enablement
  • place-based digital infrastructure can complement service redesign
  • partnerships across local government, health services and technology providers are important.

Gaps

  • evidence is based on a case study evaluation
  • limited comparative or controlled analysis of outcomes
  • uncertainty about scalability and longer-term sustainability
  • limited detail on differential impacts across population groups.

Commentary
This programme shows how digital infrastructure can shape access to technology-enabled care. By focusing on connectivity in a disadvantaged urban area, the testbed addressed a foundational barrier that often sits outside traditional health and social care planning.

The reported reductions in GP visits and telecare costs suggest that connectivity can support more efficient use of services. However, these outcomes appear closely tied to local context, programme design and the availability of complementary services.

Rather than treating digital access as an individual responsibility, the testbed illustrates the effects of structural investment. Providing reliable, low-cost connectivity created the conditions for people to engage with connected care who might otherwise have been excluded.

Overall, the Liverpool 5G testbed highlights the role of infrastructure as an enabler of equitable technology use in care. Its findings point to the importance of aligning connectivity investment with service delivery, while also underlining the need for stronger evaluation to understand wider applicability.