One year on from taking office the Labour Government has unveiled the long promised ten-year plan for the NHS, promising an end to ‘hospital by default’ and a promise to digital default, to deliver preventative care in patient’s home, wherever possible.

Extra funding for digital investment has already been promised in the June Spending Review, including an extra £10 billion to achieve the shift from analogue to digital health and care.

Under the 10 Year Health plan the aim is that the majority of outpatient care will happen outside of hospitals by 2035. The plan is to turn the NHS into a neighbourhood-based service focused on prevention rather than sickness.

Digital and technology critical NHS 10-year plan

Digital, and technology more widely, is utterly central to the 10-year plan, with AI, Data, robotics, genomics and wearables singled out as underpinning technologies

Pivotal roles set out for a massively expanded NHS App, imagined as the digital front door and digital service delivery channel; and a hugely ambitious new Single Patient Record, pitched as the essential glue required to deliver a patient-centred service.

The biggest changes signalled are for how people access NHS services, moving care out of hospitals through the rollout of new Neighbourhood Health Centres and a much greater role for the NHS App.

Among the other key digital initiatives promised are a national procurement for a virtual wards service. With multiple suppliers involved in the provision of a fragmented patchwork of virtual wards service this would seem to suggest a framework approach.

Recognising the frustrations of staff in time wasted logging on to multiple systems a promise is made to provide single sign on for all NHS clinical staff. Whether Imprivata should be celebrating or worrying is unclear.

AI seen as critical to future of NHS

AI features heavily in the plan, which promises that AI scribes will end the need for GP clinical notetaking, letter drafting, and manual data entry to free up clinicians’ time to focus on treating patients.

The aspiration is to “Make the NHS the most AI-enabled health system in the world”.

Speeding up adoption of innovation

To help speed up the adoption of digital technologies new innovation passports are promised. This despite NHSE last month telling trusts to stop implementations of AI scribing due to regulatory worries.

Turning to regulation the plan says NICE will assess all digital technologies (no mention of the MHRA or CQC in this role), and that “NICE will also be given a new role to identify which outdated technologies and therapies can be removed from the NHS to free up resources for investment in more effective ones”.

This is potentially radical change and an area to watch if the intention is to target existing technologies as legacy products to be replaced. Could we, for instance, see EPRs decommissioned to fund SPR aspirations?

Wearables for all to deliver preventative care

In the section on prevention there is a big drive to wearables, which it says will become “standard in preventative, chronic and post-acute NHS treatment by 2035” and that “All NHS patients will have access to these technologies, which will be part of routine care. We will provide devices for free in areas where health need and deprivation are highest”. This will surely lead to celebration at Apple, Samsung, Google and Garmin.

Further radical changs are promised on how transformation projects are funded, such as a promise to “Introduce multi-year budgets and require NHS organisations to reserve at least 3% of annual spend for one-time investments in service transformation, to help translate innovations into practice more rapidly”.

Wider role signalled for technology companies

And there is a Delphic suggestion that technology companies will be offered a wider role in service transformation, with a promise to: “Expand the role life sciences and technology companies can play in service delivery. We will streamline procurement of technology, and we will move to a single national formulary for medicines within the next 2 years.”

At every turn in the plan digital technology is seen as essential to deliver the people-centred, locally delivered preventative health. But it is also vital to achieve 2% productivity savings on which the extra spending on the NHS is predicated. This alone requires a detailed 10-year plan of action.

The new Office for Value for Money recently noted that this level of productivity savings would require trebling the 0.6% annual productivity improvements that were delivered before the Covid-19 pandemic.

Not delivery strategy yet to accompany plan

As yet the 10-year plan is very aspirational with no delivery strategy attached. The chapter on delivery was reported by HSJ to have been pulled ahead of publication, suggesting that a delivery plan remains at a very early stage.

It is a very glaring omission, with delivery plans now promised to follow by the autumn. But with the NHS in massive organisational churn due to the merger of NHSE and DHSC, halving of ICBs, and promised further bonfire of NHS organisations and agencies such as CSUs, deep job cuts as trusts try to reduce deficits, the system is already stressed, and timetables could easily slip.

This before new Neighbourhood Partnerships and Integrated Care Organisations are established. There is already an awful lot of change to contend with.

For most suppliers the key questions will be how this high-level aspirational stuff will be translated into prioritised, funded programmes and procurements. As ever the devil will be in the detail.

The NHS, and NHS digitisation in particular, emerged as the clear winners of the Spending Review (SR25) on 11 June. Out of £30 billion extra pledged to the NHS, a third of the total has been committed to accelerate digitisation.

Be in no doubt this is a step-change in NHS IT investment, which looks set to galvanise the sector and create significant new market opportunities for suppliers.

The commitment of an extra £10 billion to digitising NHS IT up to 2028-29 is by far the biggest investment in digitising UK healthcare since the NHS National Programme for IT in 2003, initially costed at £6 billion and later rising to £12 billion.

50% increase in national NHS IT investment

The £10 billion increase represents a near 50% increase in current NHS IT budgets, with a commitment from Secretary of State for Health Wes Streeting that digital budgets will not be raided to cover deficits or other local priorities. A pattern that has been a recurring Achilles’ heel of past investment announcements.

Overall NHS spending is expected to grow by 3% annually, reaching £226 billion by 2028–29. Future Health Intelligence estimates that by the end of the SR25 period total annual NHS IT expenditure (local and national) is likely to have reached £7-8 billion.

In our last Analysis and Insight on 6 June Future Health Intelligence dissected the Health Foundation’s report into the cost of completing digitisation of the NHS, which said it would require a huge £21billion over the next five years (£14.75 billion for the English NHS alone).

Health Foundation estimates closely match SR25

In the analysis we said that this eye-watering total looked unlikely to be achieved. We were too conservative, the £10 billion over three years is almost exactly three-fifths of the £14.75 billion over five years.

Either this is a remarkable coincidence, incredibly prescient, or the Health Foundation report’s authors – the report was commissioned from PA — have been talking to and influencing the right people in Whitehall.

Even with the prospect of more investment than expected the key issue will remain how the money is prioritised, and while we don’t yet have the detail on this we have an initial outline.

What we do know is that the top priorities at the national level in health will be Wes Streeting’s new Single Patient Record, which as yet remains uncosted; further investment in the controversial Federated Data Platform; and doubling down on the NHS App as the online gateway to the NHS.

Further expansion of NHS App as NHS gateway

As Future Health Intelligence reported on 24 April even the current planned evolution of the NHS App looks set to squeeze patient messaging and booking services, as more of these services are channelled through the app.

There are still contracts being awarded for patient reminders and SMS like a new £570,000 contract awarded to DrDoctor by Manchester Mental Health NHS FT but this market looks set to disappear.

Population health market faces FDP pressures

Similarly, FDP is beginning to squeeze both providers of analytics services, as ICBs are mandated by NHSE to adopt new FDP modules for analytics. And last week saw announcements by Dr Vin Diwakar, director of digital transformation at NHSE, that population health tools developed by Graphnet working with Frimley and Cheshire and Merseyside are now to be replicated in FDP as new population health modules.

Population health looks like another area where the centre aims to assimilate existing suppliers and provide a single national solution using the FDP platform. Speaking at NHSConfedExpo Diwakar made clear that the plan is to develop further modules on the FDP Foundry Platform, which will put the squeeze of further segments.

SPR may next squeeze shared records providers

Turning to the SPR programme, although the official line is that no decisions have been taken and that a market engagement exercise will inform approach, the strong expectation is that key decisions have been taken to go for a new national platform – possibly as an extension of FDP. And that the preferred approach is to centralise and not build on the existing shared care records platforms in a truly federated architecture.

If this does prove to be the direction of travel it will represent seriously bad news for existing providers of installed shared care records solutions who risk seeing their UK shared records business disappear. Firms affected include: Graphnet, Orion, Better, Interweave, Intersystems and Oracle (exposed through its Cerner Health Integration Exchange platform).

Investment extremely good news for wide range of suppliers

For most suppliers and vendors operating in the NHS IT market the extra investment represents extremely good news and will help ensure a flow of procurements and contract awards, particularly for suppliers with products able to show a clear ROI and contribution to productivity improvements.

There is a strong push to ensure that AI solutions, particularly ambient scribing, will be prioritised. Though June NHSE guidance that directs trusts to only proceed with ambient solutions that comply with appropriate medical device regulatory requirements, points to the significant regulatory challenges still to be overcome.

The SR2025 also speaks of the vital need to make record capital investment in the crumbling NHS infrastructure, spanning buildings, medical equipment and tech infrastructure and networks.

Opportunities for health tech suppliers across SR25

Opportunities for tech suppliers working in health and care will also be created by investments announced in other parts of SR25.

Across the UK as a whole a £2 billion UK’s AI Opportunities Action Plan, which will include helping facilitate AI adoption in public services.

A further £1.9 billion is earmarked for investment in nationwide gigabit broadband (Building Digital UK) to improve connectivity. This will help address digital have-nots, supporting telehealth, remote monitoring, and digital health services, especially in rural or underserved areas.

In addition to the £10 billion committed to health and care a further £600m will be invested in Life Sciences in a new national service (with Welcome Trust & DSIT) to leverage health data for research and drug discovery, aiming to position the UK as a leader in health informatics innovation.

Conclusion

Delivery of SR25 still depends on the fragile state of the UK economy, buffeted by international events, political instability at home and facing significant structural weaknesses, but this is a historic, once in a generation, commitment to harnessing technology to modernise UK health and care.

Details are still needed, with more expected in the NHS 10-year plan expected in July, but SR25 will unquestionably have a major positive impact on the UK digital health market and offers real potential to fundamentally transform the delivery of UK health and care.

On 11 June Chancellor Rachel Reeves will announce the departmental budgets for 2025-26, and how much each department will get to the end of the Parliament in 2029.

What she announces for the NHS budget will be crucial in setting the level and scale of ambition for digitising health and social care to the end of the decade.

With extremely constrained public finances, slow growth and commitments to fund on defence, the NHS is likely to fare better than many other departments facing further cuts but still fall beneath historic budget growth.

Also expected in June is the NHS ten-year plan, which has been widely trailed as placing a decisive shift from analogue as central to ambitions to fix an NHS described as ‘broken’ by Secretary of State for Health Wes Streeting.

The ten-year plan’s three core themes, all reliant on digital:

• Shifting care out of hospitals
• Shifting from analogue to digital
• Moving to preventative care

How much will digitising health and care cost?

But what level of funding is needed to achieve these ambitious 10-year plan goals, while running a health service currently having to cut staff and services to contain deficits?

In May 2025 the Health Foundation published research commissioned from PA Consulting on how much it would cost to make the shift to a digital health and care system over the next five years.

According to research published by the Health Foundation, the cost would be a huge £ 21 billion over the next five years (£14.75 billion for England).

The research estimated that £8 billion of capital investment would be needed (£5 billion in England), £3 billion of one-off revenue spending (£2.25 billion in England), and £2 billion recurring annual revenue spending each year (£1.5 billion for England).

For one-off capital and non-recurring revenue, estimated by Health Foundation  (with additional £10 billion revenue over 5 years)

Table 1 – Summary of estimated one-off cost investments by theme for the UK (in 2024/25 real terms)

What is particularly helpful about the Health Foundation research is that it makes clear that investment is required over a broad range of market segments and themes to achieve the kind of digital shift envisaged by the government:

Foundational technical infrastructure

Core networks, infrastructure, software, hardware and data storage. They are not sexy areas for ministers to announce, but digital plans and AI ambitions will remain pipe dreams while junior doctors struggle to access basic hardware and have limited access to networks.

Ensuring all trusts have an up-to-date EPR in place

While we are approaching the end of the frontline digitisation goal of ensuring every provider organisation has an EPR, almost 50% currently have limited capabilities or may require replacement within the next 5 years.

A key part of the challenge is to avoid a Groundhog Day-like replacement of current legacy EPRs with newer versions of the same legacy EPRs from the same vendors, which are still primarily designed to serve one provider organisation rather than integrated health and care delivery across a community or region.

Digital social care records

Perennially the poor cousin to health on all things digital, there is a need for far stronger integration and data sharing between health and social care.

Corporate IT

The NHS is the largest employer in the UK and requires modern HR, finance, and enterprise systems, as well as knowledge management, productivity and collaboration tools. Corporate IT and non-clinical areas remain key to achieving productivity gains.

National platforms and programmes

Core national infrastructure for running the NHS: NHS spine, Summary Care Record, Electronic Prescription Service, as well as high political priority initiatives including the NHS App, the Federated Data Platform, and the planned new Single Patient Record.  In recent years, these high-profile initiatives have consumed a disproportionate amount of limited investment.

Conclusion: doubling of digital investment unlikely

The Health Foundation-commissioned PA Consulting eport is a helpful attempt to quantify the level of digital investment required the achieve the Government’s modernisation ambitions for the health service.

Assuming the figure of £ 21 billion over five years is broadly accurate, then this would require a near-doubling of total spend on health and care digitisation over the period.  This top-level figure seems extremely unlikely.

Future Health Intelligence estimates the current level of spend on digital, national and local, revenue and capital, across the UK NHS to be approximately £4 billion per year. The vast majority of this is already committed to existing services and investments.

The Department of Health and Social Care (DHSC) is clearly in a double bind. It seems extremely unlikely that the Government will be able to commit to a programme of additional investment in digital and data approaching £21 billion over the next five years. Yet without such strategic investment, the ambitions of the NHS 10-year plan will not be possible and the NHS will remain in perennial crisis.

Therefore, it seems obvious that the DHSC will have to prioritise investments, scale back, or drop cherished projects. It has already indicated that the three national priorities will be the politically championed Federated Data Platform, Single Patient Record and the NHS App. This could potentially be bad news for front-line investment in foundational infrastructure, EPR modernisation and optimisation, and digital social care if they are squeezed.

The unfortunate reality, though, is that a broad range of investments in digital themes are required in tandem. Initiatives like FDP and NHS App will fall far short of ambitions unless front-line infrastructure and systems are also brought up to scratch.

Final thoughts

Whatever Rachel Reeves announces on 11 June, seasoned industry observers will know that there is plenty of room for slip between lip and cup on whether pledged new investments are actually delivered as initially promised. A recurring hallmark of past ambitious digitisation plans is that promised investment has often been cut or diverted. In 2023 for instance, £700m was cut from the frontline digitisation fund.

Conversely, the NHS remains the highest priority for the Labour Government, which may yet prove bold on digital investment if we see improvements in the UK economy during the current Parliament. After all, it was a previous Labour Government that brought forward the £12 billion NHS National programme for IT in 2002, initially priced at a much more modest £6 billion.

As attention moves onto the proposed Single Patient Record, questions are once again being asked of the purpose, value and scope of its older sibling, the £330m Federated Data Platform. Future Health Intelligence’s Jon Hoeksma examines claims made on behalf of FDP.

As attention moves onto the proposed Single Patient Record, questions are again being asked about the purpose, value and scope of its older sibling: the £330m Federated Data Platform.

Reports that one of the largest hospital trusts in England has declined to take FDP modules, saying they would lose functionality they already have, beg further questions about the benefits being claimed for FDP.
In November 2023, Palantir was awarded a controversial deal for FDP, the follow-on project from the NHS Data Store used in the pandemic to track vaccinations and immunisation.
FDP was procured by NHSE England (NHSE) with the stated aim of supporting: elective recovery; care coordination; vaccination and immunisation; population health management; and supply chain management.

Details of claimed benefits from FDP remain limited

Despite being championed by NHS England and expected to feature strongly in the 10-year plan, there is so far little published data and evaluation of benefits, with reported benefits so far largely anecdotal.
However, the limited evidence of benefits or evaluation has so far not appeared to slow down the drumbeat for rapid roll-out.

FDP has already been mandated by NHS England as a standard data analytics platform for use by Integrated Care Boards, upon which a series of common applications can then be delivered. It’s unknown whether the FDP contract has any provision for Palantir to be paid less as the number of ICBs is halved.

All trusts have been told to plan to use FDP by Summer 2026

And although it has not yet been mandated for trusts, it is being strongly pushed by the senior leadership of NHSE. In August 2024 NHSE director of transformation Vin Diwakar wrote to all trusts and ICBs telling them they should prepare plans for how they plan to use FDP within two years.

FDP is now being further advocated by some, including influential consultants McKinsey, as the essential foundation for the planned Single Patient Record.

Roll-out began in 2023 in ICBs as an analytics tool. NHS England has subsequently told ICBs that they should decommission analytical tools other than FDP, which should become their default. This despite caution being urged by Marc Farr, chair of the Chief Analytical Officers Network, that FDP should be shown to deliver benefits before existing analytics tools in use are decommissioned.

FDP trust modules replicate functionality some trusts already have

More controversially, FDP has also moved on to target waiting lists and care co-ordination and discharge planning activity in trusts. In many cases seeking to replicate functionality and well-established tools already in use and provided by Electronic Patient Records and Patient Administration Systems.

While there has been a degree of scepticism of the value of FDP in provider trusts, and questions about what the purpose and ultimate ambition of FDP are, the prevailing attitude from trusts leaders is to try to make the most of the platform.

In December 2023 HSJ reported that five trusts piloting FDP modules disputed NHSE claims that they were ‘actively realising’ benefits.

Leeds declines to take FDP modules, saying they would ‘lose existing functionality’

But in what may prove a highly significant development one high profile trust has firmly pushed back on FDP, declining to replace existing functionality with unproven FDP modules. Professor Phil Wood, the CEO of one of the largest hospital trusts in England has written the NHSE director of transformation Vin Diwakar saying that adopting FDP modules would mean losing current functionality.

According to The Register, the chief executive and chief digital information officer of Leeds Teaching Hospitals Trust – have said the trust would lose functionality if it adopted the FDP for some of its use cases.

The Register quotes a letter from the trusts that says of the FDP Inpatient Care Coordination, Referral to Treatment and Optica (Optimised Patient Tracking and Intelligent Choices) modules, three of the main FDP tools trusts are being told to adopt, “We already have services within the trust that deliver outpatient care coordination, referral-to-treatment validation and discharge planning… From the descriptions we have of these FDP products we believe we would lose functionality rather than gain it by adopting them.”
The report, if confirmed, marks the first known instance of a trust declining to take FDP modules and questioning whether they offer sufficient functionality and benefits.

It also raises questions of whether other trusts have more quietly declined to take FDP modules, preferring to stick to existing proven capabilities.

DHSC says 50% of trusts signed up to use FDP

The Department of Health and Social Care (DHSC) says that of the 215 trusts in England 120 NHS trusts have so far signed up to use the FDP, including 84 percent of hospital trusts.

Of these, 72 are said to be live as part of a phased rollout to provide better care and services for patients.”

According to NHSE figures, 45 of England’s 215 hospital trusts were actively using Palantir’s Federated Data Platform (FDP) by the end of 2024.

NHSE pushing trusts to adopt four modules initially

The most widespread benefits are said to be waiting list and inpatient care co-ordination modules, followed by Referral to Treatment and Optica. Further modules are expected to follow these initial four.

Dorset, South London and North Cumbria are named as sites that have benefited from using FDP modules. But the details on benefits provided on the NHSE website are limited with no independent validation or evaluation.
“This functionality helps clinical teams identify which patient entries no longer need to be included and can be safely removed from the waiting list, ensuring that the correct patients receive the necessary care and attention,” says the NHS website

“This product also aids with theatre scheduling, ensuring that clinicians have the data they need to prioritise patients with the most urgent needs and book slots for surgery.”

Examples of benefits on the NHSE website cite some large numbers without qualifying or backing them up, raising a host of questions.

Care Coordination Module
For the FDP Care Coordination module, the NHSE website states that up to the end of December 2024, FDP resulted in 69,909 ‘additional patients undergoing procedures in theatres’, this figure is described as “a cumulative total of additional patients undergoing procedures in theatres by NHS trusts with the Inpatient Care Coordination Solution until end of December 2024, compared to the previous period without FDP use.”

Superficially, this big number sounds impressive. But is it? No supporting data is provided on whether other factors such as staffing levels, or elective recovery measures may have impacted the increased number of procedures, as they likely will have. The statement strongly applies the difference is all attributable to FDP.

Waiting List Management Module

For the FDP Waiting List Management module the NHSE website claims 207,122 “patients safely requested for removal from the waitlist”. Again, a large number, but what does it mean? How many patients were safely removed? How was the determination made they should be removed? How many would have been removed in a control group not using the FDP waiting list module? And has there been a proper assessment of the impact on patient safety?

Referral to Treatment Module

For the RTT module, described as “Increasing checks that the right actions have been taken along the patient’s care pathway, in line with NHS standards,” the website says 1,107,622 records were reviewed up to the end of December using the RTT product, with 271,838 removed from waiting lists ‘for a variety of reasons’. Again, the claimed benefits raises a host of questions.

Optica module

For the Optica product, possibly the most significant benefits are claimed. “18.8% decrease in average number of delay days for long stay patients after rolling out Optica.” How has this been calculated?

NHSE must publish evidence for FDP benefit claims and commission independent evaluation

In each instance, there is no indication that a rigorous evaluation has yet been carried out or supporting evidence to back claims published. FDP modules may be performing well or capable of delivering significant benefits to the NHS and patients, but the claims are being made so far lack rigour.

The benefits claimed also imply that FDP modules are being implemented into greenfield sites, which is clearly not the case. A more rigorous evaluation would need to take account of what trusts already do and show that FDP modules offer more than trusts have already.

As in the case of Leeds, the FDP modules described closely match capabilities already available in many trusts from existing local systems.

The unfortunate impression left from the NHSE website benefits claims is that the roll-out of FDP is an imperative irrespective of benefits first being shown to be achieved.

McKinsey recommends ‘spirited buy-in’ and forcing ‘FDP-first’ approach

No doubts about FDP from its management consultant supporters though. In a new article championing FDP McKinsey says “As rollout of the NHS Federated Data Platform (FDP) nears completion, it offers a transformative opportunity to improve performance and patient outcomes. Fulfilling this potential will need a coordinated focus on value by the NHS, and spirited buy-in from across the healthcare ecosystem.”

And if a ‘spirited buy-in’ doesn’t do the job McKinsey calls for NHS to be given no choice, “the NHS could also make clear that an ‘FDP-first’ approach is expected, with both explicit guidance and financial incentives for the removal of technical debt and a high bar for digital procurement not aligned to the FDP platform.

NHS England lists the following trusts as all getting benefits from using FDP:

Barts Health NHS Trust

Bolton NHS Foundation Trust

Chelsea and Westminster Hospital NHS Foundation Trust

Chesterfield Royal Hospital NHS Foundation Trust

Countess of Chester Hospital NHS Foundation Trust

Croydon Health Services NHS Trust

Dorset Healthcare University NHS Foundation Trust

East Suffolk and North Essex NHS Foundation Trust

East Sussex Healthcare NHS Trust

Gateshead Health NHS Foundation Trust

Great Western Hospitals NHS Foundation Trust

Hampshire Hospitals NHS Foundation Trust

Harrogate and District NHS Foundation Trust

Imperial College Healthcare NHS Trust

James Paget University Hospitals NHS Foundation Trust

Kettering General Hospital NHS Foundation Trust

Kingston Hospital NHS Foundation Trust

Lewisham and Greenwich NHS Trust

London North West University Healthcare NHS Trust

Medway NHS Foundation Trust

Mid Yorkshire Teaching NHS Trust

North Cumbria Integrated Care NHS Foundation Trust

North Tees and Hartlepool NHS Foundation Trust

Northampton General Hospital NHS Trust

Northumbria Healthcare NHS Foundation Trust

Royal Surrey County Hospital NHS Foundation Trust

Royal United Hospitals Bath NHS Foundation Trust

Salisbury NHS Foundation Trust

South Tees Hospitals NHS Foundation Trust

South Tyneside and Sunderland NHS Foundation Trust

Southport and Ormskirk Hospital NHS Trust

The Hillingdon Hospitals NHS Foundation Trust

The Newcastle Upon Tyne Hospitals NHS Foundation Trust

The Walton Centre NHS Foundation Trust

United Lincolnshire Hospitals NHS Trust

University Hospitals of Derby and Burton NHS Foundation Trust

University Hospitals of Leicester NHS Trust

University Hospitals of North Midlands NHS Trust

West Hertfordshire Teaching Hospitals NHS Trust

York and Scarborough Teaching Hospitals NHS Foundation Trust

ICBs set to lose responsibility for digital leadership and transformation

Newly published guidance on the current restructure of Integrated Care Boards (ICBs) says that they must relinquish their role on setting digital strategy locally to provider trusts.

The new guidance says that population health and analytics, making effective use of data and intelligence, will though remain a core function of streamlined ICBs, one that they must further develop.

And the ‘default tool’ they are directed to use for population health and analytics is the NHS Federated Data Platform, says the guidance.

ICBs have been directed to cut their running costs by 50% by the end of the year, which translates to approximately 12,500 job losses. They are also being directed to merge, with numbers likely to reduce from the current 42 to between 23 and 28.

The newly published Model Integrated Care Board – Blueprint v1.0 sets the priorities for ICBs to plans against. They must deliver plans for their restructure by the end of May

This cuts and consolidation process aims to create larger, more efficient bodies capable of overseeing care quality and managing services effectively but are primarily driven by cost-saving considerations.

Ministers have acknowledged that they had not assessed the impact of the proposed job cuts on service delivery in advance of making announcements on cuts.

The move is part of a wider cost cutting, ‘efficiency’, strategy to streamline NHS operations and eliminate overlapping roles between NHS England and the Department of Health and Social Care (DHSC).

ICBs to lose digital leadership role

On digital and technology leadership and transformation, the blueprint guidance says ICBs should “Transfer digital leadership to providers over time enabled by a national data and digital infrastructure”.

Shifting digital leadership back to provider trusts marks the end of an uncomfortable three-year period in which ICBs have been charged with formulating digital strategy across health and care communities but often lacked the staff or resources required.

In parts of the country ICBs have proved an important factor in driving collaborative procurements and convergence, but in others large provider trusts have retained a high degree of autonomy largely riding out the ICB period.

Primary Care IT to transfer out of ICBs

The loss of ICB digital influence will extend to primary care, which has been a core responsibility of ICBs inherited from their CCGs and Primary Care Trusts predecessors, dating back to 2002 (see below). On General Practice IT the guidance says, DHSC will “Explore options to transfer out of ICBs ensuring consistent offer.”

No further details are yet available on what this may mean but a new primary care IT framework is in the process of being developed.

This uncertainty risks further delaying already glacially slow efforts to open the primary care market to more competition.

It seems likely that policy makers may even be hoping that the combination of an expanded NHS App and planned new universal national digital patient record may provide a way to leapfrog the current market.

Population health remains core ICB function

While ICB functions on digital strategy and leadership are being shed the blueprint says they will retain population health and analytics as a core function and will be expected to invest in further developing.

“Using data and intelligence (including user feedback, partner insight, outcomes data, public health insight) to develop a deep and dynamic understanding of their local population and their needs and how these are likely to change over time.”

They will also be expected to evolve “Leveraging real-time data and predictive modelling to identify risk, understand variation, and direct resources where they will have the greatest impact (allocative efficiency).”

To enable ICB decisions to be guided by population health data and insights, ICBs will need to develop strong population health management approaches underpinned by robust data capability.

“This will need to include developing the capabilities to segment the population and stratify risk and build a person-level, longitudinal, linked dataset integrating local and national data sources alongside public and patient feedback,” says the guidance.

Federated Data Platform by Default

Data can be integrated reliably between services to provide real-time, accurate data enabling better decision-making and interoperability. ICBs are directed to use the Federated Data Platform to achieve this.

The guidance unequivocally states: “NHS Federated Data Platform (FDP) will be crucial to enable this work and should be used as the default tool by ICBs.”

The direction to use FDP further entrenches the monopoly position being created before FDP has proven its value beyond small pilots, with other suppliers of pop health and analytics tools facing being squeezed

ICB shaped hole will hamper NHS 10-year plan

The need for a community-focused commissioner of health services, and at times provider of local primary and community services, with a remit for population health, planning, workforce, community engagement, has been a consistent theme of NHS policy since at least 2002.

Although ICBs are currently being drastically reduced in number, headcount and responsibilities, the need for local organisations planning and commissioning health and care at the level of coherent natural sub-regional communities, looks to be key requirement to deliver the aspirations of the ten-year plan.

The current immolation of ICBs to address NHS deficits may be followed by a rediscovery of their need to deliver plans for shifting care into the community, and patients taking greater control of their health, underpinned by technology, data and digital services.

Timeline of ICBS and predecessors

Primary Care Trusts (PCTs)

Created: 1 April 2002
Operated: 2002 – 31 March 2013
Disbanded: 31 March 2013

• PCTs were established under the Health and Social Care Act 2001.
• They were responsible for commissioning primary, community and secondary care from providers.
• By 2006, there were 152 PCTs across England.
• PCTs were abolished as part of the Health and Social Care Act 2012, with their responsibilities transferred to newly created CCGs.

Clinical Commissioning Groups (CCGs)

Created (statutory): 1 April 2013
Operated: 2013 – 30 June 2022
Disbanded: 30 June 2022

• CCGs were introduced under the Health and Social Care Act 2012, replacing PCTs.
• They were clinically led organisations, responsible for commissioning most NHS services, including hospital and community care.
• At their peak, there were around 211 CCGs, later reduced through mergers to around 106 by 2021.
• CCGs were abolished when the Health and Care Act 2022 came into force.

Integrated Care Boards (ICBs)

Created (statutory): 1 July 2022
Operating: 1 July 2022 – Present
• ICBs were established under the Health and Care Act 2022 as part of wider Integrated Care Systems (ICSs).
• They took over the commissioning responsibilities from CCGs.
• ICBs are designed to bring NHS organisations and local authorities together in formal partnership to improve health outcomes and reduce health inequalities across a defined geographic area.
• There are currently 42 ICBs in England.

Market implications for the expansion of the NHS App

Future Health Intelligence’s Jon Hoeksma examines how the rise of the NHS App is set to disrupt the NHS IT market, squeeze some suppliers and require others to reinvent themselves or see their business model disappear.

Policy makers have long had ambitions for the NHS App to become the digital front door for the NHS, in recent months, these plans have evolved to focus on the App becoming the transactional hub for a wide range of NHS digital services.

The NHS App is one of three key platforms the 10-year NHS plan is expected to focus on, the others being the controversial Federated Data Platform and the proposed Digital Patient Record. Each of the three has significant potential to disrupt the NHS IT market and displace or supplant current suppliers.

All EPRs to be integrated into NHS App within 12 months

Increasingly, the vision is for the NHS App to connect directly to Electronic Patient Record systems as used in hospitals, mental health and primary care, thus removing the need for middleware providers who have previously managed the interfacing and interoperability problems.

In March, speaking at Rewired25, the national lead on the NHS App, Milton Keynes University Hospital NHS FT CEO Joe Harrison, announced that even EPR hold-outs like Epic would be connected to the NHS App, with all EPR providers expected to be linked within 12-months.

Usage of the App has accelerated doubling from 25m a month in March 2024 to 50m log-ins a month. The goal is to hit 100m a month in 2026.

Patient communications to be channelled through NHS App

The aim is to ensure direct EPR integrations with the NHS App will be used for booking all inpatient and outpatient appointments, disintermediating current appointment booking services.

In January 2025 the Government set the target for 70% of elective appointments to be viewable through the NHS App by March 2026.

The same blueprint exists for patient messaging and communications, including SMS, email and snail mail, to secure messaging channelled through the NHS App.
A £1m of savings on messaging platforms by switching from to messaging through the NHS App is one of the savings NHS England attributes to the App.

NHS App messaging services free to NHS

It may lack the functionality and integrations of commercial products but under a programme called NHS Notify NHS App messaging is free to NHS organisations. https://notify.nhs.uk/, and trusts are starting to be pushed hard to adopt.

This pressure to channel services through the App creates a very significant challenge for the diverse range of service providers who currently provide a variety of middleware and intermediary services, based around services connecting patients to NHS services to providers. They now risk seeing their traditional market quickly disappear.

The areas covered include: patient appointment booking, appointment reminders, patient messaging, patient portals, and patient engagement platforms.

Patient messaging and booking providers need to reinvent themselves

Many of these specialist service provider companies will have to rapidly reinvent their proposition, such as moving further into clinical workflows, or risk being squashed by the NHS App juggernaut.

And some of the leaders in the space are already feeling the effects of the squeeze, and the pendulum swing back away from digital patient communications (while GP telephone consultations have exploded, video consultations remain a tiny percentage of the total) following the end of the pandemic.

Induction Health, a warning tale of disappearing markets

One notable example is Induction Health, which had been a leader in patient messaging, video consultations and appointment booking tools, through its acquisitions of Zesty (2020) and Attend Anywhere (2021), but Induction has seen its AIM share price languish post-pandemic.

In April the Induction Board recommended shareholders accept a knockdown offer by Canadian software group VitalHub of just £9.7m for the business, less than annual turnover. The bargain price was largely due to fast declining revenues and a disappearing market.

Ironically, a key client for the Zesty appointment booking software business had been Milton Keynes NHS FT, led by Joe Harrison, pioneering exactly the kinds of services now being channelled through the NHS App.

Other suppliers risk being squeezed too

Other suppliers who may feel the squeeze include DrDoctor, who despite having repositioned themselves as a clinical transformation business with AI workflows, still have a core product set of scheduling, communication, video consultation and appointment booking tools.

Similarly, AccuRx, which enjoyed huge growth thanks to its SMS vaccine appointment and patient booking and messaging tools, could yet face a major challenge if the NHS App absorbs these kinds of messaging services and functions.

Healthcare Communications, part of Cisco Webex, is a further patient SMS messaging provider likely to be impacted.

Looking at the Personal Health Record space, meanwhile, specialists like Patient Know Best may also eventually feel the heat. To date, they have been agile and were one of the first providers to connect to the NHS App. Their products spanning patient portals and PHRs

But PHR services may come into the sights of the NHS App, particularly alongside the new Digital Patient Record, expected to be proposed by the Digital and Data group feeding into the NHS 10-year plan.

The position for patient engagement portal providers also looks uncertain. In the last few years NHSE policy has been to encourage local investment in PEP platforms to enable patients to get speedier access to test results and book appointments. Local investments have been channelled through the Elective Recovery Fund and Frontline Digitisation.

Patient portals may also be disintermediated by NHS App

But here again the direction of travel now appears to be towards the NHS App as the default point of access. NHS England has already integrated many hospital patient portals with the NHS App via a feature called NHS App ‘Wayfinder’.

Speaking at Rewired25 Harrison told NHS service providers to get aboard the NHS App train: “If you’re not connected to the NHS App, we will move on without you,” Harrison warned, describing it as “now the most comprehensive and most used patient engagement tool in the world”.

A total of 99.7% of all GP practices are now connected to the app, and 82% of acute trusts, with 100% expected to be connected by next March
“There are no excuses if you’re an NHS provider, or you’re in primary care and you’re spending money on text messages,” reported Digital Health News.
“There are no excuses for organisations to be inefficient and using other ways of recording data for our citizens.”

NHS App likely to remain top of agenda

Is this a message likely to cut through the NHS? Well, the central role for the NHS App has already been made clear byWes Streeting, Secretary of State for Health and Care.
And if that wasn’t enough, the new permanent Secretary at DHSC has just been announced as Samantha Jones, who just happens to be married to NHS App boss Joe Harrison.

Future Health Intelligence’s Jon Hoeksma analyses the likely impact of the abolition of NHSE will be, examining the potential impact on specific programmes and services currently provided.

The March announcement that NHS England is to be abolished, with roughly half of its 14,500 staff to go as its functions are taken over by the Department of Health and Social Care (DHSC), raises very significant questions for the NHS IT market, the future pace of digital plans and future delivery of national services.

NHSE plays a pivotal role on digital and data

In the digital domain NHS England, since taking over NHS Digital in 2023, plays a critical role in delivering national initiatives like the NHS App and Federated Data Platform, and core digital services like Spine. It oversees national data collections spanning operations, management and research and reporting.

Further areas include standards, certification and clinical safety.  The list is long and diverse. NHSE also critically funds and manages the front-line digitisation programme, cyber security, training and a wide range of other programmes big and small.

All of these are thrown into uncertainty, with the likelihood that in many cases entire functions, programmes and teams will be outsourced, disbanded, axed or devolved to trusts and future merged

NHSE abolition creates huge new uncertainty

The most immediate concern is the high degree of uncertainty that the radical restructure, due to take two years to complete, will cause for digital and data programmes and functions across the NHS.

The abolition of NHSE, 50% job cuts, shift of some responsibilities to DHSC; and accompanying 50% reduction of headcounts in ICBs, in turn triggering almost inevitable mergers, creates a perfect storm for uncertainty. The changes will create a cascade effect of disruption, with the impact rippling out to all parts of the NHS.

From this vantage point is almost impossible to see how the changes will not initially significantly slow and delay the government’s planned tilt to digital for the NHS over the next few years.

What functions, programmes and teams will continue?

One key question is what functions and programmes will be axed and what will remain in the new organisation? This analysis article offers some initial erly thoughts.

NHS England had barely completed the painful takeover of NHS Digital and Health Education England in February 2023, and completing 7,000 job cuts, before the latest announcements.

Most of the NHS Digital staff transferred to the NHS England Transformation, which before latest cuts was thought to have approximately 5,000 staff.

Examining what may stay or go

It’s worth examining in more detail what the NHSE Transformation Directorate does currently and whether it’s likely to continue to do so in the future:

Patient facing services

NHS App
The NHS App remains the flagship digital front door to the NHS for patients to access core health services, including GP appointments, prescription ordering, viewing medical records, NHS 111 integration, organ donation, and COVID Pass.

It features prominently in the draft NHS 10-year plan, is core to the tilt to digital and patient empowerment. However, there is significant duplication and overlap with NHS11 and NHS.uk that offer scope for rationalisation.

Future Health Prediction: NHS APP will survive and move to DHSC (possibly to be merged with NHS.uk website and NHS 111)

NHS.uk Website
The national website for health advice, service finder tools, and public health information, including trusted health content, symptom checkers, and service directories.

Future Health Prediction: NHS.uk will survive and move to DHSC (possibly to be merged with NHS.uk website and NHS 111)

NHS 111 Online
The digital counterpart to the telephone-based 111 service, and linked to NHS.uk, with features including symptom assessment, triage, onward referrals to A&E, urgent treatment centres, and pharmacy.

Future Health Prediction: uncertain and may be merged with NHS App or could even be a candidate to be outsourced as lots of good commercial symptom checker services now available

Clinician-Facing Services

Spine
The central infrastructure supporting core NHS services in England, which comprises a series of sub-components:

Summary Care Record (SCR), Electronic Prescription Service (EPS), NHS Number Lookup, Patient Demographics Service

Future Health Prediction: Spine services will likely be maintained as core NHS infrastructure and transfer across to DHSC. A more radical vision of the digital and data role of the centre would be to give PDS and identity assurance a more central role.

e-Referral Service (e-RS)
Previously called Choose and Book e-RS is the Digital platform for booking referrals from primary to secondary care. The service plays a key part in plans for elective recovery and patient choice agenda. However, critics point out that some of the service delivery is fiction and subject to wasteful gaming, such as some hospitals cancelling all e-RS appointments only to rebook them.

Future Health Prediction: Wes Streeting has become the latest Health Secretary to alight on ‘choice’ as a key principle, suggesting choice of appointments could be offered through the NHS App. e-RS will survive, though likely with a further name change.

Market management and procurement

GP IT Futures
The long-running framework intended to modernise and open up the GP tech market beyond legacy suppliers to approved GP clinical systems and digital tools. Objectively, it has failed to achieve its aims and a duopoly of Optum (EMIS) and TPP still dominates, but there may finally be the first shoots of new entrants in the market.

Future Health Prediction: Will transfer to DHSC in some guise and continue to prove glacially slow.

Frontline digitisation
The programme to support and fund trusts in digitising by putting in place EPRs has nearly run its natural course, with over 95% of trusts now with EPRs in place or contracted. NHSE provides a mix of business case support, attempts to manage the market and steer business cases towards convergence on favoured suppliers. The programme is less than opaque.

Future Health Prediction: There is a strong argument for simply disbanding frontline digitisation team now it has achieved its goal. However, FHI understands that NHSE has been proposing that it morph into a large EPR optimisation programme, rumoured to be budgeted at up to £4 billion. This yet to be launched programme looks vulnerable when the NHS is looking for national savings.

However, the ten-year plan digital and data working group has also suggested that the way to digitise more effectively is to centralise procurements. If the centralising strand prevails, this will likely become a core new digital functional programme within DHSC.

Data, Records & Analytics Infrastructure

Summary Care Record (SCR – part of Spine)
The long-running national summary record of key patient information available across care settings, providing details of medications, allergies and adverse reactions.

Future Health Prediction: The long-running SCR, which has been in use for almost for almost two decades, may yet prove a victim of the next 10-year plan, which seems likely to advocate new Digital Care Records, which may or may not be built on current foundations.

Shared Care Records (via LHCRs and LCRs)
Shared Care Records, previously local health and care records, have largely been regionally driven, managed and sustained, with a tiny amount of support from NHS England to support areas like integration. They provide the best example of interoperability between primary, secondary, community, and social care.

Future Health Prediction: Although LHCR has proved an unquestioned success, it has scant investment from NHSE in recent years. Local Care Records may yet prove a victim of the next 10-year plan, which seems likely to advocate new Digital Care Records, or they could yet be identified as the foundations on which to build.

Federated Data Platform (FDP)
The controversial flagship £500m programme intended to secure, federated use of operational and care data across ICSs, which has proved a lightning rod for privacy and ethics campaigners due to the lack of clarity on purpose and central role of Palantir.

Future Health Prediction: FDP has to date had sufficient top-level political support to ride out any restructure, indeed it may well pick up further momentum as a result of the restructure, but the vaunted claims to provide an operating system for the NHS have not been matched by delivery and with the downgrading of ICSs (ostensibly the intended customers) it’s even less clear what the purpose and value are.

The news that Ming Tang, NHSE lead on FDP, has been appointed interim CDIO at NHSE means the FDP looks secure.

NHSmail
The national secure email system for NHS and social care, commissioned by NHS England and run by Accenture.

Future Health Prediction: The NHS remains ever more tightly bound to Microsoft; the ubiquitous adoption of Teams has left it even more dependent.  This means this will continue. But a more radical restructure of NHS IT might ask, does the NHS need a centrally run email system that ties it in ever closer to Microsoft?

Data collections

Following the abolition of the NHS Digital NHS England inherited responsibility for being the statutory custodian for health and care data for England, responsible for over 200 data collections, including Hospital Episode Statistics and other core NHS data.

This is one of the largest areas of activity that could potentially be outsourced.

Future Health Predictions: Data collection and analysis may be the area that sees the most radical shake up from the NHSE Transformation Directorate portfolio. The FDP may pick up significant expansion opportunities.

In the first of a series of short market analysis snapshots from Future Health Intelligence, Jon Hoeksma briefly examines the digital priorities in the new NHS England Priorities and Planning Guidance 2025-26

The new Priorities and Planning Guidance from NHS England is probably best thought of as a holding position when it comes to digital, with NHS App, Federated Data Platform and EPRs forming a familiar trinity of digital priorities.

More details are expected to follow when the ten-year plan is published later in the Spring. The ten-year plan has a dedicated workstream four on digital and data, co-chaired by Ming Tang, NHSE director of data and Tim Ferris, former head of transformation at NHSE.

The specific priorities and guidance on digital are limited. Still, the need for wider use of digital is at least implied throughout the document at key points, including for enabling greater patient self-care and shift of services into the community, without a lot of detail yet on how.

The top priority is around driving use of the NHS App

Providers must communicate to patients through NHS App and the NHS App messaging service.  Similarly, all GP practices are expected to enable all core NHS App capabilities.  These include health record access, online consultations, appointment management, prescriptions management, online registration, and patient messaging.

Achieving these shifts in patient communications and services would represent a very significant move to making the NHS App the digital front door of the NHS.

This could represent bad news for patient communication firms like AccuRX and DoctorDoctor, but potentially good news for patient engagement platfoms that were early to integrate to the NHSApp like Patients Know Best.

But this ambition has to be tempered by recent history, which has seen a very slow evolution of the NHS App.  Since the end of the pandemic there has been a pattern of policy confusion and false starts.   As recently as December it was touted by Health Secretary Wes Streeting as the tool to deliver patient choice ambitions.

There is no doubting the policy ambition to make the NHS App a central pillar of NHS services, but continued confusion over what this means in practice and priorities.

The second main digital focus in the guidance is further pushing adoption of Federated Data Platform (FDP)

The guidance states: “all systems [must] adhere to the ‘Federated Data Platform (FDP) First’ policy, connecting their own digital and data infrastructure to the FDP. NHS England will support adoption of the FDP to 85% of all secondary care trusts by March 2026”.

While most NHS digital leaders appear committed to making the most of the FDP and using the available capabilities, some even being enthusiastic, it remains unclear what the ultimate objectives of NHSE’s strategic digital project are.   Is it primarily about management and operational data and reporting or is the aim to create a single operating system for the NHS.

Key questions remain around what data is to be connected, with GP data so far remaining outside scope.

Originally promoted as a data store to enable much easier direct reporting on activity, vaccinations and other operational data, it has since expanded to include a range of clinical applications including reducing cancer pathways and targeting waiting lists.  During the course of 2024 ambitions appeared to further extend into becoming a form of patient record and interfacing directly with core EPR systems and population health.

The FDP proposition continues to evolve, as it does so it could potentially challenge a range of suppliers of Business Intelligence, Analytics and Population health Management tools.  Potentially it could even prove a challenge for shared records providers.  Watch this space.

With FDP’s key champion Ming Tang co-chairing the digital working group for the ten-year plan FDP looks set to remain centre stage on NHS digital priorities for some while to come.

The third area highlighted is to continue provider digitisation focusing on EPRs

The guidance states that planned electronic patient record (EPR) system procurements and upgrades should continue, and all trusts without an EPR should continue to work to procure and implement one as quickly as is safely possible.

This is very much in line with existing policy and all the indications are that the drive from NHSE remains towards convergence, steering procurements into collaborative shared EPRs where possible.

The presence of Dr Tim Ferris, widely thought to favour premium integrated EPR systems, as co-chair of the digital working group of the 10-year plan strongly suggests that NHSE will continue to favour high-end EPR solutions.  This would appear to be good news for leading integrated EPR suppliers including Epic and Oracle, but bad news for suppliers such as Daedalus with less tightly integrated and functionally rich EPR offerings.

Further priorities that get a mention in the guidance are

• all providers deploy the Electronic Prescription Service wherever possible
• all providers integrate systems with the NHS e-Referral Service
• all providers achieve and maintain compliance with the NHS Multi-Factor Authentication Policy and act to strengthen their cyber security
• all systems mitigate against digital exclusion, including by implementing the framework for NHS action on digital inclusion

The new Guidance is published following the rapid Darzi Review published in September 2024, but in advance of what is anticipated to be a more substantial 10-year NHS Plan currently being drawn up and expected in the Spring.

Jon Hoeksma, Future Health Intelligence