Proposed NHS Online Trust risks creating a two-tier system – but patient insight can overcome this

Published : 16 April 2026

The government recently announced a consultation to create a new NHS Online Trust. Gordon Kay, Research Director at Public Voice, looks at how centring this development around patient experience and need could achieve an innovative service that works for all, instead of creating a two tier system that would only work for some.

The logic of this Trust is that it will help reduce the long waiting lists for planned care services by enabling people to have online consultations and be referred for surgery without the need of a face-to-face meeting. Patients would still need referrals from a GP, but the consultant could be from anywhere in the country. Initial services for the new trust would include gastroenterology, gynaecology, ophthalmology, and urology. You can read more here.

Healthwatch organisations across England were asked by the Department of Health and Social Care (DHSC) to submit responses. Three of Public Voice’s services Healthwatch Barnet, Healthwatch Croydon and Healthwatch Haringey provided insight from our general surveys, recent reports and some direct research specifically for the submission. Click the links to read them.

The submissions from our local Healthwatch showed similar themes. Many patients welcomed the convenience of digital services, particularly in reduced travel time which would make a big difference for those with mobility issues and quicker access due to reduced waiting lists. Younger people and those who were more digital first in their daily lives would also benefit from this innovation.

However, there were many concerns about creating a two-tier service: one that works for those with easy access to reliable technology and knowhow, and those who do not.

Concerns have been raised by service users about the proposed NHS Online Trust creating a two-tier service: one that works for those with easy access to technology, and one that falls short for those who do not.

Gordon Kay, Director of Research at Public Voice

Better communications and support formed the main suggestions provided. Croydon residents and service users suggested that supporting staff confidence to be well informed with this technology can build trust with patients. Haringey residents focused on the need for live support when using digital services and the need to have formats and information in multiple languages. Barnet residents raised issues of accessibility and how this new service will work for those with visual impairments, learning disabilities and mental health challenges, where digital can currently be a challenge.

Practical suggestions on how the NHS can better deliver this included coproduction with patients and working with community organisations who engage with people where they are. This includes working with faith and other trusted leaders to develop resident engagement. This may help overcome language and culture barriers which could inform any further engagement campaign.

The NHS should also evaluate success, working with patients to decide what success is, and tracking patient journeys using qualitative and quantitative data to better understand their experience. There should also be a focus on patient outcomes as well as regular monitoring of functionality. All of this will help build trust.

The need to conduct effective research of patient insight and coproduction is crucial to ensuring services meet patient expectations and needs, particularly those with health inequities. While the drive to digital has the potential to bring services closer to people by being in their own homes, and of course save precious resources, only quality insight from a diverse range of voices will help deliver this essential service successfully.

Unfortunately, significant changes in service delivery do not always come with enough service user insight, leading to frustration, disappointment and, of most concern, disengagement. One hopes that this time, DHSC will take what has been heard by Healthwatch across England as a basis to committing to an effective consultation with service users. A small price to pay now for greater benefit later. By centring this development around patient experience and needs, they may well achieve an innovative service that works for all.