Our insights inform Government’s plans for a new Online NHS Trust for elective care
We have stated that, while we welcome the ambition to improve access and reduce waiting times through digital transformation, great care must be taken not to widen inequalities through digital exclusion.
Elective care covers a broad range of planned, non-emergency services – from tests and scans to outpatient appointments, non-urgent surgery and cancer treatment.
Drawing on our extensive engagement with Hertfordshire residents and feedback from voluntary sector partners, our submission stated that a new NHS Online Trust could only work alongside existing systems - not instead of them.
Under current Legislation, local Healthwatch must be consulted whenever a new NHS trust is proposed. This gives us a valuable chance to use your feedback to shape the future of the NHS.
What did we say?
Our submission responded to the key questions posed by the consultation. Some of these included:
What insights can you share about local people’s use of digital health services?
Many residents are digitally confident and already use online systems to manage aspects of their care. For some, these approaches provide reassurance, convenience, and reduced travel. However, our Online GP Services research found that over half would prefer to contact their GP by telephone or in person, rather than online.
Digital exclusion is a significant concern and the digitally excluded are often higher users of healthcare. Hertfordshire has a significant ageing population with pockets of deprivation and rural isolation. If digital pathways become the main route, inequalities may widen.
What has worked well to help people access digital health services?
Evidence from voluntary and community partners shows that digital upskilling works best when it is face-to-face, personal and practical. For example, Age UK Hertfordshire has successfully supported older people to use the NHS app.
However, many of these schemes rely on volunteers and need sustained investment if digital pathways are to expand safely and equitably.
How can we help patients understand how the Online NHS Trust will work in practice?
- Patients will need clear, consistent, plain-language explanations of what is available online and when it is appropriate. They will also need to know that escalation to in-person care is available (if needed) and be reassured that their referral is always a genuine choice. Printed materials, easy read formats and verbal explanations will be essential.
- Functionality and integration will be critical. Current frustrations with duplication between GP systems and the NHS App must not be replicated at scale.
- Patients will need clarity about where they are in their pathway, what happens next and who to contact. Older patients and vulnerable groups will need visible oversight to prevent feelings of abandonment and to provide continuity of care.
What are your key areas of concerns?
- Health inequalities - those who don’t/can’t use digital may experience longer waits than those accepting treatment through the Online NHS Trust. Non-digital routes must be maintained, along with investment in digital champions and connectivity schemes.
- Accessibility - screen-reader incompatibility, BSL and cognitive accessibility must be addressed at design stage. Accessibility testing, embedded reasonable adjustments and co-design with disability groups will be essential.
- Fragmentation and integration - confusion between multiple platforms must be resolved, record sharing and interoperability between different providers will be essential.
- Trust and safety - clear authentication systems and alternatives to link-only messaging will alleviate concerns about scams.
- Continuity of care - many patients already feel “forgotten” by services, so named contacts, visible tracking of care journeys and clear escalation processes are essential.
How should people’s experiences be used for service improvement?
Experience capture should include real-time feedback within the NHS App, targeted outreach to those who decline digital pathways and independent evaluation. The voices of those who do not opt into the Online NHS Trust are as important as those who do.
In summary
We recognise the potential of the Online NHS Trust to reduce waits and improve flexibility around elective care. However, choice must be genuine rather than theoretical. Digital transformation requires sustained investment in inclusion, interoperability and accessibility. Without this, there is a risk of widening inequalities.
We would also like to thank Dacorum CVS, Age Uk Hertfordshire, Citizen’s Advice Watford and Age Friendly Hertfordshire for assisting us with this response.
Government response:
I want to thank all respondents for their contributions to the consultation, which the Secretary of State will be considering when making their decision on the establishment of the Online NHS Trust.
The consultation responses will also support the ongoing policy development of NHS Online, and the programme will continue to work with patients, carers, and their representatives to develop the service. Further information assessing the expected impact of establishing the NHS Online Trust, including the impact on equalities, will be published following any decision and legislation to establish the new NHS Trust.
- Dr Zubir Ahmed MP, Parliamentary Under-Secretary of State for Health Innovation and Safety
