Productivity will not save the NHS without people centred design

The conversation around the NHS, regardless of who is in government, is dominated by one word: productivity. The challenge is immense, with persistent waiting lists and a workforce stretched to its limits. The consensus solution is a cocktail of technology and workforce transformation, underpinned by a £10 billion technology investment. This narrative presents technology as a neutral, liberating force, set to free up precious clinical time and revolutionise care delivery.

This is backed by significant capital investment. The £10 billion NHS technology investment is earmarked for upgrading IT systems, replacing outdated equipment, and scaling up new technologies like AI-powered clinical decision support tools. The aim is to reduce the 13.8 million hours that doctors lose to outdated and inefficient IT every year from restarting computers, waiting for systems to load, to navigating multiple systems to access patient information. The plan details how AI and automation will streamline diagnostics, how digital health records will reduce administrative burdens, and how digital 'virtual wards' will provide more care outside of traditional hospital settings.

This vision is both compelling and necessary; invest in better tech, free up clinical time, improve retention, and deliver more care more efficiently. This is the promise to a health system desperate for solutions.

However, this vision rests on a dangerously flawed assumption: that technology, in itself, is the answer to improving productivity. For leaders navigating this transformation, we must ask some difficult questions:

• What if our relentless drive for tech-led productivity inadvertently creates more problems than it solves?
• What if, instead of liberating our clinicians, the technology pushes them closer to the edge
• What if the drive for digitisation leaves our most vulnerable patients further behind?

In the rush to digitise, we often focus on the tools themselves and forget the people, both clinicians and patients, the technology is meant to serve. This isn't just a technical challenge; it's a human one.

Not all technology has delivered time savings, whether technology gives time back depends on how it is implemented and used, as well as the type of technology. For example, computerised decision support has reported time savings in 85% of 27 studies, while robotic surgery did so in only 52% of 31 studies. The critical flaw is the assumption that technology seamlessly integrates into clinical workflows. The reality on the ground is often the opposite. Decades of evidence, including recent studies from The Health Foundation, show that the implementation of Electronic Patient Records (EPRs) and other digital tools can, without careful design, increase the administrative burden on clinicians. A 2023 study found that poorly designed digital systems are a significant contributor to clinician burnout, with cumbersome interfaces and a high volume of low-value alerts creating frustration and "death by a thousand clicks".

This creates a vicious cycle. We deploy technology to solve a productivity problem, but if it is not user-centric, it increases administrative load. This, in turn, fuels burnout, a key driver of the workforce crisis the NHS plan is trying to solve. The Royal College of Nursing has repeatedly highlighted that its members are leaving the profession due to the pressures of non-clinical administrative work, which detracts from direct patient care. The productivity gains could in reality, be the result of cost-shifting, transferring the time-cost from an outdated paper process onto the cognitive load of a clinician navigating a complex digital system.

This has a direct and profound equity impact on patients. When clinicians are time-poor and burdened by administrative tasks, the patients who lose out most are those with complex needs, multiple long-term conditions, or communication barriers, the very patients who require more time, empathy, and nuanced human interaction. An over-emphasis on quantitative metrics like "appointments per hour" can lead to a transactional model of care that fails those who don't fit neatly into a standardised digital pathway.

To avoid this we must pivot from a tech-centric to a people-centric strategy. The £10 billion investment will only deliver value if we invest just as heavily in the human factors that drive successful adoption.

Mandate Meaningful Co-Design: Procurement and implementation must move beyond tokenistic consultation. Trusts should mandate that clinicians, nurses, and allied health professionals are not just consulted, but are embedded in design and decision-making teams with protected, paid time to participate. As highlighted by NHS Providers, involving frontline staff is the single most critical factor for success.

Build digital skills across the workforce: The skills gap is real; national analysis finds many staff use electronic records only at a basic level, with limited training and poor implementation holding back benefits. Safety investigators also report clinicians struggling to find information in systems, with slow hardware and outdated functionality that can undermine care. The Long Term Workforce Plan recognises this and commits to a digital skills assessment tool and scaled learning, which now needs protected time and local coaching so every team can use core systems with confidence.

Invest in Continuous Digital Capability: The "one-and-done" training session at rollout is insufficient. We need to build ongoing digital capability, creating roles like "digital champions" or peer mentors within clinical teams. This requires investing in protected time for continuous learning, allowing staff to master systems and innovate within their own workflows.

Develop Digital Leadership: Senior leaders, from ward managers to board members, must be equipped with the skills to lead digital change, understanding the principles of user-centred design, change management, and how to critically evaluate the promises made by technology vendors.

Measure What Matters: Success cannot be measured solely by system-level efficiency metrics. We must develop and track metrics that capture the real impact on the workforce and patients. How much time is spent on direct patient care versus the screen? How does the technology affect the quality of the patient-clinician relationship? The CQC's focus on well-led and responsive services provides a framework for this more holistic view, which is increasingly moving beyond simply checking for compliance with standards into the overall quality and effectiveness of care delivery.

The lesson is clear, gains come from fit to workflow, thoughtful rollout, and sustained capability building, not from the technology alone. Ultimately, technology can be a powerful amplifier. But it will amplify the strategy we choose. A strategy that prioritises tools over people will only amplify frustration and burnout. A strategy that puts our workforce first will amplify their expertise, compassion, and capacity to care, which is the only path to a truly productive and equitable NHS.

• NHS England. (2023). NHS Long Term Workforce Plan.
• The Health Foundation. (2023). NHS workforce plan: a plan of two halves.
• HM Treasury & DHSC. (2024). NHS productivity plan to treat more patients and cut waiting lists.
• Royal College of Nursing. (2022). Last shift survey findings.
• The Health Foundation. (2023). Shining a light: The impact of digital technology on the NHS.
• Ross, J. et al. (2023). Factors relating to the delivery of digital clinical decision support for hospital healthcare professionals: a systematic review. BMJ Health & Care Informatics.
• NHS Providers. (2023). Digitally enabled care and the role of NHS trusts.
• Care Quality Commission. (2023). CQC's new assessment framework.