Lewisham and Greenwich NHS Trust

Justin Beardsmore

Through this article, Justin Beardsmore critiques the lack of radical reform in the UK’s health digital strategy, highlighting the shift back to the Department of Health, NHS Connect’s role, automation and cost efficiency, while questioning maturity in debates on EPR and postmodernism.

A few months back, I wrote a piece on the priorities of the new incoming UK government health team and the role of digital. I resisted the temptation to write an immediate post-election prediction, as the overcrowded debate went no further than ‘Digital is the future.’ I still don't understand what the move from analogue to digital means. What have we all been doing since the noughties? At least we had ‘Here is nine billion for digital; get on with it.’

Five months on, with the Darcey report already on the shelf, the National Health Services England ((NHSE) operating priorities plan for 2025/2026 and the government policy paper Road to Recover, it is a good time to revisit. It's safe to say there is no Lansley reform moment. ‘We will fix social care and this is how’ moment never came, even though it would have energised all sides of the political aisle and broader middle England. This radical moment would have cemented the government's place in history and set up a 12-year term.

What we do know is that it will be a more workwise approach. NHSE delivery functions will be absorbed into regional and government departments. Strategy has already moved back into the Department of Health. The newly empowered local systems will be allowed to get on with delivery. NHS and the private sector are now seen as delivery units—suppliers, not customers. We will have a substantial Secretary of State for Health who can wield power across government, which has not been seen since Jeremy Hunt's tenure. Therefore, we should assume a stable and consistent approach over the next few years, but no radical change.

“To automate or not automate is an ongoing conversation. It's unclear whether there’s a carrot-and-stick approach to the ‘live within your means’ rhetoric.”

Externally, we know that growth is going to stagnate. Businesses are not seeing the immediate benefit of AI, so healthcare wants neither for the next few years. Business confidence is neutral. European and the UK governments will need to invest in European defence, including cyber. Hence, the live within your means rhetoric.

Knowing what we know, the question is where digital leaders should focus their limited resources.

In my original article, I wanted NHSE to be more visionary, citing the need to fund the role of GEN AI on the NHS Connect platform. The visionary may not be there yet, but the 2025/20026 NHS planning ‘GUIDE’ mandate that all providers should, where possible, migrate to NHS Connect is a welcome message. It will irritate advanced sites, but convergence always means giving up pockets of innovation to gain access to a bigger prize. It just needs to be handled sensitively. The central teams must also push fast and rapidly by turning on the extra functionality and local senior digital leadership must keep the pressure on. This will drive buy-in.

There are three immediate and one long-term benefit from this. Improved cyber security and cost reduction are the first two. Offloading the problem is a standard macro approach. The third is to reduce the friction to be business; key resources can move and collaborate across organisations without needing to be onboarded. Little things will become easier.

In the longer term, the ability to share low-code solutions via the NHS Connect platform mirrors the standardisation that centrally purchased MS SQL Cals had on the NHS data ecosystem. Individually commissioned low-code apps built on the NHS Connect platform will all have strong cohesion and loose coupling, which means scalability across the NHS. This could be a paradigm shift, especially when AI studio comes online.

The banning of the transfer of capital budgets to revenue is welcomed; this legacy practice has had a cumulative impact on UK infrastructure. You can see the difference when you travel through northern Europe. However, it has had a reverse effect on local digital teams. Local teams have come to depend on this national transfer to fulfil their subscription-based cybersecurity needs. The outcome is that executive teams are blind to the actual cost of securing digital cottage industries. This may be a needed catalyst for change, where executive teams start to call it out for what it is. Systems need to look at pooling their resources for highly skilled tasks and offloading commodified workloads.

To automate or not automate is an ongoing conversation. It's unclear whether there’s a carrot-and-stick approach to the ‘live within your means’ rhetoric. However, the health service journal’s report that NHS orgs collectively cut 10,000 posts last year indicated there is movement, if not substantial. The advice to the digital teams is to anticipate the question from the business and get ready to address it. There will be an emergence of shared instances and pay-as-you-go models, so entry costs will make the point problem more achievable. You can now grow without upfront five-year business cases. The issue is more: can the pay-as-you-go models reduce entry costs so the £100,000 opportunity is possible or can organisations come together to create volumes?

I finished my original article by stating that whatever the priority, there needs to be a focus on delivery. You need to tick things off the list. The move to convergence is starting to be challenged by what is being termed the post-modernist approach to EPR. The fact that postmodernism and postmodernity are being used interchangeably shows the lack of maturity in the debate. The advice is to assess where you are and where you want to be. Is it EPR, portal or bed management? If you have total control of your data, what would you do with it? We already know inequality creates demand in the system and where the most unequal parts of the country are. More importantly, when do you want to get there tomorrow or in just grim time or is the AI revolution currently five years plus? If you are not already set up to develop code, even low code and have just been managing applications, you need to address that before even thinking of postmodernism. As the saying goes, you must understand the rules before breaking them.