Key Takeaways
- The NHS 10-Year Plan sets ambitious digital transformation goals but faces a significant gap between strategic vision and delivery capacity.
- Previous NHS digital strategies have struggled with inconsistent funding, changing priorities, and insufficient attention to implementation support.
- Delivery challenges include workforce digital skills gaps, variable IT infrastructure across trusts, and competing operational pressures that deprioritise transformation.
- Bridging the ambition-reality gap requires sustained investment, protected implementation capacity, and accountability mechanisms that track progress against milestones.
Overview
While I was away in sunny Wales last week, the long awaited and anticipated NHS's new Fit for the Future: 10-Year Health Plan for England dropped. The Plan set out more detail on the bold ambition to transform the NHS from a technological laggard to a global digital leader. At its core lie three radical shifts:
- Hospital to community
- Sickness to prevention
- Analogue to digital
This digital transformation is designed to put power in patients' hands. It aims to create a patient-controlled, data-enabled health system, with frontline staff empowered to reshape services and moving away from today's outdated systems and fragmented bureaucracy. Underpinning this shift is a huge promise: better outcomes, fewer inequalities, and a more financially sustainable NHS that will drive wider economic growth.
The ambition is impressive, but will the design and delivery live up to expectations?
Here are the top Digital Commitments planned for the next 10 years
1. Single Patient Record (SPR)
What's planned: A secure, authoritative record for every citizen, accessible through the NHS App, designed to enable truly coordinated, personalised and increasingly predictive care.
This is an essential and ambitious goal, a secure, truly joined-up Single Patient Record (SPR) could be transformative for how care is coordinated, personalised and made more predictive. But its success will depend on how it is achieved. Key will be keeping it practical, agile and deliverable out in the real-world. We can't afford to repeat the mistakes of the past with slow, over-engineered, and costly national IT programmes that ended up in the NHS tech graveyard. Right now, digital maturity and alignment across Trusts and ICSs is, at best, patchy. Some areas are likely ready to move quickly, while others still struggle with data quality, connectivity and fragmented legacy systems.
Getting this right means starting with what already works locally on the ground, not ripping it up and starting again. It means setting clear, consistent national data standards that everyone signs up to, putting robust governance in place, and investing in shared local infrastructure that's genuinely interoperable. Rather than being imposed centrally, it needs to be a flexible, evolving foundation built with local systems, for local people. Success will depend more on whether people trust it, use it and see real value in their day-to-day care.
NHS App as the 'Front Door'
What's planned: By 2028, the NHS App will be the default access point for self-referrals, booking tests, e-consults, medicines management, vaccines, children's health, carer coordination, even real-time care feedback.
Consolidating more functionality into the NHS App makes sense, it's more efficient for the system, saves money by reducing the duplication of commercial tools, and gives patients the convenience of accessing digital services in one trusted place. But the challenge will be achieving that. The App's usability needs serious improvement; the current version is still clunky in parts and this will only get more complex as these new features are added. The plan also assumes people will naturally adopt this digital shift, yet millions still lack access to devices, data, digital skills or have low trust in technology and the wider health system.
My Health: An Approved NHS 'Dr Google'?
What's planned: NHS AI triage, direct booking into specialties, digital self-management tools, an NHS version of the 'doctor in your pocket'.
In theory, the proposed NHS My Health function brings together safe, trusted digital advice under one roof, avoiding the risks people face when turning to generic Google searches and access unverified and often risky health information. But with the planned expansion of AI in triage and self-management, transparency will be critical. Patients need to understand how the AI works, what it's trained on, what bias it might carry and what risks it could pose in their care. In short, we need to build 'AI literacy' so that people can make informed choices, trust what they're being told and feel confident using digital tools to manage their health.
A Neighbourhood Care Platform
What's planned: A national platform for virtual care, remote monitoring, alerts, scheduling, care plans, making virtual wards consistent and scalable.
"Proactive management of patients to become the new normal, reaching out at the first signs of deterioration to prevent an emergency admission to hospital".
The idea of a national Neighbourhood Platform has real potential to reduce costs by consolidating today's fragmented supplier landscape and creating more consistent, scalable remote care. Importantly, supporting patients within their own homes has huge potential to improve their quality of life and avoid hospital-associated deconditioning. People who recover at home, recover faster. But the mixed results we've seen so far highlight the risks which flow from poorly designed or inconsistently delivered virtual wards can actually deepen inequalities and lead to duplicated costs instead of savings. To avoid this, there needs to be clear governance, robust infrastructure and practical support for local teams to implement virtual care safely and effectively, otherwise, it risks becoming yet another patchwork solution that delivers patchy benefits.
AI and Automation
What's planned: AI scribes, ambient voice tools and admin automation to free up frontline time, boost productivity and cut waiting lists.
AI scribes and automation are a logical focus to help free up time and improve productivity, but without redesigning roles and investing in workforce skills, they could just add more pressure to already overstretched staff and risk increasing burnout. Rolling out AI across the NHS demands a health workforce that understands how to use it confidently and safely, yet we know there are significant gaps in digital skills that urgently need to be addressed. There are still open questions too such as what training will be funded for staff? How exactly will AI tools be trained and tested? And how will we manage and monitor for bias, so that new technology doesn't embed old inequalities? These practical issues need clear answers if AI is to deliver on its promise.
So the ambition is big. But it's clear that we still have some familiar delivery gaps:
Digital Leadership
One of the plan's biggest blind spots is the absence of detail on who will drive this transformation, both nationally and locally. Delivering a shift from analogue to digital at this scale demands strong, visible digital leadership embedded throughout the system, from National teams, down to frontline staff. Yet we are currently dismantling the very structures that could lead the change, leaving remaining staff worried about job security, hardly the culture or conditions within which innovation can thrive. There's no real strategy here for developing confident digital leaders or creating the capacity to manage this change across organisations. Without that, we risk big ambitions getting stuck in silos, with patchy adoption and wasted investment. National direction is important, but local ownership and empowered, capable digital teams that can deliver real innovation.
Workforce Skills
We know there are longstanding gaps in digital skills right across the NHS workforce, both clinical and non-clinical. Staff need practical, ongoing support to build confidence with new tools, adapt to new workflows, and understand how digital fits into safe, person-centred care. Yet the plan says little about how we will systematically upskill people, retrain those at risk of being left behind, or make digital literacy a core part of every role. We must build real workforce capacity, with a focus on digital skills, new roles and change management. Without a serious focus on this, even the best technology will struggle to be used properly and deliver its promised impact. Digital transformation is fundamentally about people, not just software.
Legacy Infrastructure
It's impossible to modernise healthcare without a strong foundations. Too many parts of the NHS are not digitally mature, and still run on outdated hardware and system, unreliable networks and patchy Wi-Fi, the basics that underpin every digital ambition. This plan calls out the problems but offers no clear, funded roadmap to fix them. Without that, the ambitious 'digital front door', single patient record and expanding use of AI will run into the same barriers they have for years. Local leaders need confidence that they can rely on resilient, modern infrastructure that works.
We need to agree clear, practical data standards and interoperability for the Single Patient Record and the NHS App, keeping it usable, scalable and avoiding over-engineering. And as we bring in more AI, we have to embed open, transparent governance with patient voice at its core, and actively monitor for any unintended consequences.
Equity is a Real Risk
Finally, while the plan talks a lot about putting more power in patients' hands, there's worryingly little on how we make sure everyone can actually use it. To achieve digital health equity we need practical, funded measures to reach people who face real barriers, such as access to broadband, data and devices, or have low literacy, skills or confidence.
We need to embed equity considerations throughout the transition from internal governance to the design and deployment of digitally-enabled services and through to monitoring, follow up and evaluation, investing in practical mitigation of digital inclusion along the digital transformation process. This includes skills development, digital patient support, local hubs and support patients with access to data and devices. Local digital hubs, navigators and trusted outreach can make a huge difference, but there's no mention of them here. If we don't design this shift with inclusion at its core, we risk deepening inequalities rather than narrowing them, the opposite of what a modern NHS should stand for. Ultimately, we need to redesign digitally enabled equitable care, putting patients, properly supported at the centre, delivered by clinicians with the skills to deliver digital health services.
This is a once-in-a-generation ambitious chance to modernise the NHS to streamline fragmented inefficient systems, empower patients and deliver better quality care. The plan rightly calls out the injustice that people in working-class jobs, rural communities or ethnic minority groups have worse NHS access and outcomes. A digitally-enabled NHS should narrow that gap, but only if the shift to 'bricks to clicks' is inclusive by design. If not, we risk communities with poor broadband, no devices or low literacy being locked out of the digital shift which will see a widening, not closing of the digital health gap.