Can Digital and Data Lay the Foundations for Equity? 

Health inequalities remain one of the most persistent challenges in our system, and turning ambition into real change is often far from straightforward. This blog series looks at the 10 Year Health Plan for England through an inequalities lens – exploring where the evidence shows we can make the biggest difference, and the potential pitfalls we should avoid. Across the series, our Associate Director for Policy and Practice Engagement, Dr Liam Loftus, draws on the evidence base to highlight what is most likely to work in practice.

You only have to have skimmed the 10 Year Health Plan for England to get a sense of how central digital and data are to its ambitions – the fact that there are 122 references to “digital,” and 191 to “data,” speaks a lot to that. To say that digital transformation therefore sits at the heart of the Plan is, if anything, an understatement. 

For those concerned about health inequalities, that prominence often creates anxiety. History tells us that new technologies tend to benefit those who are already better served, while others are left behind. But it does not have to be this way. If designed deliberately, digital tools and better data have the potential to become some of the most powerful levers we have to narrow the gap.

This blog explores some of the areas where that choice will matter most: accessibility of digital services, and not just what data we capture, but also how we measure success overall.

The NHS App is set to become the “front door” to the health service. The Plan envisages it enabling people to book appointments, communicate with professionals, view care plans, self-refer, and even act as a “doctor in your pocket”. It is an ambitious vision, and one that could improve access and convenience for millions.

But access is not evenly distributed. Around 6% of UK households still do not have internet access at home, and millions more lack the skills or confidence to use digital services effectively. An estimated 6.8 million people have poor digital skills, with this disproportionately affecting older people, women, and those on lower incomes.

Alongside this sits a related, and often overlooked, challenge: health literacy. Health literacy refers to people’s ability to access, understand and use health information. In the UK, around 43% of working-age adults struggle to understand written health information, rising to 61% when numeracy is involved. These challenges are not evenly spread either – they are clustered in people and communities already experiencing disadvantage.

The good news is that there is a growing evidence base for what works. Our evidence review shows that interventions tailored to specific communities – such as locally delivered digital health literacy programmes – can be effective. Even relatively simple changes matter: simplifying language, using visuals and pictograms, and offering narrated or animated content can significantly improve understanding and engagement.

The message is clear: digital transformation will widen gaps unless we consciously design it not to. But if we do, there is good evidence that it can work for everyone.

For a deeper dive into what this could look like in practice, I’d recommend this blog from Dr Sash Harasgama. 

Beyond how people access services, digital systems also determine what the NHS knows about the people it serves.

Buried deep in the Plan is a line that is easy to miss, but one that could make all the difference. That is the plan for “the introduction of tested and validated personalised social risk assessments, to more consistently capture non-clinical risk factors for ill health, so that care can be tailored and co-ordinated to improve patient outcomes and reduce health inequalities.”  In practical terms, this points towards more systematic recording of the social determinants of health – such as housing insecurity, financial stress, low literacy, or social isolation – within the patient record.

Why does this matter? Because evidence shows that understanding social risk can improve the quality of consultations, support more personalised care, and help predict and improve health outcomes. It allows clinicians to tailor advice and interventions to people’s real-world circumstances.

Many GP practices have already begun doing this informally. More structured approaches are now being tested and evaluated at scale, including across parts of London. For practices looking to get ahead of the curve, we’ve produced practical guidance on how to implement social needs screening in ways that are proportionate and effective.

Handled well, this could be one of the most powerful ways data can support equity rather than obscure it.

The Plan also proposes changing how success is measured. It commits to a major expansion in the use of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) – see Box 1. By 2029, these are intended to be used universally, published openly, and made available to patients when choosing providers through the NHS App.