The NHS has placed digital-first communication at the heart of its modernisation plans. National policy now positions the NHS App, email and text messaging as primary channels for contacting patients, with the aim of reducing reliance on paper and improving the speed and clarity of information. This direction makes a lot of sense in theory. Digital channels support timely updates, reduce avoidable contact and help people move through the health system with greater confidence.
So far, much of the progress has been made by digitising structured documents such as appointment reminders and standardised clinic letters. These are well suited to templates and automation, so it is logical that they have been the focus of early delivery. While this represents positive momentum, it actually only reflects roughly half of the actual volume of patient correspondence taking place across NHS organisations.
The next phase of digital-first success depends on addressing the other, often-overlooked half of patient communication: the large, varied and complex world of unstructured mail.
The scale and complexity of unstructured communication
Across NHS organisations, FOI requests reveal between 45-60% of outbound communication does not follow a rigid template. Typed consultant letters, diagnostic summaries, discharge notes, follow-up instructions, forms and one-off updates are created every day by clinical and administrative teams. These documents often use formats developed locally over time, with different conventions in structure, tone and layout.
This variation makes unstructured communication challenging to manage at scale. A document’s layout might shift slightly depending on who produces it or which department it comes from. While these differences may seem small, they add up across thousands of documents each month. They make it more difficult to route communication efficiently, ensure accessibility or integrate documents reliably into digital systems.
For trusts working towards modernised, end-to-end communication processes, this complexity can slow progress and limit the benefits achieved through digital-first initiatives.
The challenge deepens when viewed through the lens of accessibility. Under the Accessible Information Standard, the NHS must ensure that all patients receive information they can understand and use. Structured documents are easier to convert into accessible formats, but unstructured documents often contain layout issues, dense text or unclear language. Patients with visual impairments, cognitive challenges or lower digital literacy feel the impact most sharply and trusts often lack the tools or processes to correct the problem at scale.
Understanding the true cost of unstructured mail
If digital-first is to become a reality rather than an aspiration, the NHS needs to face up to the unstructured mail challenge. The first step is recognising its scale. Many organisations lack a clear picture of how many unstructured documents they produce, how they are distributed, or what they cost to process. Understanding these baseline factors creates a foundation for decision making. It allows teams to quantify where the burdens fall, what role duplication plays and how much administrative time is absorbed by manual workarounds.
Once this landscape is understood, organisations can look to solutions that streamline unstructured documents automatically, without requiring clinicians or administrative teams to redesign their workflows. Modern document-processing technologies can interpret varied layouts, identify key fields such as address blocks, and prepare documents for digital delivery without needing rigid templates or formatting rules. This removes the burden of standardisation from staff and allows existing clinical correspondence to flow more efficiently through digital channels.
Alongside these capabilities, NHS organisations can explore more intelligent routing of outbound communication. Digital-first does not mean digital-only. Many patients welcome messages through the NHS App or email, while others continue to prefer postal communication or require accessible formats. Automated routing helps ensure that each document is directed to the right channel based on patient preference and eligibility, reducing unnecessary cost and avoiding situations where digital-ready patients still receive paper by default or where others receive communication that does not meet accessibility requirements.
The cultural aspect is equally important. Unstructured communication tends to accumulate in organisations because no single team feels ownership of the entire process. Clinical staff focus on content; administrative teams focus on distribution and digital teams focus on channel adoption. The result is a disjointed experience for patients. A more collaborative approach is required; one that treats communication as a patient safety and operational performance issue rather than a clerical task. Shared accountability encourages teams to redesign processes together and ensures communication standards are applied consistently across specialties.
A strategic opportunity hiding in plain sight
For many NHS leaders, the instinct is to pursue incremental improvements. Yet tackling unstructured mail represents a more strategic opportunity. It unlocks the greater savings and efficiencies that digital-first promises, reduces administrative duplication, improves record accuracy, strengthens accessibility and creates a more coherent patient journey. Most importantly, it provides a foundation for personalisation. When systems understand what each document contains and how it should be routed, they can deliver information in ways that respect patient needs and preferences.
mHealth conversations often focus on apps, platforms and new digital services. But none of these innovations can deliver their full value until the communication they depend upon is structured, standardised and ready for digital delivery. Unstructured communication may not be glamorous but modernising it is the step that will finally allow the NHS App — and the broader digital ecosystem — to reach its true potential. Trusts that address the unstructured mail problem head on will be the ones that realise the full value of digital-first and set new standards for clarity, efficiency and patient trust.
By Mark Statton, Head of Public Sector Strategy, Quadient
About the author
Mark Statton leads Quadient’s Public Sector Strategy, driving innovation and transformation across government and public services. With extensive experience in strategic planning and digital transformation, Mark focuses on helping public sector organisations enhance citizen engagement, streamline operations, and deliver better outcomes through technology.
Passionate about modernising communication and service delivery, Mark works closely with stakeholders to align solutions with policy objectives and evolving citizen needs. His leadership ensures that Quadient remains a trusted partner for public sector organisations navigating complex regulatory environments and digital-first mandates.
