NHS tech investment needs better delivery, not greater urgency
- 6 May 2026
NHS digital investment is being held back not by lack of urgency but by weak delivery on the ground, writes Professor Joe McDonald
After more than three decades working in the NHS, I’ve learned that large-scale digital investment rarely fails because the ambition is wrong.
It fails because there is a disconnect between national intent and the complexities of frontline practice, and digital transformation is no exception.
With recent news that the single patient record is delayed until 2030 and work on neighbourhood health tech hasnât commenced due to a lack of âclear visionâ, itâs clear that there is a significant mismatch between timeframes and delivery.
Political motivations
Digital tools are often presented as essential to improving productivity, access to services and better patient experience.
And rightly so â they have a key role to play in these areas.
There have been some great examples of success in recent years, such as shared care records and the Global Digital Exemplar programme.
However, in equal measure, there are examples where benefits experienced by patients and staff are unevenly spread.
Speed is part of the debate, but the deeper problem is that digital programmes are often driven by politically motivated decisions and considered successful once they are live, rather than once they are optimised and working effectively in the long term.
Digital programmes are too often considered successful once they are live, rather than when they are optimised and delivering meaningful improvements for patients and staff.
These issues were highlighted in a recent roundtable discussion I hosted with Dame Chi Onwurah MP, alongside NHS digital leaders, system executives and frontline clinicians.
What struck me was how consistent the observations were amongst attendees, despite people coming from very different parts of the health and care system.
Conditions for success
There was broad agreement that digital programmes succeed when a few basic conditions are already in place.
Strong clinical leadership matters. So do relationships between organisations that go beyond formal governance and allow teams to solve problems together.
Where digital teams are embedded in services and able to adapt systems to real workflows, technology can genuinely improve access and coordination.
Technology improves care when digital teams are embedded in services, systems reflect real workflows and organisations are able to work together beyond formal governance.
Where these conditions donât exist, progress is far harder.
Several participants at the roundtable described situations where the same tools produced very different results across neighbouring systems.
It wasnât to do with enthusiasm for digital (or lack of it), or even funding. It related to workforce capacity, digital skills, organisational stability and the ability to support change over time.
The result? Uneven access to joined-up care that maps closely to delivery capability, rather than to the quality of the technology itself.
Uneven access to joined-up care is driven less by the quality of the technology and more by differences in delivery capability, workforce capacity and system support
Interoperability featured heavily in the discussion. Despite years of national focus, frontline teams still spend too much time navigating gaps between systems.
Shared care records were often cited as a positive step at the roundtable, but also as a reminder that technical connectivity is only part of the answer.
Without clear standards, sustained investment and agreement on how information should flow in practice, staff continue to rely on workarounds and personal relationships to get the job done.
Without clear standards and sustained investment, interoperability remains incomplete and frontline staff are left relying on workarounds and personal relationships
Accountability was another recurring concern.
Digital responsibilities are spread across national bodies, systems and providers in ways that can feel opaque on the ground.
When programmes stall or fail to deliver the expected benefits, it is often unclear who is responsible for stepping in, adjusting course or providing additional support.
That lack of clarity slows progress and contributes to a sense that delivery risks are being passed around rather than addressed.
Workforce capacity runs through all of this.
Digital change is frequently layered onto services already under strain, with limited time for training, optimisation or reflection.
Participants spoke about systems going live and then being left to âbed inâ without the ongoing support needed to make them work well.
Over time, this reinforces the impression that digital transformation is something that happens to services, rather than something they are supported to shape.
Digital transformation is too often something that happens to services, rather than something frontline teams are supported to shape and sustain over time
It was in this context that the issue of government timelines came up, which is apt given the recent 10 year plan impact statement that highlights the issue of âoptimism biasâ in major digital programmes.
For those with long memories and experience of the National Programme for IT (NPfIT), this was less a revelation than a confirmation of lived experience.
Large programmes almost always take longer than planned, particularly when they have to accommodate legacy systems, local variation and stretched teams.
Expectations for digital programmes are still set as if delivery will happen under ideal conditions, despite the reality of workforce shortages, legacy systems and competing priorities
The difficulty is not that plans evolve, but that expectations are often set as if delivery will happen under ideal conditions.
When those assumptions meet the reality of workforce shortages, fragile infrastructure and competing priorities, timelines slip and confidence takes a knock.
Clinicians, who are repeatedly asked to adapt to new systems, begin to question whether lessons are really being learned.
Learning lessons from the past, finally
Iâve been involved in a white paper that reflects these concerns. It argues for much-needed realism: clearer ownership of outcomes, authentic clinical engagement, implementation timelines that reflect service capacity, and proper investment in what happens after systems go live.
Training, optimisation and governance cannot be seen as optional extras.
None of this undermines the case for urgency. The pressures facing the NHS are immediate.
But progress will depend less on how quickly programmes such as the single patient record and neighbourhood pioneers are announced and more on whether they are supported to work in the places that need them most, and for the long term.
Professor Joe McDonald is medical director at Sleepstation and The Access Group, former NHS trust medical director, national clinical lead for IT, founder of the Great North Care Record and consultant psychiatrist.
He is the author of  FHIR and Loathing in Las Vegas, featuring a compilation of columns published by Digital Health News over the years.
