The spring Budget 2024 announced £3.4 billion funding for NHS technology and transformation to drive productivity improvements and support the NHS Long-term Workforce Plan. The money is earmarked to be provided over a three-year period, starting from April 2025.
This funding and focus on technology is welcome and much needed, especially considering that the government's progress on digital transformation was rated as inadequate in 2023.
The key question though is whether this funding, and the associated commitments, will radically transform the NHS's digital performance and translate into improvements in patient experience and outcomes. The funding may seem generous, but it is also spread thin, there are many unknowns, and some long-standing challenges remain unaddressed.
What is the intended use of the funding?
A large proportion of the funding - £2 billion - is allocated towards improving fragmented and outdated IT systems across the NHS. In a system where 8% of GP time is lost to IT issues, nurses have heavy laptops that lack sufficient battery life, and 22% of doctors say their IT systems are not fit for purpose, this investment and focus is much needed. It is easy to see how fixing these basics can improve productivity and use of technology. But to do this, the £2 billion needs to cover both the basics - such as well-functioning computers, a shift to the cloud, and good internet connectivity - as well as stretch to other uses, such as upgrading approximately 10% of MRI scanners to incorporate AI, and digitising transfers of care. In 2022, £2 billion was allocated to roll out electronic patient records alone, so it is highly possible that getting the basic NHS IT modernised and AI-ready will cost much more
£1 billion of the funding is allocated for staff-facing technology. This funding is intended to accelerate the use of the federated data platform and potentially improve theatre utilisation. There is also a commitment to pilot AI to automate back-office functions - such as writing letters and clinical note taking. If implemented successfully, this application of AI has the potential to reduce administrative workload for staff, delivering on the aspiration of the Topol Review, releasing time for clinicians to provide care.
The remainder of the Budget funding is allocated to several tools and initiatives, for example to improve flexible working for staff through the digital staff passport, enhance the digital experience for patients, and enable digital services to support preventive health care.
Will the funding be enough to solve productivity issues in the NHS?
While this package is positive, it will only go so far in addressing productivity in the NHS.
First, for the funding to have the intended impact it must be protected for spending on digital technology and transformation, and leaders must be encouraged to use it for the intended purpose. The NHS has a history of raiding capital budgets to prop up day-to-day costs and underspending on technology.
Second, it is essential that the funding is used effectively. NHS transformation often suffers from short-term and rushed funding, with multiple pots that take lots of effort to access. The way the funding is allocated needs to be refined in partnership with integrated care systems to ensure it can be used to support long-term and strategic change.
Third, while there is a significant focus on digital tools, it is not just the widgets that enable transformation but also staff time and skills, and having the right culture and capacity to change processes. Staff confidence is particularly important for cutting-edge technologies such as AI, where bias can have negative implications. To instil confidence in digital tools among staff and leaders, there needs to be more robust evidence generation co-ordinated across the NHS and research institutions.
Finally, some of the anticipated productivity gains are assumed to be a result of direct patient use of technology. However, this requires a digitally confident population and appropriate service design. The reality is that approximately 25% of the UK is likely to struggle with online services, yet the Budget overlooks the need for cross-departmental and partnership approaches to improve the public's digital capabilities and prevent widening inequalities.
The Budget also only focuses on the NHS, overlooking social care, even though a previous policy paper emphasised that digitalised health and social care is necessary for vastly improved and integrated services. With no additional funding for social care digitalisation, this part of the system will lag behind, with likely inefficiencies and a negative impact on staff and the people who draw on services.
Conclusion
The investment in NHS technology is very welcome and long overdue. But if it is to have the intended productivity impact, the funding needs to be protected so that it can be spent on technology and transformation. While some of the funding will need to be spent on getting the basics right, other elements of the transformation will need concerted action by leaders to empower staff so that they have the support, time and funding to be able to change their digital and work environment for the better.