Planning to Delivery: The Realities of Digital Transformation in the NHS

This week, NHS England published its Medium-Term Planning Framework, setting out how the health service will plan and deliver ambitious change between 2026 and 2031. It sets the scene for a transition away from reactive annual planning toward a five-year horizon designed to stabilise systems and drive reform. Alongside it sits the 2025/26 NHS Delivery Plan, which translates the strategic vision and direction into immediate priorities. Both provide a welcome alignment between policy and delivery which asks health systems not only to plan differently but to deliver differently.

The three national shifts are clear: moving care from hospital to community, from sickness to prevention, and from analogue to digital. Yet while the first two have long been part of NHS reform ambitions, it is the digital shift that now is presented as critical to its ability to function, adapt, and survive. Transitioning into a digitally mature, data-driven health system that improves access, productivity, and outcomes is essential. But success will depend on whether the NHS can deliver both the digital foundations and the digital future that this vision demands.

The Planning Framework presents digital capability not as a modernisation project but as the foundational infrastructure on which the rest of reform depends. Every Integrated Care System (ICS) is expected to align its digital, data, and technology plans with workforce, finance, and clinical priorities. The goal is not simply to digitise services, but to make data and digital the structural enablers of prevention, integration, and efficiency.

Every provider must proactively offer NHS App-first communication. All GP practices must enable full NHS App functionality, including access to health records, appointments, prescriptions, and messaging and continue to deploy the Electronic Prescription Service and NHS e-Referral Service. Every trust must complete or actively progress electronic patient record (EPR) procurements, while organisations are required to integrate with the Federated Data Platform (FDP) to enable shared intelligence and improved population health management.

In short, the NHS has moved from encouraging digital adoption to mandating it. The expectations are specific, measurable, and time-bound. The question is whether they are deliverable.

Digital transformation will not deliver value unless workflows are redesigned, staff are trained, and governance is embedded. Deliverability depends on addressing these gaps head-on. The shift from analogue to digital is a multi-year endeavour that requires deep cultural and structural change.

Variable Maturity Across Systems

Digital maturity across organisations is uneven. Some organisations operate with integrated data platforms, shared care records, and real-time analytics. Others rely on outdated systems and fragmented information sources. Many staff still contend with slow log-ins, unreliable networks, and clunky software. This variation limits system-level planning and will constrain the national ambition for an integrated, digitally enabled NHS. It also undermines equitable access to digital care.

Digital Maturity Assessments have found that while over 90% of trusts now have EPRs, only a fraction use them to full potential. A July 2025 analysis by Future Health Intelligence found that NHS England spent £230.5 million on paper patient records in 2023-24. The NHS has digitised paper, not practice. In many organisations, digital remains separate from operational and clinical planning. While technology has been procured, staff adoption is inconsistent.

Workforce Readiness and Culture

Deliverability depends on people. Many organisations still lack the digital and analytical workforce required to design, implement, and interpret technology. Clinicians face pressure to adopt new systems without adequate support. Data analysts are often seen as support staff rather than strategic enablers.

Without engagement and confidence, digital tools risk becoming expensive layers of complexity rather than drivers of efficiency. Workforce development must therefore be central to any credible digital strategy. Digital literacy, user-centred design, and data ethics should be treated as core competencies.

Funding Digital Maturity

The most immediate constraint on digital deliverability is financial. The Delivery Plan and the wider NHS reform programme demands rapid expansion without providing dedicated investment for infrastructure, inclusion, or workforce development.

Digital transformation cannot be financed through efficiency savings alone. It requires sustained funding across capital for infrastructure, revenue for maintenance, and investment in training, governance, and evaluation. Clear accountability for return on investment must include not only economic and clinical outcomes but also the wider social value of an inclusive, digitally enabled health system.

The Framework makes reference to digital inclusion with a nod to the NHS's Inclusive Digital Healthcare Framework, yet inclusion feels mentioned more as a principle rather than a requirement. This gap is significant when we consider that digital inequity is now one of the most visible and measurable forms of health inequality.

While millions of patients now use the NHS App, others remain excluded due to a range of factors which include a lack of skills, language barriers, affordability or lack of internet access. Digital-first communication can improve access for some but will isolate others. An NHS App-first policy, while efficient, risks marginalising those who cannot or will not use digital channels.

If systems do not design for diversity, the shift from analogue to digital risks perpetuating the very inequities the NHS seeks to reduce.

AI adds a further layer of complexity. As predictive and generative tools enter care pathways, bias in data or algorithms could deepen existing disparities. Governance for AI must be integrated into clinical governance, with explicit accountability for transparency, oversight, and bias monitoring.

Digital inclusion should be measurable. Health systems must know who is not using digital channels and why. Plans should set out clear actions to reach digitally excluded groups by partnering with community organisations, libraries, and local authorities to build skills, capability and trust. Digital inclusion frameworks and approaches already exist, the challenge is to apply them systematically and hold systems accountable for progress.

To deliver an inclusive digital-first health system, we need to focus on these ten priorities:

1. Align strategy across domains

Digital transformation should be planned alongside workforce and equity priorities within a single integrated strategy. Integration ensures that every digital investment also strengthens workforce sustainability and reduces inequality.

2. Make delivery measurable

Every digital objective must be supported by a clear operational roadmap that connects activity to measurable improvements in outcomes, health equity, efficiency, and patient experience.

3. Procure technology for outcomes

Procurement decisions should be tied to demonstrable value. Contracts must articulate expected benefits for clinical quality, workforce sustainability, and equitable access.

4. Target gaps in capability

Investment must focus on closing down the persistent disparities in digital maturity between different providers. A consistent national baseline is essential for shared learning and measuring progress.

5. Develop the digital workforce

We need to recognise that digital transformation depends on people with the skills confidence and capacity to drive change and adopt technology. Staff need structured opportunities to build confidence and capability. Training should cover digital literacy, communication, ethics, and the practical use of data in everyday care.

6. Create time and space for adoption

Digital change requires time to learn and adapt. Organisations must design implementation plans that recognise the reality of clinical workloads and competing pressures and release time and bandwidth for staff to be involved.

7. Build trust through transparency

Trust is the foundation of digital adoption and underpins both staff adoption and public confidence. Staff must trust the systems they use, and the public must trust how their data is handled. Both require openness about how technology, data, and AI are used, protected, and governed.

8. Strengthen governance and oversight

Each system should have clear structures and accountability for data ethics, cyber security, and AI oversight. Governance should be anticipatory and aligned to clinical and organisational risk with ethical review built into decision-making.

9. Monitor inclusion and act on it

Digital inclusion should be a tracked and reported metric. Health systems should know who is not engaging with digital channels, understand why, and work with local partners to close those gaps. Digital inclusion must be tracked, reported, and acted upon.

10. Link progress to values

Digital maturity is not only a technical achievement. The real test of success is whether digital transformation improves care for everyone. Metrics should capture improvements in access, experience, safety, and workforce wellbeing, alongside financial efficiency. The goal is not only to digitise services but to create a fairer, smarter, and more resilient health system.

At Equiti Health, we believe that to deliver the NHS shift of analogue to digital, health and care systems need digital maturity assessments that establishes a baseline for readiness and improvement.

To support this need, we've developed the EquiIndex™, a digital health equity maturity framework that helps organisations evaluate and strengthen equity throughout their digital transformation journey. It offers a structured, evidence-based approach across seven domains: leadership, governance, workforce capability, infrastructure, technology, inclusion, and evaluation.

The EquiIndex™ translates digital inclusion principles into measurable, actionable criteria. It enables organisations to understand how well they are achieving equitable digital transformation, and where improvement is needed.

We are currently offering early adopters free access to the EquiIndex™ for organisations and individuals who wish to explore the tool, provide feedback, and take part in beta testing. 👉 Find out more here

By 2031, the NHS will be judged not by how quickly it digitised, but by how fairly it did so. The objective is not to create a digital NHS, but a health service that uses digital capability to extend reach, reduce disparities, and build healthier communities.

Success will rely on an NHS that makes digital change inclusive, supported by ethical and transparent data governance, and powered by a confident, capable, and resilient workforce. Deliverability will depend on health systems having the skills, tools and funding to sustain transformation over time.

This is ultimately not just about technology, but about values, trust, and a vision for the kind of health system the NHS chooses to become.

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References

1. PPL. Digital takes centre stage in NHS Operational Planning guidance. 2025. Available at: https://ppl.org.uk/digital-takes-centre-stage-in-nhs-operational-planning-guidance/

2. The Health Foundation. Electronic patient records: why the NHS urgently needs a strategy to reap the benefits. 9 April 2025. Available at: https://www.health.org.uk/reports-and-analysis/analysis/electronic-patient-records-nhs-strategy

3. NHS England. 2025/26 priorities and operational planning guidance. 30 January 2025. Available at: https://www.england.nhs.uk/long-read/2025-26-priorities-and-operational-planning-guidance/

4. DigitalHealth.Net. NHS must move EPR use beyond digitising paper, warns report. 10 April 2025. Available at: https://www.digitalhealth.net/2025/04/nhs-must-move-epr-use-beyond-digitising-paper-warns-report/

5. New Statesman. The NHS's digital problem: how old infrastructure is slowing down transformation. 2024. Available at: https://www.newstatesman.com/spotlight/healthcare/nhs/2024/08/nhs-digital-transformation-infrastructure-technology-patient-records-artificial-intelligence-waiting-lists

6. NHS England Digital. Digital tools funding 2025/26. 2025. Available at: https://digital.nhs.uk/services/digital-services-for-integrated-care/digital-pathways-framework/digital-pathways-tools-guidance-and-next-steps-for-2024-25/digital-tools-funding-2025-26

7. Health Foundation (via The Register). NHS staff still sceptical on electronic records. 10 April 2025. Available at: https://www.theregister.com/2025/04/10/nhs_electronic_records_face_skepticism/

8. Government Transformation. Digital overhaul needed to address NHS operational challenges. 2024. Available at: https://www.government-transformation.com/transformation/digital-overhaul-needed-to-address-nhs-operational-challenges

9. NHS Confederation. 2025/26 NHS priorities and operational planning guidance: what you need to know. 2025. Available at: https://www.nhsconfed.org/publications/202526-nhs-priorities-and-operational-planning-guidance-what-you-need-know