Key messages

Policy implications

Gaps

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.

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.

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.

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.

Key statistics

Key messages

Policy implications

Gaps

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.

Key messages

Policy implications

Gaps

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.

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.

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.

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.

Key messages

Policy implications

Gaps

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.

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.

Key messages

Policy implications

Gaps

Commentary
This policy review provides historical context for how technology has developed within UK social care systems. Technologies such as telecare, monitoring devices and digital communication tools have been promoted as solutions to rising demand, workforce shortages and pressure on public finances. The report notes that many policies have framed technology as a means of enabling people to live independently at home for longer while potentially reducing service costs.

The analysis also shows that technology has been introduced within a broader transformation of the care system, including a shift towards community and home-based support and increasing reliance on digital infrastructure. However, implementation has often been fragmented, with central government supporting research and innovation while local authorities determine how technologies are adopted in practice.

From a social care equity perspective, the report highlights that technological change must be considered within the wider organisation of care systems. Access to reliable internet infrastructure, digital services and appropriate support can vary across regions and populations. If digital solutions are introduced without adequate infrastructure, evaluation and support, they may reinforce existing disparities in access to care.

Overall, the review argues that technology alone cannot resolve structural challenges in social care. Instead, effective use of digital tools requires a holistic approach that considers workforce roles, infrastructure, regulation and the broader organisation of care services.