Outsourcing won’t fix the NHS digital workforce gap

The NHS’ shift to digital requires a permanent, resilient digital workforce, writes Lee Rickles, chief information officer at Humber Teaching Foundation Trust

NHS England’s recent publication of a preliminary market engagement notice for “digital clinical development and support services” marks a pivotal, if somewhat paradoxical, moment in our national digital strategy. 

On one hand, the government’s 10 year health plan sets an ambitious trajectory for a digital by default service, operating 24/7. 

On the other, the very organisation tasked with steering this ship is currently dismantling its own engine room.

As NHSE seeks to understand market interest for up to 68 full-time equivalent (FTE) roles across clinical safety, medical device regulation, and content authoring, we must ask if the current cycle of redundancy followed by re-procurement is a strategic necessity or a self-inflicted wound to the system’s long-term sustainability?

The Capability deficit

The request for information (RFI) is candid. NHSE has acknowledged that it cannot fully resource the digital requirements of the 10 year health plan internally. 

The expertise sought includes clinical safety engineering, qualified persons for medical device regulation, and the modelling of AI impacts. These are the foundational guardrails of modern healthcare technology.

Is the current cycle of redundancy followed by re-procurement is a strategic necessity or a self-inflicted wound to the system’s sustainability?

The estimated requirement of 68 FTEs to cover clinical safety assurance, medical device services, and subject matter expertise, highlights a specific deficit in qualified digital-clinical roles. 

These are professionals who understand both the rigours of the bedside and the complexities of the bitstream.

The cost of contraction

This move to buy in expertise is happening while NHSE and integrated care boards (ICBs) undergo a radical workforce reduction. 

With one in four NHSE staff reportedly applying for voluntary redundancy and a projected system-wide redundancy bill of £1bn, the optics are challenging.

In January 2023, former NHSE clinical information officer John Quinn warned of a “very stark picture” regarding the ability to support ongoing programmes. 

Those warnings are now manifesting as a reliance on business and management consultancy services.

From a leadership perspective at the trust and regional level, this raises three critical concerns:

1. Value for money: Is the £1bn spent on redundancies, combined with the inevitable premium of private-sector consultancy rates, truly more cost-effective than retaining and upskilling our existing workforce? Consultancy provides incremental capability, but it often fails to build the residual capability that stays within the NHS once the contract expires.
2. Loss of institutional memory: Digital clinical safety is as much about understanding the nuances of NHS workflows as it is about regulatory compliance. When we lose veteran staff to redundancy, we lose the hidden knowledge of why certain systems fail in a live clinical environment.
3. The Summer 2026 horizon: The RFI suggests contracts will not be in place until the summer of 2026. In the fast-moving world of AI and medical device software, a two-year lead time for “strategic sourcing” risks leaving the NHS perpetually playing catch-up.

Strategic sourcing or survival?

The documentation argues that external support is crucial to ensure development is “not constrained by insufficient clinical and regulatory specialist capability”.

For those of us leading electronic patient record optimisation, regional shared care records and secure data environments (SDEs), we know that capacity is indeed the greatest bottleneck.

We can’t afford to treat clinical safety and digital assurance as a commodity that can be switched on and off via a procurement portal

However, the decade-long nature of the plan suggests we should be building a permanent, resilient digital workforce. 

By outsourcing the qualified person roles for medical device regulation, we risk becoming a client that no longer understands the technical depth of what it’s buying.

A path forward

As this is currently an RFI and not a formal tender, there is still time for NHSE to refine its approach. We should consider:

• Hybrid models: Instead of pure outsourcing, can we use these funds to create clinical-digital fellowships or secondment models that draw expertise from trusts and ICBs, keeping the investment within the NHS family?
• Regional collaboration: Leveraging the expertise within existing SDEs and regional hubs to provide the clinical safety assurance NHSE needs, rather than defaulting to large-scale management consultancies.
• Retention over redundancy: Where staff in the transformation directorate possess these niche skills, every effort should be made to redeploy them into these new 68 FTE roles before they are lost to the private sector – only to be sold back to us at a higher price.

The 10 year health plan is the right vision, but the current shrink-to-grow tactic is high-risk. We can’t afford to treat clinical safety and digital assurance as a commodity that can be switched on and off via a procurement portal.

If we are to move from a digitally-stretched service to a digitally-enabled one, our primary investment must be in people. 

We must ensure that the “significant increase in scale and pace” promised by the government is matched by a significant increase in our commitment to the professionals who make digital health safe and effective.

Rickles is speaking at Digital Health Rewired, which takes place at the Birmingham NEC on 24-25 March 2026. You can register here.