£10 Billion NHS Tech Bet: High hopes and broadband dreams

More questions than answers
This week saw the announcement of the spending review for public services. The NHS received a large proportion of the funding available, but there are more questions than answers. Why? In the next few months, there will several publications including a national infrastructure plan, an industrial strategy, and the NHS 10-year plan. These will all have an impact on the NHS and how care is delivered.

The infrastructure plan will affect how accessible physical services are, how green the NHS can be, and the electricity costs for the NHS. The industrial strategy will influence the innovations, tools, and technologies available for addressing the challenges facing the NHS. However, it’s no surprise that the NHS 10-year plan is likely to have the biggest impact, and we don’t yet know what it will contain. We do know how much money has been set aside though.

The money is just the start
The spending review announced £10 billion over three years for technology in the NHS, approximately doubling the tech budget. Great news! But it’s important to note that we don’t know what that funding is intended for. Often, aspirations far outstrip the funding, and historically timelines feel disconnected from the reality of how long it takes to make change happen. Will the funding match aspirations, and how will it be phased?

We do know some of what the tech budget will be spent on. The NHS App is specifically mentioned to receive funding for more development, enabling patients to manage medicines and prescriptions, receive NHS communications securely, and increase their access to medical services such as tests directly. The Single Patient Record is also specifically mentioned, giving patients a unified view of their medical history and enabling two-way communication and active management of their healthcare. And there's also funding for a new Health Data Research Service, so expect more data concerns to navigate. But that’s as much as we know.

Productivity and AI

It's clear productivity (whether you like the term or not) is important for the government, as are waiting lists. With the recent excitement surrounding AI, I expect ambient scribes to be funded and rolled out. I’m not convinced they will have the productivity benefits that are assumed, but there's some research in progress that will clarify this question. The government has set a 2% productivity target per year, and I imagine tech will be seen as a way to deliver this. This means identifying the tech, business cases, procurement, process change, and implementation. Assuming it goes smoothly and staff have the time while tackling the backlog, reconfiguring ICBs, and creating neighbourhood health, then the tech transformation will take time and create disruption (which can mean productivity drops) in itself.

A win for digital inclusion

Lastly, it is worth mentioning the £1.9 billion over the next three years for connecting homes and businesses with high-speed broadband and delivering 4G connectivity to rural areas. Ensuring patients, carers, and the public can access digital services is absolutely essential to realising a digitally enabled health and care system. Rural regions theoretically should get the greatest benefit from digital tools but this needs good connectivity.

Broader Considerations

Capacity to Absorb Funding
Does the NHS have the capacity to absorb the funding with staff focused on addressing the waiting list? Without sufficient capacity, tech risks sitting on the shelf. Rushed capital spending has, in the past, created technology dead ends with tech sitting unused or unsuitable for future software like AI. Without investment in the staff skills and expertise to implement and integrate technology, there’s a risk of relying on scarce change management staff and technical capabilities, which drives up costs or elongates timelines – something that happened during the hospital EPR roll out. Money is just the start of the change. £1 billion or £10 billion, the impact relies on the technology actually being used.

Capital Budgets

We know the capital budgets could be spent improving old scanners, expanding the diagnostic capabilities of the NHS, and generally updating legacy devices and connectivity. These are immediate changes that bring benefits to productivity, reliability, and staff engagement. Investing in imaging equipment could help bring our capacity up to the level of comparable countries. The capital budget increase is acting on a recommendation from Darzi who stated “Despite the first clinical use of MRI taking place in an NHS hospital, the health service has far fewer MRI and CT scanners than comparable countries. Moreover, many of the machines are old: this means that they are less powerful and so take longer for each scan and that more time is lost due to breakdown and maintenance.”

Procurement

It is likely that the historic capital/revenue split will continue, making it challenging to procure software under recurring payment mechanisms (e.g., subscriptions). Flexible business models will be needed from industry and different commissioning models, which is part of the new role of ICBs.

Designing with the future in mind

Lastly, there is the question of what happens after the spending review period. Tech needs ongoing funding to cover maintenance and operational costs. If after the spending review period there is a change in priorities or a drop in funding, services will be cut. This is linked with the need to design services to consolidate technology and tools and simplify. We’ve seen tech initiative after tech initiative creating layers of tools that patch over other systems and add fragmentation. A modern system is as much about new technology as it is about thoughtful selection and design.

An encouraging start but needs more details

Time will tell what the plans show and how the funding will be used. The government’s vision for the NHS and the promises of significant financial investment are encouraging, but it’s just the start with the practicalities of implementation, staff capacity, and ongoing support critical to realising the ambitions yet to be published in the forthcoming 10 year plan.

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Transparency on AI use: GenAI tools have been used to help draft and edit this publication and create the images. But all content, including validation, has been by the author.