NHS restructures are eroding digital leadership at the worst possible time

Cutting digital capability at a time when it’s needed most risks long-term consequences for the NHS, writes John Mitchell on behalf of the Digital Health Networks ICS Digital Council

There is a troubling paradox at the heart of the current NHS restructuring.

Integrated care boards (ICBs) are under pressure to deliver significant savings, with a strict cap of £19 per head of population for running costs.

At the same time, NHS England and ICB reorganisations are stripping away digital leadership, skills, and organisational memory across the system. This raises concerns that the very capabilities needed to navigate the coming years are being dismantled.

It is important to note that not all ICBs are able to offer the full spectrum of digital leadership services, even where there is the will to do so. Funding constraints mean that some boards must make difficult choices, prioritising core operations over broader digital ambitions.

Many digital health professionals now speak openly about the ‘perceived decimation’ of digital roles

Despite these limitations, there remains a broad and significant pool of digital experience and expertise across the system, built up over years of investment and collaboration.

Many digital health professionals now speak openly about the ‘perceived decimation’ of digital roles—a perception that, for many, feels all too real.

Digital transformation is not a luxury; it is essential for improving access, delivering safe digital innovation, streamlining care, reducing manual workload, and supporting clinical teams.

It is also the only viable route to closing the financial gap, making the current direction of travel especially concerning.

Digital leadership diluted

Transitioning from ‘analogue to digital’ is not simply about buying more technology.

Shifting from ‘treatment to prevention’ or ‘hospital to community’ requires significant digital transformation, which in turn depends on leadership, consistency, and clear decision-making.

Under new ICB and regional structures, digital leadership roles are being merged, downgraded, or eliminated.

Responsibilities are shifting but not always being reassigned, resulting in confusion, fragmentation, and increasingly siloed digital decision-making. The focus is shifting from holistic patient and population needs to organisational survival.

This is not the first time such changes have occurred, but the stakes are now higher.

Digital infrastructure underpins electronic patient records (EPRs), shared care records, cybersecurity, data, remote monitoring, population health, and operational flow. Without strong leadership, these ambitions are at risk.

Shrinking teams and lost expertise

The workforce situation is equally challenging. Many ICBs are already operating digital services on minimal resources, with staff barely able to maintain basic operations.

Voluntary redundancy (VR) schemes are removing key personnel, and VR clauses often prevent experienced staff from returning for extended periods, resulting in a permanent loss of expertise.

Digital capability takes years to build, relying on local knowledge, relationships, and organisational context

Digital capability takes years to build, relying on local knowledge, relationships, and organisational context. Once lost, it is difficult—if not impossible—to rebuild.

This raises a critical question: what is the value of years of investment in digital leadership programmes if those very leaders are now being ushered out the door?

The £19 per head cap

The £19 per head target is a major talking point in the NHS, and for good reason.

Running safe, modern digital services on this budget is extremely difficult when factoring in cybersecurity, EPR optimisation, shared care records, data platforms and analytics, infrastructure, clinical safety, and 24/7 operational resilience.

These are not luxuries—they are essential to the health service. If the only way to meet the cap is through top-slicing, digital services take a disproportionate hit, as they are still too often seen as ‘back office’.

What is the value of years of investment in digital leadership programmes if those very leaders are now being ushered out the door?

This approach undermines the productivity and efficiency gains the target is meant to enable, saving pennies now at the cost of pounds later.

Breaking the connection between strategy and delivery

There is a tension between the government’s ‘three shifts’ and the financial mechanisms being used to deliver them.

The ‘left shift’—moving care from hospitals to the community—requires data, workflow, and coordination across boundaries.

Digital leaders are essential for engineering this flow, building standards, governance, infrastructure, and relationships. Headcount caps and broad VR schemes risk removing the very people who act as system conveners and integrators.

Without them, each organisation optimises its own area, leading to fragmentation and making the ‘three shifts’ operationally impossible.

Neighbourhood models and transition risks

Neighbourhood models could be a significant step forward, but they depend on digital coordination and delivery.

Shared information, interoperable tools, clear data governance, MDT coordination platforms, and consistent operating models are all required. None of this is achievable if digital expertise continues to drain from the system.

Replacing experienced local teams with expensive external consultants rarely ends well. It is a classic case of trying to build something new while removing the tools and people needed to build it.

There is also significant transition risk. IT operations cannot pause while structures are redesigned.

Replacing experienced local teams with expensive external consultants rarely ends well

EPR support, cyber monitoring, 24/7 infrastructure, and clinical safety reviews must continue. If already stretched teams lose more capacity, risks become very real.

There have already been incidents where digital gaps have directly impacted clinical services—these should serve as warnings.

A practical alternative

There is a growing case for pausing further reductions to digital leadership and operational capacity until the new system architecture is genuinely in place.

The redesign of neighbourhood models, shared platforms, data flows, and supporting infrastructure is not yet mature. Reducing digital capacity before these new models are stabilised introduces avoidable risk.

A more sensible approach would be to maintain the current baseline of digital leadership and expertise until the future-state operating model is functioning.

Only then can the NHS safely reduce duplication or consolidate teams without jeopardising resilience, innovation, or patient care. In short: don’t cut today what tomorrow will depend on.

The NHS is right to seek savings, and digital can be organised more efficiently. However, cutting capability at a time when it is most needed risks long-term consequences.

Digital is not a support function—it is how modern healthcare works. If digital capability is allowed to erode now, the NHS will feel the consequences for years to come.

 This opinion piece is based on the Digital Health Networks ICS Digital Council’s position statement. You can read the full statement here.