The UK’s healthcare system is undergoing a digital revolution. From the NHS App touted as a 'doctor in your pocket' to AI-powered chatbots that triage symptoms, technology is reshaping how patients access care. These innovations promise greater convenience, efficiency, and patient empowerment. We are also seeing this hype within the Armed Forces too.
However, amidst the excitement over artificial intelligence (AI) in health, there lurks a quiet but significant risk: digital exclusion. In simple terms, not everyone can join this digital health revolution, and those left behind are often the people who need care the most. This is why we started the Veterans Digital Needs Study. The digital divide is always on a continuum, and we will always have people being excluded.
The promise and the pitfalls of digital healthcare
Digital and AI-driven tools offer tremendous potential benefits. Imagine booking GP appointments, viewing test results, or receiving instant health advice through an app; all from the comfort of home. In theory, such tools could streamline services and even reduce waiting times.
The UK government’s Ten-Year Health Plan leans heavily on expanding the NHS App as a central hub for health services, aiming to make it the front door to the NHS for patients. Likewise, AI algorithms are being explored to handle administrative tasks and provide decision support, freeing up clinicians’ time for direct patient care.
Yet, these digital-by-default approaches come with important caveats. They hinge on the assumption that patients are connected, digitally aware and digitally savvy. If healthcare becomes 'digital first' without adequate support, it risks creating a two-tier system where the tech-proficient benefit, while others are left behind. In other words, the same innovations meant to democratise healthcare access could inadvertently deepen inequalities if we’re not careful.
Understanding digital exclusion in health
Digital exclusion refers to the lack of access, skills, or confidence needed to engage with online services and devices. In a health context, this could mean not having a smartphone or internet connection, struggling to use apps and websites, or feeling uncomfortable with technology.
Importantly, digital exclusion often overlaps with social disadvantage, it tends to affect many of the same groups who already face health inequalities. For example, older adults, people with disabilities, those with low income or education, certain ethnic minority communities, and rural residents may all be at higher risk of being digitally left out.
Crucially, digital exclusion isn’t a binary all-or-nothing state but a spectrum. Some individuals have zero internet access, while others might have a smartphone but lack the skills or confidence to use health apps effectively. Even having access doesn’t guarantee meaningful use, issues like low literacy, cognitive impairments, or language barriers can prevent people from benefiting from digital services. The more healthcare services move online (booking systems, consultation portals, triage, electronic records), the more those unable to use these tools risk being left behind.
Who Is being left behind?
It’s often assumed that “digital natives” (younger generations) will adapt easily to AI-driven health services, but what about older patients and other at-risk groups? This also includes veterans. In the UK, the vast majority of people who have never used the internet are over the age of 55. In fact, of the 4.5 million UK residents who have never been online, 94% are over 55. Among the eldest, digital exclusion is even more pronounced – around one-third of people over 75 lack even basic digital skills. That means many seniors cannot navigate an app or website to book an appointment or look up health information.
Additionally, roughly 6% of UK households have no internet access at all, which disproportionately affects the elderly and those with a low-income. It’s not just age: disability is a factor too – a quarter of adults who lack basic digital skills have a disability or long-term health condition. Geography and income play a role as well; for instance, in the most deprived areas of England, older people are far less likely to be online regularly compared to those in more affluent areas.
This isn’t to stereotype all older people as technophobic; many seniors do embrace tech. But on a population level, older adults, the poor, and the vulnerable are the groups most at risk of digital exclusion. We all face declining abilities as we age, so digital exclusion is a life course issue that can affect anyone in time. The key point is that those who are already socially or economically disadvantaged are more likely to lack digital access, which in turn can compound their difficulty in getting healthcare.
Consequences for health and care inequality
What happens when healthcare goes digital-by-default, but a patient can’t or won’t use the digital option? The outcomes can be worrying. Patients who struggle with online systems might delay seeking care or miss out on preventive services. For example, a recent study found that older patients often misunderstood automated online symptom-checkers, leading to unnecessary anxiety or delayed care for serious issues.
It’s easy to see how an AI-driven triage system could inadvertently funnel a confused user down the wrong path; some might end up in A&E (Accident & Emergency) for non-urgent problems after misinterpreting app advice, while others might avoid using the app altogether until their condition worsens. Both scenarios put added strain on services and can result in worse health outcomes.
There’s also the risk of patients falling through the cracks. If GP surgeries prioritise online booking and digital consultations, will traditional options remain truly accessible? Even if phone lines stay open, those who aren’t quick with technology could be at a disadvantage for securing appointments. In one case, certain GP practices saw long queues of sick patients forming in person because some could not manage the new online booking systems. For a person with limited digital skills, something as basic as renewing a prescription or consulting a doctor can become an uphill battle.
This digital divide in healthcare can literally be a matter of life and death. Advocacy groups for the elderly have pointed out that a 'digital-only' approach could be unsafe or even life-threatening for some seniors. If an older person with chronic illness is expected to use an app to report symptoms or request medication but cannot do so, their condition may deteriorate unchecked.
The National Pensioners Convention estimates that between 500,000 and 700,000 older people in the UK would struggle to navigate online health tools or the NHS App; effectively locking them out of parts of the system. The result is a widening gap in healthcare experiences: a tech-literate patient might get faster service and more autonomy, while a digitally excluded patient faces delays, confusion, or no service at all. This emerging two-tier system is the opposite of the equality that the NHS strives for.
Bridging the digital divide in an AI-driven NHS
The good news is that awareness of this quiet risk is growing, and efforts are underway to ensure no patient is left behind as we digitise healthcare. NHS England itself acknowledges that “digital by default” must not become “digital only”. In practice, this means that while the NHS App and AI tools expand, traditional channels like telephone lines, face-to-face appointments, and paper correspondence need to remain viable options for those who prefer or require them.
Inclusivity should be a guiding principle whenever new health tech is rolled out. For example, any AI symptom checker or patient portal should be designed for universal usability, following accessibility standards (e.g. simple interfaces, large text options, support for screen readers and multiple languages). User testing should involve diverse groups, including older adults and people with disabilities, to ensure the tools make sense to everyone, not just the tech-savvy.
Another key strategy is investing in digital inclusion initiatives. The UK government’s 2025 Digital Inclusion Action Plan and various charity-led programmes recognise this need. This can include providing free or low-cost internet access and devices to those who can’t afford them, as well as offering training and support in digital skills. Community venues like libraries, adult education centres, and GP surgeries themselves can host digital help sessions; not just generic IT classes, but health-specific digital coaching.
For example, teaching an older person how to navigate the NHS App or safely look up NHS-approved health advice can build confidence and demystify the technology. Research shows that practical, hands-on support over time (rather than one-off courses) is most effective in helping people gain digital skills that stick. There are also creative approaches: in some areas, NHS teams have trialed simplified devices (like one-button tablets or smart hubs) to enable patients with low tech literacy to join video consultations and access online care, with promising results in reducing isolation and improving access.
Perhaps most importantly, health leaders must treat digital inclusion as a core part of healthcare quality, not an afterthought. Just as we wouldn’t build a clinic without wheelchair access, we shouldn’t deploy AI health systems that exclude large swathes of the population. Every new digital health initiative should ask: Who might be unable to use this, and how can we support them or provide an alternative?
The NHS’s own framework on inclusive digital healthcare emphasises keeping non-digital routes open and providing support for those with barriers, from loaning devices and data plans to partnering with community organisations for outreach. By actively mitigating exclusion, digital health can truly enhance care for all, rather than amplifying existing inequalities.
Ensuring AI benefits everyone
As AI-driven health systems become the norm, it’s vital to ensure that technology doesn’t outpace empathy and inclusivity. The potential of AI in healthcare is exciting, automating routine tasks, analysing medical data faster, even personalising treatments. But these advances will ring hollow if a significant portion of patients cannot access or trust the systems delivering their care. We must be vigilant that biases (like ageism or assumptions about tech ability) aren’t inadvertently built into our digital tools. For instance, an algorithm should not assume every user is comfortable with complex app navigation, and every digital service should have a human fallback option.
Overall, the goal is a hybrid healthcare model that blends digital innovation with compassionate, inclusive and empathetic care. An older patient who prefers the phone or a clinic visit should get the same quality of service as one who handles everything via an app. Choice is key: patients should be able to engage with the NHS in the way that works for them. This might mean extra effort and investment in the short term, funding community digital support, maintaining multiple access channels, but it pays off by preventing people from slipping through the cracks. In a country where millions are still offline or not confident online, such efforts are not a luxury but a necessity.
In conclusion, the march of AI and digital tech in healthcare offers immense promise, but we cannot ignore the quiet risk of digital exclusion. A truly modern, AI-enhanced health system must also be an inclusive health system. By recognising who is at risk of being excluded and taking proactive steps to support them, the UK can ensure that its digital health revolution leaves no one behind. After all, healthcare is at its best when it’s accessible to everyone, whether they’re tech enthusiasts or technophobes. The future of medicine can be high-tech and human-centric at the same time, and achieving that balance is the cure for the digital divide in our health system.