The NHS stands at a crossroads. The government’s 10-Year Plan sets out one of the boldest visions in its history: a Single Patient Record to follow people through life, an NHS App as the digital front door, and the use of AI to support care in every hospital. It also promises a stronger emphasis on prevention, underpinned by digital tools, and a dedicated transformation budget to make it possible. Few dispute the ambition: these commitments are among the most far-reaching ever made for digital health, and as the Tony Blair Institute has argued, the NHS App could evolve into a “doctor in your pocket”, transforming how people access care.
However, these ambitions are not new. The NHS has long promoted the “shifts” from analogue to digital, hospital to community, and treatment to prevention. They have appeared in successive strategies for decades. The real question is whether this latest plan will finally be backed by the policy choices, investment and delivery discipline needed to turn aspiration into action, and whether that is realistic in today’s climate of financial constraint and workforce pressure.
The task now is to look past the headlines and consider three factors that will determine whether the 10-Year Plan can move from digital ambition to impact:
- Capacity, prioritisation and funding
- Interoperability and data foundations
- People and trust
Capacity, prioritisation and funding
NHS digital and IT teams already carry a heavy load, maintaining legacy systems, responding to urgent operational needs, delivering cyber improvements, and supporting multiple transformation projects with limited resource. Adding a new set of national priorities without clearer sequencing risks overwhelming these already stretched teams. Evidence from wider public sector programmes is sobering: McKinsey found that fewer than 30% of government transformation efforts fully succeed, while BCG reports around 70% of large-scale digital initiatives fail. Most failures are not down to technology, but to people and process: unclear goals, lack of accountability, competing priorities, and limited support for change.
The risk for the NHS is clear. Without a sharper focus on what is most important, the 10-Year Plan could become a long list of initiatives with little impact. As Jon Hoeksma has argued, success will require “prioritisation and sequencing”, not attempting to deliver everything everywhere at once.
This challenge is compounded by the requirement for Integrated Care Boards (ICBs) to cut their running costs by 50%. Many of those leaving are experienced staff with the knowledge to lead and coordinate digital change. The effect may be to weaken local capability at precisely the time when it is most needed. Large “super ICBs” may emerge, but greater scale could mean decision-making is more remote, slower, and less responsive. In practice, it may be 2027 before commissioners are in a position to make significant investments in the 10-Year Plan. Where does this leave us in terms of the scale of change that can realistically be achieved over the next decade?
There is also the question of whether investment will match ambition. The plan promises dedicated investment for prevention and innovation and sets a target of 2% annual productivity growth for three years, with digital named as one of the key enablers. It also points to a new financial framework, moving towards value-based funding that rewards outcomes rather than activity.
What the plan does not set out is how these ambitions will be resourced in practice. There is no ringfenced digital budget, and no clarity on how much of the promised transformation funding will flow into digital infrastructure, data foundations, or workforce capacity. Nor is it clear whether investment will come from new money or from the reprioritisation of already stretched budgets. Further detail may follow, but for now the financial foundations of the digital agenda remain uncertain.
Interoperability and the hidden foundations of data
Much of the commentary on the plan has focused on visible initiatives: apps, booking tools and triage systems. But these will only ever be as effective as the data beneath them. As Ram Rajaraman observed, the real starting point for the plan is data. Without reliable, structured and well-governed data, ambitions such as a Single Patient Record or a digital front door risk being little more than new wrappers for the same fragmentation. This echoes the argument from The King’s Fund, that interoperability is not simply a technical issue of APIs and platforms, but a social one, built on trust between staff and leaders. It depends on shared priorities, consistent definitions and metadata, access to long term funding and skilled workforce, capacity for transformation and governance that incentivises collaboration rather than competition.
A number of leaders have gone further. Rowland Agidee argues that data management itself is the true digital foundation. Without robust governance, metadata and stewardship, digital initiatives will struggle to scale or integrate. Tito Castillo makes a similar point in his article on interoperability: data is not simply “reused” but must be actively repurposed across settings; metadata, the context that gives data meaning, is one of the most neglected assets in healthcare; and while information governance tends to focus on protecting data, true data governance is about enabling its safe and effective use. Data maturity is not a one-off project but a process: data evolves and becomes more valuable through use. And for that to work, clinicians must be at the centre of how data is captured and curated
This becomes especially important as care shifts from hospital to community. Without strong data standards and infrastructure across organisational boundaries, records will remain fragmented, and the potential of population health management will be limited. More fundamentally, digital cannot succeed without wider systemic reform. This means a shift from fragmented, reactive services that treat people as ‘cases’ to integrated, preventative approaches that work with people, families and communities. Without this shift in structure and mindset, data will remain siloed, and digital transformation risks reinforcing the very problems it seeks to solve.
This points to a wider challenge: cultural change and leadership. Digital transformation is as much about relationships and behaviours as it is about systems (figure 1). Progress depends on leaders who can work across organisational boundaries, set common priorities, and create the trust needed to share data and redesign services. Without strong, consistent leadership, technical programmes risk becoming isolated projects rather than catalysts for system-wide change.
Figure 1: Key Components of Digital Transformation
For patients, the outcome should be simple. They should not have to see a “digital NHS.” They should experience a service that already knows them, avoids duplication, identifies risks earlier, and makes decisions more consistently. That will not come from a new app alone, but from the unglamorous but essential work of getting the data foundations right.
AI, automation and trust
The plan’s commitment to AI in every hospital reflects the urgency of raising productivity. Automating routine documentation, streamlining correspondence, and supporting clinical decision-making could release valuable time and improve consistency.
But adoption will only succeed if patients and clinicians trust the technology. For clinicians, that means tools that are transparent, embedded in workflows, and supported by clear lines of accountability. For patients, it means confidence that AI will be used ethically and safely, without reinforcing existing inequalities.
In the near term, the strongest opportunities lie in admin and workflow support rather than high-stakes clinical decisions. Drafting clinic letters, summarising records, coding activity and easing scheduling can reduce pressure on staff without displacing clinical judgement. As the King’s Fund has highlighted, decision-support tools have potential, particularly in image-heavy specialties, but they will require careful piloting, clear evidence standards and strong professional oversight before use at scale.
Experience shows that new technologies gain traction in the NHS when they can be integrated smoothly into existing workflows, when their purpose can be explained with clarity, and when their benefits are easy to demonstrate. Without this, new tools risk being seen as an additional burden rather than a genuine enabler of better care.
Sector leaders reacting to the plan have also highlighted these concerns, warning that without careful attention to digital inclusion, the very groups who stand to benefit most could be left behind. Workforce readiness is equally critical: without investment in training, support, and time to adapt, AI risks being sidelined rather than scaled.
From vision to impact
The 10-Year Plan has set out an ambitious digital future. But turning that ambition into reality will require:
- A focus on fewer priorities, delivered well.
- Sustained investment in the hidden foundations of data and interoperability.
- Strengthening, not weakening, the workforce and organisational capacity to lead change.
If the next phase of work can focus on these fundamentals, the NHS has an opportunity to modernise not only its infrastructure but the experience of care itself. If not, we risk repeating the familiar pattern of ambition without impact.
