From online to everywhere: Turning the NHS Online Hospital into a living network

In the Monzo meets medicine piece earlier this year, we posed the question: what if the NHS adopted the challenger mindset that reshaped banking? The argument wasn’t about digitising what already exists, but about re-imagining it and enabling the fundamental changes required to address the burgeoning demands of 21st century healthcare.

Fast-forward a few months and the government has publicly declared its ambition to build a national Online Hospital by 2027 – marking a bold step in a similar direction. The vision is to make care more accessible, community based, data-driven, and connected across the system. The question now is whether the NHS can move beyond digitisation and think like a true patient-centred, technology-enabled, and remote-first organisation.

A moment of alignment

The notion of an Online Hospital echoes the ideas explored in The Everywhere Hospital report, where we asked what would happen if we rebuilt healthcare from the ground-up – using the latest technologies, data standards, and design principles. The aim was never to present a finished model, but to challenge assumptions about what a hospital is, what it could be, and where care should happen.

The Everywhere Hospital concept reimagines the hospital as a distributed, cloud-native, and patient-centred network. It builds on lessons from sectors that have already been transformed by technology. When Monzo reshaped banking, or Amazon reshaped logistics, they didn’t simply digitise existing systems. They built agile and scalable infrastructure around users. The same thinking could apply to healthcare.

Cloud-first care

If the Online Hospital is to succeed, it has to be cloud-first by design. Many parts of the NHS still run on fragmented, locally hosted systems that struggle to communicate. Meanwhile, industries around us use cloud infrastructure to scale, adapt, and respond in real time. The NHS hesitates for many reasons: legacy estates, contract lock-in, safety obligations, and risk appetite. A cloud-first approach can still meet these constraints if procurement, security, and architecture are designed together.

Cloud-first only works if it is open by default: interoperable APIs, shared terminology, and clear safety cases. National patterns for messaging and identity, and local freedom to customise services, keeps vendors honest and teams productive. It’s critical to build once, reuse widely, and evidence safety and benefit as you scale.

Neighbourhood health: Where “online” meets “on the ground”

Furthermore, The Online Hospital can only work if it connects national ambition with local delivery – enhancing, rather than compromising human-to-human connection. That bridge already exists through Neighbourhood Health, a programme now scaling across England with active implementation sites.

To make prevention a reality, coordination and communication tools need to be simple, pragmatic, and embedded in neighbourhood-level workflows. To make this happen it is critical that we design these tools with users at the centre, reducing the admin burden on clinical staff and closing the digital divide for patients.

This is where the Online Hospital meets the Everywhere Hospital mindset. Technology must serve the relationships that underpin care, not the other way around.

Inclusion by design: Closing the digital divide

If an Online Hospital is to widen access, rather than widen gaps, inclusion has to be designed in from the outset, not added as an afterthought. That means developing services that work on low-cost devices and with low bandwidth; plain-English content in multiple languages; large-print options and voice support; and assisted-digital routes through pharmacies, libraries, community hubs, and family carers. It also means keeping phone and in-person options for those who prefer them. Digital should be “plus”, not “instead of”.

Co-design with people who are least comfortable online must be routine: older adults, people with sensory impairments, those with limited data plans, and communities with lower health literacy. To this end, practical features matter, including clear consent flows, the ability to nominate a proxy or carer, offline appointment reminders, and simple two-step verification that does not lock out users without smartphones. When you build these paths in from the start, you reduce non-attendance, raise satisfaction, and avoid disempowering the very patients who stand to benefit most.

Culture, collaboration, and continuous learning

Good technology alone is not enough to deliver transformation. Culture is the harder frontier. We have to bring people along with us on this journey. Healthcare is one of the most risk-averse and highly regulated sectors in the world and innovation often competes with the daily realities of workforce pressure and clinical risk.

Adopting a start-up mindset means giving space to experiment, test, and iterate. In our projects, agile delivery is as much about listening as it is about coding. Co-designing tools with clinicians, understanding friction points, and evolving the product based on real feedback helps keep digital systems relevant to the frontline.

Thinking of the Everywhere or Online Hospital not as a destination, but as a mindset, encourages us to review every process and ask whether we are solving problems with today’s technology or simply digitising yesterday’s ones. What’s more, we need to consider whether there are any missed opportunities to optimise certain processes without incurring significant disruption.

From digital hospital to living network

The NHS’s Online Hospital ambition signals intent. But to make it real, the focus must move from building a digital replica of the hospital to building a living, learning network. A system that uses cloud infrastructure for resilience, neighbourhood teams for connection, and agile methods for constant improvement.

The opportunity now is to apply the same curiosity and creativity that made challenger banks redefine finance. Because in healthcare, the biggest innovation isn’t the technology itself, but the willingness to rethink how we use it.

About the author

Dr Harry Thirkettle is director of health & innovation at Aire Logic, as well as a mentor, leader, doctor, and entrepreneur. A former surgeon, Dr Thirkettle made the decision to stop practising medicine when he realised that, through scaling technology, he could help many more people – patients, clinicians, and caregivers alike – to navigate the NHS and achieve the best possible health outcomes. Dr Thirkettle is also heavily involved with the NHS Clinical Entrepreneurs Programme supporting NHS staff to become innovators through coaching, ideation, business strategy, and planning. He is passionate about advancing developments that can streamline clinical pathways, as well as therapy apps that put improving people’s health in their own hands – supporting earlier diagnosis and disease prevention.