The NHS now delivers mental health treatment over video as standard. Remote sessions are a permanent fixture of how care gets done, not a holdover from the pandemic.
An analysis of OFCOM and NHS data by PsychiatryWitnesses.co.uk estimates that 4.7 million people in rural England live in homes without full-fibre broadband, based on OFCOM’s 2024 finding that 48% of rural premises lack full-fibre coverage applied to England’s rural population of 9.7 million. Full-fibre is the infrastructure on which a stable, uninterrupted NHS video appointment depends.
That matters because NHS Talking Therapies, the government’s primary service for treating anxiety and depression, received 1.83 million referrals in 2023/24. Remote delivery is now central to how that volume of appointments gets fulfilled.
“What changed during the pandemic was never reversed,” said a spokesperson for PsychiatryWitnesses.co.uk. “Video appointments are baked into how mental health services operate. That’s mostly a good thing. They remove travel barriers and help people who struggle to leave the house. But they only work if the connection does.”
The problem runs deeper than coverage figures suggest. OFCOM’s “decent broadband” standard, the legal minimum under the Universal Service Obligation, requires just 1Mbps upload speed. NHS video appointment platforms typically require at least 2Mbps upload for reliable video. Homes that officially meet the government’s adequacy benchmark can still fall below the threshold for a stable psychiatric appointment.
“A frozen screen or dropped call mid-session isn’t just frustrating,” the spokesperson said. “For someone in a fragile mental state, that disruption can be destabilising. And for patients who have already waited months to be seen, a failed appointment is often enough to stop them trying again.”
Full-fibre broadband reaches 71% of urban English premises but only 52% of rural ones. Rural mental health provision is already stretched: fewer services, longer waiting times, further to travel. Remote appointments were intended to close that gap. Without the infrastructure to support them, they often can’t.
“Rural patients end up with the worst of both worlds,” the spokesperson said. “No reliable local service and no reliable digital alternative. The broadband gap and the mental health gap are drawing the same map.”
