Four tech tensions that the NHS can’t afford to ignore

There are unavoidable tensions on the journey to a technology-enabled NHS, writes Dr Malte Gerhold, senior adviser at management consultancy PPL  It’s eight months since the publication of the government’s NHS 10 year health plan, and its call for technology and digital to reform the NHS. I subscribe to the plan’s central tenet that technology is among our most important levers to change how care is delivered. But the policy directions on technology emerging since are not obviously amounting to a coherent whole. These mixed signals are likely the result of not sufficiently acknowledging unavoidable tensions on the journey to a technology-enabled NHS. Tensions that require an open conversation with the public, patients and staff about the future we actually aspire to, and the trade-offs inherent to this journey. I’m sharing four tensions I’ve observed in discussions about technology with staff, patients and industry, which I hope can help frame policymaking and conversations to make technology in the NHS a success. Technology vs implementation It’s hard to not make this sound obvious, but whether technology succeeds in reforming the NHS will depend on how well we implement it, not just having the ‘kit’ in place. Despite this, political interest in implementation – and, most importantly, the resources invested in it as a result – remain a poor cousin to talking about the tech itself. Implementation receives disproportionately small amounts of national funding, relative to research or new pilot initiatives. The NHS will never be world leading on tech and innovation if it isn’t also world-leading on its implementation, and optimisation. New technology, including the recent advancements in AI, is exciting. But realistically, the greatest gains we are going to see from tech in the NHS over the next two to three years are from optimising technology already in place. The NHS will never be world leading on tech and innovation if it isn’t also world-leading on its implementation, and optimisation We’ve learned this from electronic patient records, which started with ‘digitising paper’ and only recently triggered a serious debate on how EPRs improve staff workflows and patient experience. Spending some of the £10bn investment in tech, announced in the 2025 budget, on implementation would be a great opportunity to address this imbalance. We need an honest conversation about what successful implementation requires, industry’s role in being accountable for benefits – and that more tech is not always better while we should still get more out of the existing one. Technology infrastructure vs signals of change That same £10bn was an acknowledgement of the need to continue to invest in technology infrastructure. But there remains a curious gap in current policy to demonstrate more seriously that technology really can make a difference to staff and patients. The NHS App and NHS Online are probably intended as such ‘direction setters’ for patients, and ambient AI scribes for staff. I worry, however, that these initiatives still take too long before they are more widely visible. Despite the 30 million or so of us with the NHS App on our phone it’s hardly in wide use. Alongside the investment in infrastructure, we need conversations with professionals and patients on where we can make faster progress with technology that makes a difference to how they provide and experience care. If we are serious about reforming the NHS, let’s take a bold approach to making tech happen across larger parts of the country. Doubling down on any one technology is politically difficult, but it’s possible. We need to demonstrate that change is possible. Political commitment vs honest evaluation Once publicly committed, politics struggles with honest assessments of what is and isn’t working. Evidence in health care is often mixed or slow to emerge, and no politician likes to backtrack. Yet that is just what we need to experiment with technology driven change, and adjust course. It means being willing to invest more in evaluation, and transparently so. Funding for evaluating implementation and spread too often remains an afterthought. This would also drive us to articulate better what success looks like. Not all technology is about productivity. If it can make staff lives easier, or improve patient experience, that’s valuable too Current debate quickly jumps towards productivity. But not all technology is about productivity, nor should it be – if it can make staff lives easier, or improve patient experience, that’s valuable too. We need to hold this tension between making commitments to demonstrate tech can make a difference, while also evaluating success from each of these perspectives and have a more genuine debate about what is and isn’t working – rather than rigidly locking in national priorities. Technology future vs social desirability Our heads are buried in today’s problems. But if we don’t articulate what we want the future of care to look like, then we don’t direct technology to where we want it – we simply react to where industry takes us. A valuable but unreliable guide. This conversation should start from a commitment to responsible technology and AI. A future for our care that isn’t just technically feasible and regulatory compliant, but also socially and ethically desirable, to the benefit of all. How much are we willing to trade off the human connection in care with, say, the speed of diagnosis or access to care? If we see prevention or the empowered patient at the heart of future care, what technology do we need to make that happen? There’s a leading but currently sparsely populated role for clinical leadership to shape this future, and that of their professions, rather than manage the status quo. Let’s talk about what we want technology to do for us, not just what it can do. Where does this take us? NHS leadership, including politicians, and all of us in this field have the responsibility to have a more open debate about technology and its trade-offs, and the future of health and care we want to see. We should monitor not just whether the changes we’re making are effective, and meet the success we’ve defined, and can be scaled – but also whether they are getting us closer to this future. Successful technological change in the NHS is clinical as much as political and social. Let’s acknowledge these tensions and complexity, rather than opt for tempting but misleading simplicity. It won’t make the journey towards a reformed, sustainable NHS any easier, but it will help us have a more consistent, and honest, debate about what it means to get there. Gerhold is speaking at Digital Health Rewired, which takes place at the NEC Birmingham on 24-25 March 2026. Register here.

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