Healthwatch Nottingham and Nottinghamshire Responds to NHS Online Proposals
The response draws on local insight and patient feedback to highlight both the potential benefits and the significant risks of moving toward a national, virtual healthcare model.
👉 Read the full consultation response here:
The proposed Online NHS Trust represents a major shift in how care could be delivered — moving toward a system that is not tied to geography and relies heavily on digital access.
While this could improve access for some patients, our response makes clear that such a transformation must be approached carefully to avoid unintended consequences.
Key concerns raised
1. Risk of widening health inequalities
Not everyone can access or confidently use digital services. Older people, disabled people, and those without reliable internet or devices may be left behind unless strong support systems are built in.
2. Underestimating workforce pressures
The proposal suggests clinicians can contribute small amounts of additional time. HWNN warns this is unrealistic given current NHS staffing pressures and risks increasing burnout.
3. Loss of local accountability and continuity
A national, non-geographical service could weaken connections to local care systems, making coordination, safeguarding, and responsibility more complex.
4. Lack of clarity on social care integration
Many patients rely on both health and social care. The response highlights a lack of detail on how a digital NHS trust would work with local authority services.
5. Safeguarding concerns
Virtual care may make it harder to identify issues like abuse or coercion. Clear safeguarding processes are essential but currently underdeveloped in the proposal.
6. Limited evidence behind claims
The consultation references “proven” digital care models, but does not provide sufficient evidence or data to support these claims.
The response calls for:
- A clear equality impact assessment
- Realistic workforce planning
- Strong integration with local services
- Transparent evidence and data
- Robust safeguarding frameworks
- A phased, test-and-learn approach before national rollout
In our reponse we emphasise that patients do not all want a “digital-first” system — they want choice.
Digital tools can be helpful, particularly for convenience and follow-up care, but many people still value face-to-face interaction, reassurance, and continuity with known professionals.
Improving access and reducing waiting times are important goals. But as we highlight, digital healthcare is not automatically fair or effective for everyone.
Getting this right means designing services with patients, not just for them — ensuring that innovation enhances care without leaving people behind.
