We need to move from ‘techno optimism’ to ‘techno realism’
- 15 July 2025

Optimism on tech is welcome but what’s needed next is a clearer vision for the future care model and a more detailed, credible plan for service change, writes Malte Gerhold
With the NHS under considerable stress from rising demand and squeezed resources, it’s unsurprising that the government’s 10 year health plan bets heavily on technology and AI to help tackle the pressures and improve care.
In many respects, its ‘techno optimist’ vision is a positive and much needed one, beginning to describe a ‘digital first’ ambition for the NHS.
Proposals to create a single patient record and develop more functions of the NHS App, if done inclusively, could help create the step-change in people’s ability to manage their health that will be needed for the NHS to remain sustainable.
Equally welcome is the commitment to using technology to support staff, such as ambient voice technology – on which the Health Foundation is supporting research in collaboration with THIS Institute.
Successfully translating the plan’s vision into reality will be a huge effort. Much has already been made of the missing ‘implementation chapter’. Indeed, the Health Foundation has long argued that policymakers must focus not simply on technology ambitions and procurement, but on supporting the NHS to actually implement and use tech effectively.
Deeper than implementation
But what’s missing on technology goes deeper than implementation. The plan focuses more on the technology itself than the underlying change it is enabling, or what needs to ‘sit around’ the technology to achieve this.
In many places the plan doesn’t really spell out what truly technology-enabled care models should look like – how services and pathways will need to be redesigned, how professional roles and ways of working will need to evolve, and what underpinning capabilities are required to make it all work.
Take the NHS App. Centre stage in the plan are ways the functionality of the app can be expanded to provide a better ‘front door’ to the NHS and support patients to manage their health.
Yet many of these uses of the app – sending test results, screening invitations, appointment reminders, etc – are ultimately just digitising existing processes. They can make interacting with the health service more convenient, and save money on letters and postage, but they are not really changing the way care is delivered.
To get the benefits the government is hoping for from technology, the NHS App will need to go beyond digitising care to reshaping it
To be truly transformative, and to deliver the benefits the government is hoping for from technology, the app will need to go beyond digitising care to reshaping it. And the plan does describe more transformative uses of the app – such as the collection of health data from wearables to help manage conditions, potentially as part of a national virtual ward system.
But here the app will be just one part of much more complex changes in services, processes and behaviours. And to get these transformational benefits, the government will need both a clearer vision for the future care model and a more detailed and credible plan for the resulting service change.
This must include identifying what investment, training, support and guidance will be needed to make it happen.
New regulatory framework
To be fair, the future is uncertain, and the plan does highlight some of the gaps to be filled. Updated regulation and guidance will be needed to ensure new uses of tech are safe and effective, and to tackle evolving issues around AI such as clinical liability and post-market surveillance.
It is positive to see the government commit to a new regulatory framework for medical devices and an NHS AI strategic roadmap “that will enable clear ethical and governance frameworks for AI” – something the Health Foundation has highlighted the need for.
Also welcome is the plan’s commitment to co-designing new uses of technology with patients and staff. Previous Health Foundation research has highlighted a social gradient in willingness to participate in health technology development, so ensuring the app is designed in an inclusive way will require proactive engagement with diverse social groups.
The plan discusses the advanced integration of AI into EPRs, but not what’s urgently needed to get them working well today
The plan does acknowledge the need to ‘get the basics right’ on tech, and the recent spending review committed £10bn for investment in technology for the NHS in England (consistent with what we have estimated is needed to meet existing commitments).
But the plan pays little attention to the significant further work required. It opens by saying “the NHS must not only catch-up: it must lead” and then focuses almost exclusively on the latter. But the NHS can’t lead unless it catches up first.
Electronic patient records (EPRs) are a case in point: the plan discusses the advanced integration of AI into EPRs, but not what’s urgently needed to get them working well for staff and patients today.
The direction set out in the 10 year health plan is a positive and ambitious one. But translating the plan into reality is going to require significant attention to, and support for, changes in pathways, roles and ways of working, as well as the underpinning skills, culture and infrastructure.
Without that, it is a ‘techno optimist’ vision. The priority now is helping to turn it into a ‘techno realist’ plan.