NHS digital ambition needs reality check amid frontline work pressures

All change but little progress

“We’re a little way into that plan now, and I don’t see an awful lot of change happening,” said Micklewright.

He believes part of the issue is the structural change taking place, both at central and local integrated care board (ICB) level.

In March 2025, prime minister Keir Starmer announced he would scrap what he called “the world’s biggest quango”, namely NHS England, to take back democratic control of the NHS.

The NHS, particularly those services responsible for technology delivery, has been fraught with confusion over responsibilities, leadership and a lack of structural consistency for years. 

Integrated care partnerships (ICPs), overseen by their statutory bodies, were officially introduced in 2022 as part of the Health and Care Act.

There are currently 42 ICBs across England, however, as part of the government’s 10-year plan, these will face up to 50% cuts to operating costs, and are expected to merge into fewer, larger regional entities.

Micklewright said that while the strategy says the “ambition is for digital leadership to move out of the ICBs eventually and take place at the more regional blueprint, no one has said what digital leadership looks like across the whole demographic, how they would work with all of the hospitals and the thousands of GPs that would sit in a region”.

He added that ICBs have been told to shrink down and do “less of the digital stuff”, but that there is nowhere for them to hand it over to.

The money pot

There is also an issue of funding, and where money is being spent, alongside the lack of direction for digital and regional NHS leaders. “All of that confusion has significantly slowed down efforts,” said Micklewright.

“We can’t just keep throwing money at a problem,” he said. “We need to get really smart about how that money is getting used, and maybe shift it so the money is not being invested in new innovation, but in the new adoption efforts.”

The 2025 Budget promised £300m additional capital investment in NHS technology, but concerns have been raised that the funding is too focused on projects and platforms that have already been centrally approved by the government, rather than fixing a crumbling infrastructure.

Analysis of the budget by the NHS Confederation found that while the technology capital is intended to deliver 2% productivity growth each year of the Spending Review period, the announcement was too focused on already-approved programmes, such as the NHS App and the roll-out of the Federated Data Platform.

Micklewright agreed with this sentiment, adding that he has not spoken to any healthcare organisation that feels the money is enough to keep the status quo, “let alone take some really big gambles in terms of how you’re delivering”.

He feels that the funding is more covering the “low-hanging fruit” and is all about the “sexy headlines”.

“Being able to say there’s a new AI health advisor on your app you can access for quick advice is a quick win,” said Micklewright. “It’s one team, one procurement, and you get the product out there. The hard work and the real work is galvanising and demonstrating leadership across a really broad, demoralised workforce and trying to address those things.

“Things like trust, education, training, what digital leadership looks like? They’re really thorny questions.”

As an example, Micklewright pointed to the Ambient Voice Technology (AVT) supplier registry published by NHS England in February 2026. The list is a national self-certified registry of AVT suppliers available to support and accelerate local procurement.

“We’ve been waiting for that for about six to nine months. Last summer, our digital team was saying, ‘Should we do our own framework around AVT or wait for NHS England?’” he said, adding that he was glad they did their own, because the framework they were envisioning from NHS England was far from reality.

“When it finally came out, it’s not really offering any governance, assurance or trust,” said Micklewright. “It’s a self-assessment process, and then you go on there and nobody checks you, nobody makes sure you remain compliant even as your product updates. Local organisations still have to go through the effort of doing their own due diligence, assessments and assurance work.

“We want a catalogue, and someone to say everything in that catalogue is safe and approved for you to use,” he added. “And every time those products change or update, we want them to say, ‘Don’t worry, because we’re going to make sure it’s still safe and appropriate.”

Micklewright also highlighted the issue with governance and assurance around digital products in the NHS. The health tech market in the UK is filled to the brim with innovative companies, desperate to get a foothold in the NHS and help it achieve its ambition. However, according to Micklewright, this is difficult to do.

“We are haemorrhaging small businesses in the digital sector because they can’t get into the NHS,” he said. “We’ve spent hundreds of thousands of pounds on innovation accelerators in the entrepreneur programme.

“And by the time they’ve got really, really great products, we’re incapable of approving and adopting them at scale. So, either they just fold, or they move to the US. There’s a huge brain drain.”

New GP contract

Primary care is central to the NHS’s ambition to deliver more preventative, community-based care, but resources are scarce.

GPs face increasing expectations, including expanded digital access and population health management responsibilities, without corresponding increases in funding or capacity.

At the same time, the latest GP contract, which will come into force in April 2026, was pushed through without without full negotiation with the profession, risking disengagement from the very people tasked with delivering.

“You can’t deliver this plan without general practice, but they’re not being brought into the design of it in a meaningful way,” said Micklewright.

“They’ve imposed the contract on general practice. That is not the way to win around a professional group to deliver your ambitions.”