Martyn Jones

Patients risk having serious conditions including cancer being missed under plans to make millions of hospital appointments virtual in a bid to tackle the NHS backlog, experts warn.

From October next year, doctors will deliver millions of hospital appointments virtually under plans set out by former health secretary Wes Streeting. 

Patients referred by their GP will be able to select a virtual appointment with a consultant anywhere in the country through the NHS app.

The new ‘NHS Online’ service will initially focus on specialties including gynaecology, urology, gastroenterology and ophthalmology, with 8.5 million appointments expected to be delivered by the digital trust in its first three years.

But health leaders and patient groups fear the move could result in vulnerable patients being overlooked, with serious illnesses harder to identify without face-to-face examinations.

One patient representative consulted on the plans raised concerns about ‘serious conditions slipping through the net’. 

Another respondent from Healthwatch said: ‘It’s not a fair choice’ with historically long waiting times pushing patients towards the digital route, where ‘things can easily be missed if not seen in person.’

The concerns come just weeks after a survey found older patients already feel ‘dehumanised’ by the NHS’s increasingly digital-first approach to GP care.

Wes Streeting, the former health secretary, insisted that ‘everyone will benefit’ from the online service, even if not using it directly 

When announcing the plans last year, Mr Streeting said patients would ‘be seen faster and more conveniently… by someone who will be able to get a sense of their condition and give them a course of action.’

However, doctors and patient advocates warn many conditions still rely heavily on physical examinations and procedures that cannot be replicated remotely.

For example, experts are unconvinced the model will work for gynaecological cancers, where doctors may need to inspect the cervix for abnormalities that could indicate disease. 

Gastroenterology patients are often referred for gastroscopies, where a camera is inserted into the stomach to investigate possible problems including cancer.

Questions also remain over how NHS Online will work alongside local NHS services and how patients with worrying symptoms identified during virtual consultations will be referred for further tests or treatment.

Dr Becks Fisher, director of research and policy at the Nuffield Trust, said that while the service would be helpful for some patients, ‘tricky questions remain’, particularly around how the service would be funded.

She added: ‘NHS IT infrastructure could also pose a problem, as it will need to enable relevant information – like scan results to be seen across different NHS organisations, something that is infamously difficult at the moment.’

Healthwatch also warned there was a risk patients could become more lost in the system, leading to confusion over who was responsible for their care. 

The organisation is calling on the Government to model the impact the online service could have on in-person capacity, finances, appointment targets and over-diagnosis. Currently, no such modelling exists. 

There are also concerns the plans could deepen inequalities in access to care. Current NHS rules state there must be a range of booking methods to avoid creating a ‘two-tier’ health system in which wealthier and more digitally confident patients can access care more easily than older and more vulnerable groups.

Older patients may particularly struggle with the app-based model. Charity Re-engage warned last week that vulnerable older people are already being forced to self-medicate, attend overcrowded A&Es or simply hope symptoms resolve on their own because of difficulties accessing healthcare.

The online service will rely on NHS doctors taking on additional paid hours while working remotely from home. Jonny Brown, director of the NHS Online programme, said: ‘They’ll be employed by the NHS, but we will ask them to do additional hours for us and they’ll be paid fairly for the hours that they work for us.’

He also said the NHS believed the flexibility would attract doctors ‘and make them keen to work for NHS Online.’

An NHS survey found 60 per cent of consultants were interested in joining the service, with doctors already working part-time more likely to express interest.

Stuart Andrew, the shadow health secretary, said: ‘Those that need face-to-face appointments shouldn’t be fobbed off with a video call if it means serious illnesses like cancer have a greater chance of being missed.’

An NHS spokesperson responded: ‘The NHS Online hospital will never replace in-person care.

‘People will always have the option of face-to-face care if they wish or need – and this initiative is designed to give patients the convenient option of receiving specialist care for common conditions from the comfort of their own homes.’

When imagining her retirement, Janet had foreseen a life filled with golf, travel and finally unwinding after years of working 60 hours a week as a solicitor.

Yes, she had niggling knee pain – but a bit of rest seemed to keep it in check.

By the time I saw Janet in my physiotherapy practice in Surrey, things had deteriorated dramatically. Now in her early 70s, her left knee was so stiff she dragged it along when walking. She barely left the house, her confidence was gone – and the lively woman she once was had changed utterly.

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X-rays revealed arthritis. Her doctor had referred her to a knee surgeon, who thought she needed a total knee replacement.

But Janet was hesitant. Her mother had endured a failed knee replacement that left her reliant on crutches.

Janet had one of the stiffest knees I’ve ever seen, locked in place at a 60-degree bend. A healthy knee has a 135-degree bend, and you need at least 90 to climb stairs. She admitted she hadn’t climbed stairs properly in a year, resorting to shuffling up on her bottom.

I thought there was still hope. We started her on a 12-week intense physiotherapy course, focusing on gently moving her stiff joint and daily home exercises, such as seated knee extensions – where she would sit in a chair and slowly straighten her leg, holding briefly at the top – and gentle heel slides, lying down and drawing her foot back to encourage bending in the joint.

After her first session, her movement improved from 60 to 63 degrees – hardly noticeable. But we continued working to build strength in her muscles, as well as loosening her joint. After 12 weeks, Janet could bend her knee to 95 degrees, enough to climb stairs normally, sit comfortably in a chair and walk more freely.

Conditions affecting older people such as arthritis, osteoporosis and daily pain – can be helped, and surgery avoided, through simple exercises, says physiotherapist Will Harlow

After a year of sticking to her daily exercises, she had 130 degrees of bend – and could ride a bike, squat and enjoy long walks. She felt joy in her life again and, once more, was free and independent.

My casebook is filled with stories like Janet’s. The longer I’ve worked as a physiotherapist, the more I’ve seen how mobility can insidiously slip away.

It’s often subtle at first – a creaky knee, a touch of back pain, or a sense of unsteadiness.

While it’s easy to chalk these things up to ‘just getting older’, much of this is preventable. So many of my clients have received nothing but painkillers and platitudes from their GPs – ‘it’s just wear and tear’, they’re told. But those doctors are wrong.

I’ve seen how conditions affecting older people – arthritis, osteoporosis, sarcopenia (muscle loss), poor balance and daily pain – can be helped, and surgery avoided, through simple exercises.

I began my career in the NHS, and set up my own practice for the over-50s in 2018 (as well as offering tips to my 1.7million subscribers on YouTube, search for HT-Physio). The oldest patient I’ve successfully helped was 99 years old – proof it is never too late to start. With a little knowledge, anyone of any age can improve their mobility and future-proof their independence . . .

Bendy toes equals better balance

I imagine few know you can reduce your risk of falling simply by ensuring your big toe is bendy.

This is because our big toe joint must bend to allow us to push through the toes when walking.

Without this, our ability to walk with good balance is hindered – so stiffness in this joint increases our risk of falling. Wiggling your toes whenever you’re sitting will ease stiffness, strengthen your foot muscles – and improve balance.

Balance declines over 50 due to changes in our vision, inner ear and proprioception – the ability to sense where your body is in space, without needing to use your eyes.

Inside your joints, you have thousands of tiny receptors called proprioceptors, which are highly tuned to detect even the slightest disturbance. But when they become impaired with age, your balance is affected.

The good news? Balance can be improved. Many of my patients go from housebound to confident walkers by improving balance.

Balance ‘snacks’ – short bouts of exercise scattered throughout your day – are an easy way to do this. For example, stand on one leg while brushing your teeth or waiting for the kettle to boil. Studies show practices like these can lead to a 31 per cent reduction in falls over 12 months.

Seated eye tracking – where you follow your finger with your eyes as you slowly move it from side to side – is also fantastic as it trains the coordination of eyes with balance. It also helps with dizziness or unsteadiness. Do it for 30 seconds, three times a day.

10,000 steps? Think speed instead

You might imagine walking slowly reduces the risk of falling. But research in the journal Ageing Research Reviews in 2021 found a slow speed is associated with a higher risk of falls, as well as being a good predictor of early death. I like to think of walking like riding a bicycle. Try it slowly, and you’ll know how hard it is to maintain balance. As you speed up, momentum builds and balance becomes effortless. Walking is similar, which is why walking slowly leads to unsteadiness.

So while, of course, the number of steps you take per day is important (I advise everyone to walk as much as they can), perhaps more significant is walking speed. Those who walk faster boast a lower risk of either hospitalisation or death by any cause.

First turbocharge your calves

Will’s book will be published later this month

Weakness in the calf muscles can be a big contributor to losing pace. This is because the calves generate 70-80 per cent of forward propulsion in walking – and older adults can lose 11-35 per cent of calf strength over a lifetime, which makes walking less efficient.

In one study, in the Journal of Experimental Biology in 2015, researchers simulated a loss of calf power in younger participants using a device that restricted movement. They found hip muscles had to compensate, costing them twice the energy expenditure to walk at the same speed. That’s like paying twice as much for the same service.

Heel raises – where you hold a stable surface, stand on one leg and raise yourself up onto your toes and back down again – are vital for strengthening these muscles and keeping your walking pace up. Aim for 20 repetitions, three times a week.

Fix sore necks – with eyes closed

Research has shown people with neck and shoulder problems have reduced upper-body proprioception. This appears to be a two-way problem: pain and stiffness in the neck disrupt the signals sent by proprioceptors, meaning the brain receives less accurate information about where the head sits in space.

Without knowing where the head is, the larger surrounding muscles tend to overwork to compensate – and it is this chronic overactivation that drives so much of the tension and pain that these people experience.

But as we’ve explained above, proprioception is a skill that can be trained. Stand facing a mirror, close your eyes and move your head into a random position. Keep your eyes closed and reposition your head to perfect centre, facing straight ahead.

Open your eyes. You might be surprised to find you’re a long way off what you thought was centre. This means you’re lacking in proprioception of the neck. A few minutes practising this exercise every day can improve proprioception, alleviating neck pain.

The power of hopping

One of my patients, Fran, in her late 60s, fell and fractured her wrist. A subsequent scan revealed she had advanced osteoporosis. Doctors warned her against lifting anything heavier than a kettle – and when asked how long she’d need to be so careful, the answer was stark: indefinitely.

Something about that verdict didn’t sit right with me. I knew osteoporosis wasn’t always a one‑way street. So we began with resistance training – just using her body weight at first.

We started with sit-to-stand from a chair and push-ups done against the wall, to gently stress the bones of the upper body.

We then added small loads: books in a backpack, light dumbbells. Slowly, her strength returned. A year later, Fran went back for another scan: her bone density had improved – by just a few percentage points, but in a condition where even maintaining density is rare, this was a victory. Vitally, Fran had also reclaimed her physical confidence.

So how was this improvement possible? When we apply regular, targeted stress to our bones, they respond by reinforcing themselves.

There are two ways of doing this. First, by impact with the ground, such as landing from a jump, hop or even a hard stomp. Research shows ten to 15 purposeful jumps can make a difference – as long as they’re done regularly and with enough force.

In one study, published in the journal Bone in 2013, a group of men with an average age of 70 were asked to do 50 small hops per day (on just one leg, in short sets).

After a year, the hopping leg showed a meaningful increase in bone density; the other leg saw no change. However, you must only run and jump if you’ve had confirmation from a medic that it’s safe for you to do so.

For those with severe osteoporosis, the second bone-boosting technique is advised: resistance training. The action of just holding weights puts healthy stress through your bones, triggering activity in bone-building cells. When the muscles contract hard, the tendons pull on the bones, sending a powerful signal to these bone-building cells to increase the rate of new bone formation.

A study in 2017 on women with osteoporosis investigated the effects of twice-weekly resistance training and found that after eight months, the resistance- training group had increased bone density by around 3 per cent, while the control group experienced a further 2 per cent loss.

Your bones also love a fast walk

Studies suggest that walking briskly may improve bone density, while slow, leisurely walking appears not to. This is likely because faster walking produces greater impact through the skeleton with each step.

At a leisurely pace, this impact is simply too small to stimulate the bone-building response; increase the speed, and the mechanical signal becomes strong enough to prompt the skeleton to adapt by producing more bone.

Astonishingly, other research found when someone stops walking and becomes bedbound, bone breakdown begins within just a few days of bed rest. After only two to three weeks without walking, scans already show a noticeable drop in bone density.

Always wash between your toes 

Foot pain becomes increasingly common over 50, and can be caused by muscles weakening.

Muscles that support the arch help prevent you falling when you lose your balance. So foot strength is not just a matter of foot function, but of safety. Generally, those who have a foot arch that rolls inwards when standing or walking have weak foot muscles.

You can make a big difference with relatively easy habits. Researchers at Harvard recommend washing between your toes daily – because getting your fingers in between your toes moves them in ways that are impossible using your foot muscles alone, mobilising the tiny joints.

The ‘short-foot’ exercise is also vital – this isn’t always easy at first, so stick with it. Stand with your feet hip-width apart. Then try to activate the small muscles in your foot by squeezing your toes towards your heel. Hold the contraction for several seconds, then relax the foot. Aim for 15 per foot, and three sets a day.

Double chins cure neck pain

Neck and shoulder pain can be helped if you strengthen the tiny deep neck flexor (DNF) muscles under your chin, which allow you to press your chin to your chest. They play a pivotal role in keeping your head in the right position.

When the DNF muscles don’t do this properly, the larger neck muscles take over causing tension, tightness and pain.

Strengthen your DNF by tucking your chin in to make a double chin. Hold for three seconds, then relax. Do this little and often and results can come in a few weeks.

■ Adapted from Independence For Life, by Will Harlow (Hay House, £20), to be published on May 26. © Will Harlow 2026. To order a copy for £18 (offer valid until May 30), go to mailshop.co.uk/books or call 020 3176 2937

These six exercises target areas that matter most as we age: leg strength, balance, hip stability and core control. Done consistently, they give you a solid foundation for staying active and independent. 

1. Sit to Stand

Strengthens legs. Do three times a week.

Equipment: A chair.

Your knees should be at 90 degrees when sitting. Shuffle forward to the edge of the chair, tuck your feet slightly under your knees and flat on the floor. Push down through your feet to stand, without using your hands (cross them over your chest).

To sit down, bend at the hips and knees, and lower yourself slowly onto the chair. Aim for 10-20 repetitions; three sets.

2. Modified clam

Strengthens hips and reduces strain on the back muscles. Do three times a week.

Equipment: An exercise mat.

Lie on your side, with your lower leg straight and your top knee bent and on top. With control, lift your bent knee upwards, keeping your upper foot touching your lower leg, then return to starting position. Aim for 10-15 reps on each side; three sets.

3. Heel Raise

Strengthens calf muscles to help walking pace and stair-climbing. Do three times a week.

Equipment: A chair. Stand with your feet hip-width apart and hands on the chair for support. Rise up onto your toes over a count of two, lifting your heels as high as possible, then slowly lower over three seconds. Aim for 10-20 reps; three sets.

4. Tightrope Walk

This trains coordination, balance and control for steady walking. Do daily. 

Walk in a straight line as if on a tightrope, placing one foot directly in front of the other, arms out to the sides for balance if needed. Focus on an upright posture. Aim for 10-20 steps; three sets, spread through the day.

5. Knee Push-Up

Strengthens chest, arms and core; improves posture. Do three times a week.

Start on your knees, with hands under your shoulders and upper body in a straight line. Take two seconds to bend your elbows to lower chest towards the floor, then one second to push back up. Aim for 8-15 reps; three sets.

6. Toe Taps

Strengthens core and improves stability, reducing strain on lower back. Do daily.

Equipment: Exercise mat. 

Lie on your back with knees bent at 90 degrees, feet off the floor and core braced. With a controlled movement, lower one foot to tap the floor, keeping the knee bent, then return it and repeat with the other leg. Continue, alternating legs. Aim for 10-20 reps on each leg; three sets.

Is it hip arthritis — or simply weak glutes?

That pain in your hip may not be arthritis. There’s another lesser-known hip condition that’s just as common: greater trochanteric pain syndrome (GTPS) causes pain on the side of the hip but is a soft-tissue problem, not your hip joint.

As it’s lesser known than hip osteoarthritis, most of my patients with GTPS come to see me asking whether they need a new hip.

Thankfully, the cure is simply rehabilitation, because it’s down to weak glute muscles. When we walk, we shift our weight from one leg to the other, and as we do so the glutes work to keep our pelvis level.

When the glutes fail to do their job properly, the pelvis drops a few millimetres to one side every time you take a step. Your body can compensate for this for a while, but as time goes on the increase in stress on the tissue causes inflammation. The cure is to strengthen those glutes – with squats or similar exercises.

Don’t rely on costly scans

I’ve lost count of the times a worried patient has paid for an MRI scan, only to be told it couldn’t identify the cause of their pain.

This is because there’s often a poor match between what we see on a scan and what someone actually feels. I’ve treated people with severe ‘bone-on-bone’ arthritis who had no pain at all, and others with no changes on their scans who were in agony.

In one of my favourite studies, published in the American Journal of Neuroradiology in 2015, researchers looked at the spinal MRI scans of more than 3,000 people of all ages – almost everyone had some degree of spinal degenerative change, but none reported any back pain.

The CDC said Tuesday it was working closely with FIFA on safety and screening measures ahead of the World Cup as a team from Congo, which is experiencing an Ebola outbreak, plans to travel to the US for the tournament. 

The World Cup is scheduled to kick off on June 11 and the men’s soccer team from the Democratic Republic of Congo is scheduled to play in Houston, Texas, against Portugal on June 17. 

However, concerns are arising because the DRC is currently dealing with an Ebola outbreak involving the Ebola strain Bundibugyo virus disease (BVD), which has no approved vaccine or treatment and kills up to half of people it infects. 

An American doctor working in the DRC has contracted the virus in the African nation’s latest outbreak and six other American workers are feared to have been exposed. They all are being evacuated to Germany and the Czech Republic for care. 

The CDC has elevated a travel advisory to the DRC to level 3, warning Americans to ‘reconsider nonessential travel.’

The agency also announced on Monday that it was increasing screening and monitoring for people arriving from areas affected by Ebola outbreaks and restricting entry for non-US passport holders if they have been in Uganda, the DRC or South Sudan in the past 21 days. 

The outbreak has left at least 136 people dead with more than 540 cases now suspected. One additional person has died in neighboring Uganda.  

CDC officials did not provide specifics surrounding screening and procedures ahead of the World Cup, but reiterated that it is ‘actively working with FIFA to ensure safe traveling and passage’ and to ensure the ‘American public remains safe throughout’ the competition. 

Guards stand outside the Rodolphe Merieux Laboratory, National Biomedical Research Institute (INRB), where samples from suspected Ebola cases are being tested in the Democratic Republic of Congo

The men’s soccer team from the Democratic Republic of Congo is scheduled to play in the NRG Stadium in Houston, Texas (pictured above) in June

The officials said the risk to the general US public remains low but urged travelers to the area to avoid contact with any sick individuals. 

The CDC also said travelers should watch for symptoms of Ebola for 21 days after leaving the DRC. 

About 25 people are working in the US office in the DRC, and the CDC said it is sending another person to the region from Atlanta. 

It is also sending personal protective equipment and deploying additional resources to the DRC and Uganda to provide ‘direct technical assistance for aggressive disease tracking and contact tracing.’

This is the 17th Ebola outbreak in the DRC, where the virus is endemic, since it was discovered in 1976 but only the third caused by the Bundibugyo strain.

The other two BVD outbreaks were in 2007 and 2012. 

The most recent Ebola outbreaks in the DRC were in 2018 and 2020 and they killed more than 1,000 people each. The largest Ebola outbreak occurred in 2014 to 2016 in West Africa when more than 28,600 cases were reported.

The World Health Organization (WHO) has said the current outbreak does not meet the criteria of a pandemic, but it is considered a ‘public health emergency of international concern.’

Countries sharing borders with DRC, such as Uganda and Rwanda, are at an increased risk of further spread.

A man sprays a tent at an Ebola treatment center in Bunia, Congo

Ebola spreads through contact with the blood or body fluids of an infected person, as well as contact with contaminated objects or infected animals such as bats or primates.

Symptoms include fever, headache, muscle pain and weakness, diarrhea, vomiting, abdominal pain and unexplained bleeding or bruising.

The mortality rate for the Bundibugyo virus ranges from 25 to 50 percent.

The Zaire strain, which is the most common form of Ebola, can be treated with the drugs Inmazeb and Ebanga and the Ervebo vaccine, which is administered only during outbreaks.

‘Unfortunately, Bundibugyo has fewer proven countermeasures than Zaire ebolavirus, where vaccines have been highly effective in controlling outbreaks,’ Amanda Rojek, Associate Professor of Health Emergencies, Pandemic Sciences Institute at the University of Oxford, said in a statement.

The WHO said Sunday that the first known suspected case, a health worker in DRC, developed symptoms on April 24. Two infected people from DRC traveled separately from each other to Kampala, the capital of neighboring Uganda, where one died.

The WHO said there is no indication of ongoing transmission in Uganda.