Research and analysis

Chapter 5: the 3 shifts - analogue to digital

Published 17 December 2025

Applies to England

Summary of findings in this chapter

Both the public and staff support the shift from analogue to digital in principle. Both audiences recognise the impact poor technology has on patient care and staff experience at work - addressing this feels essential.

Staff - and to a lesser extent the public - see the shift to digital as vital to achieve the shifts to community and prevention. Both audiences feel that better technology will contribute to a more integrated health and care service where collaboration is easier. Staff and the public see this collaboration as essential for increasing work in the community and the focus on prevention.

Staff and the public prioritise addressing ‘the basics’. This includes shared interoperable systems, a single patient record and up-to-date equipment. Prioritising the basics is a matter of credibility. Without establishing foundational technology, the widespread implementation of advanced technology such as artificial intelligence (AI) does not feel realistic.

Staff’s most significant concern is implementation due to scepticism about whether there will be sufficient funding and capacity within the workforce to deliver the shift. This is reinforced by a perceived poor track record of delivering complex technological programmes.

Greater use of innovative technology is divisive among the public and can feel like a leap in the dark. The public are divided about the extent to which they feel comfortable with AI being used in the NHS. Staff are more open to the use of AI than the public but still have reservations about how it might impact human-centred care.

This scepticism among the public of more innovative technology is in tension with their priorities for the NHS as a whole. While the public overwhelmingly say they want to prioritise access, the technological tools that might ease access challenges, such as virtual GP appointments and an AI healthcare assistant, raise significant concerns about losing the ‘human touch’ in healthcare.

Both the public and staff feel there is a need to maintain high-quality non-digital options. Both audiences have concerns about digital exclusion making a more technologically driven NHS harder to access for certain groups. The public also emphasise the importance of choice for all patients, hoping and expecting that everyone will have access to face-to-face appointments if they would prefer them, not just digitally disengaged populations.

5.1 Benefits of making better use of technology

The main benefits of the shift to technology were largely consistent among public and staff. All were excited by its potential to improve access and enhance quality of care by supporting more co-ordinated care across the health and care system, particularly through a single patient record, and by supporting staff to focus more on patient care and less on administration.

On the Change NHS website, we asked participants an open text question about the ways in which they felt technology could improve health and care. Benefits related to integrating patient data were raised most commonly (by 3 in 10 participants on the Change NHS website), and the potential for technology to facilitate quicker and more effective diagnostic testing was raised by around 1 in 7 (14%). These benefits also came out strongly through the nationally representative survey.

Figure 12: chart showing the main ways in which public participants on the Change NHS website see technology improving health and care

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘In what ways, if any, do you think that technology could be used to improve health and care?’

	Percentage
Improvements to data management or integrated patient data	30%
Enhance testing, screening or diagnostic capabilities	14%
Streamlined administration, improved efficiency or less paperwork	13%
Interoperability, or joined-up, compatible or universal IT systems	13%
Improve care co-ordination or communication between departments	11%

Base: all those who answered this question in the ‘Start here’ survey (number equals 66,623). The survey was live between 21 October 2024 and 14 April 2025.

Figure 13: chart showing the main ways in which technology could improve health and care in the nationally representative survey

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following do you think represent the biggest opportunities for improving health and care?’

	Percentage
Improving testing and diagnostic capabilities to detect illness earlier	50%
A single electronic patient record to help care feel more joined up	38%
Making administrative processes more efficient	34%
Improving the overall quality and accuracy of care	31%
More effective allocation of resources, reducing waste	30%
The NHS introducing a universal IT system	30%
More effective appointment booking systems	26%
Enabling more and better analysis of data to support research and innovation	15%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 12 and 17 December 2024.

Staff were able to identify a wider range of benefits than the public unprompted, and to be more specific about how they expected those benefits to materialise. For example, they discussed how the shift could improve workforce productivity and empower patients to take ownership over their health. Although the public were less likely to identify these additional benefits unprompted, when prompted they often agreed that they were likely to be positive outcomes of the shift.

Supporting the integration of the health and care system, making care feel more co-ordinated and holistic 

Across all strands of engagement, participants expected that the shift to digital would make it easier for frontline staff to access patient information in a timely manner, avoid the need for patients to re-tell their symptoms or medical history, and improve the ability of services to collaborate with one another. They expected the shift would do this in 2 ways:

• shared, interoperable systems across the health and care system, regardless of organisation or location
• a single patient record bringing together primary, secondary, dental and social care data

All systems need to talk to each other. The dentist, hospitals and GP need to automatically update your medical records. It took the GP 5 weeks to update my records. It needs to be immediate.

(Public deliberative event participant, North East and Yorkshire)

A selection of ideas for change shared on the theme of technology facilitating more joined-up care

All NHS & Social [Care] services should use the same IT systems to ensure that there is a joined-up network. Patients have to continuously repeat the same information to numerous professionals, which can often be traumatising. It is also not appropriate for elderly patients, people who are neurodiverse or who have mental health issues to be relied upon to provide information about their past or present health and social care.

(Public Change NHS website participant)

Every medical service in the UK MUST have access to patient records. If the bank can do it, so should the NHS.

(Public Change NHS website participant)

A single EPR (electronic patient record) system across the whole NHS is an obvious enabler of efficient and effective patient care. At the present time each NHS Trust selects its own, resulting in a patchwork quilt of systems that can’t talk to each other.

(Staff Change NHS website participant)

Public and staff participants across all strands of engagement, as well as partner organisations, expected that this integration would make care feel more co-ordinated and efficient, addressing one of the public’s most important challenges when using the NHS. In the community engagement, this benefit was particularly important for a range of seldom heard audiences and all stated that having to retell their medical history is not only frustrating and tiring, but also sometimes traumatising. 

The basic information asked for repeatedly is reliving trauma. We’re going through it over and over again at each GP or hospital visit.

(Community engagement, people with experience of homelessness)

Staff and public participants who used the NHS more frequently also expected that staff having easier access to patient records would promote a sense of patient safety and confidence in their care. Staff in the deliberative events shared stories where risk is introduced to patient care due to having to rely on patients’ own account of their medical history. This was reflected by participants with multiple or long-term health conditions in the deliberative events, and LGBTQIA+ people and those with experience of maternity and cancer services in the community engagement, who described feeling frustration, and sometimes fear, when healthcare professionals do not have access to the correct information.

One participant recounted a holiday in Devon when she had an accident and was taken to hospital. Staff there had no idea she had cancer and were asking her difficult questions about her chemotherapy drugs and dosages, to which she didn’t know the answer.

(Community engagement, people with experience of cancer)

Less commonly, several groups hoped that a more integrated NHS would facilitate more holistic care. This view was expressed by staff, public participants with one or multiple long-term health conditions in the deliberative events, and those with experience of cancer services and experience of homelessness in the community engagement. Staff in the deliberative and online events hoped that technology would help break down established silos between teams, promoting communication and genuine collaboration. Patients hoped staff would see them as a ‘whole person’, which would improve the quality of care they receive.

Finally, staff and health system leaders hoped that a more integrated service would enable them to work more productively and give them more time to care for patients. They expected to no longer have to spend time calling another service to access patient information, nor potentially duplicating work when entering patient information to make a referral. Although not a prominent benefit for public audiences, after considering the evidence, participants in the deliberative events and community engagement agreed that this was an important potential benefit. 

[An integrated service would help because] All tasks [would be] made easier because I’ve got all the information I need to make important clinical decisions rather than having to spend ages trawling through lots of other places, records or systems to find it.

(Staff deliberative event participant, North West)

The benefit of supporting integration across the NHS and social care meant that staff and, to a lesser extent, public participants in the deliberative events saw this shift as essential to delivering the other 2. For example, staff in the deliberative events said that if more staff will be working in the community, then it is important they are able to access the same information as colleagues in secondary care so nothing is missed. This benefit is explored further in chapter 4.

Improving access to the NHS

Across the engagement, participants expected the shift to digital to improve access in 4 ways:

• improving and supporting different ways of accessing the NHS
• helping manage demand on the system
• improving the experience of waiting through clearer communication
• contributing to faster diagnostic testing

Firstly, the public, staff and partner organisations expected the shift to digital to improve remote access to the NHS - for example through the NHS App, virtual appointments and online pharmacies. Participants in the public deliberative events and on the Change NHS website, and partner organisations, recognised this could reduce waiting times and give patients more control over how to access care. For example, more than 3 in 5 (62%) participants on the Change NHS website said they would be happy speaking to a healthcare professional through a digital appointment (outside of a GP surgery or hospital) and the same proportion (62%) said they would support the NHS App becoming their main way of accessing NHS services and information.

Giving patients more control over how they access care was particularly important to several seldom heard audiences in the community engagement. For example, participants in the children and young people workshop felt virtual appointments would avoid time out of school, those with learning disabilities and/or autism said remote appointments would avoid them having to enter busy and overstimulating environments, and those in the Gypsy, Roma and Traveller community said they could enable easier access for those with no fixed address.

Offering digital alternatives such as symptom tracking apps or video consultations helps autistic individuals avoid busy, noisy and overstimulating healthcare environments like waiting rooms or hospital corridors.

(Community engagement, people with learning disabilities and/or autism)

Secondly, NHS staff, particularly those working in administrative or managerial roles, expected technology would support triage and resource allocation. This in turn would enable the NHS to better manage demand and reduce waiting times. This expectation was shared by public participants on the Change NHS website and in the deliberative events, who hoped the shift would lead to improved booking systems and appointment management - for example, the ability to book an appointment in advance rather than call up on the day. These participants felt this change would give them greater control over how to manage their care.

I’d like to be able to have a virtual appointment or an appointment on a particular day and be able to pre-book it. At the moment, I don’t know if it’s the postcode, but if you don’t sit on the phone for an hour, you can’t see a doctor.

(Public deliberative event participant, South East)

A selection of ideas for change shared on the theme of technology improving access to the NHS

Create an online booking system for booking GP appointments (with various categories), nurse appointments (with various categories), referral self-booking etc. Most things are not urgent, people just have to make urgent appointments because it is the only option.

(Public Change NHS website participant)

The NHS App should have a list of available GP appointments near you which you can book through the App, similar to the original covid jab system. People can still select their usual GP but with a [single] patient record, you can open it up so they can visit any GP in the area.

(Public Change NHS website participant)

Thirdly, there was an expectation from participants in the public deliberative events and community engagement that technology will improve the experience of waiting for appointments by improving communication. This would in turn help patients feel reassured. As noted in section 2.2.1 of chapter 2, those who use the NHS more often find communication about appointments to be outdated and disjointed. This was particularly true for people from ethnic minority backgrounds and those with experience of drug and alcohol dependence in the community engagement.

Finally, staff in deliberative and online events, public participants in the deliberative events and those with experience of cancer care and hypertension in the community engagement expected that the increased use of AI in diagnostics would lead to faster diagnosis and therefore quicker access to the right care.

AI has positive use in scans and diagnosis and should be used to speed up the process to get access to the right treatment. I hope that communication and diagnosis technology will also help with the triage process - speeding up diagnostics so those who need urgent care receive it first.

(Community engagement, experience of stroke)

Enhancing workforce productivity

Staff, public, health system leaders and partner organisations identified 2 ways that technology could support the workforce:

• teams would have a sufficient number of up-to-date devices and reliable WiFi connections - this would reduce time spent ‘booting up’ devices and logging in to multiple systems
• it would reduce the administrative burden and minimise duplication by automating routine tasks such as writing letters

All audiences felt that reducing the administrative burden for staff would free up time to care for patients. Staff also expected it would reduce stress and frustration at work, ultimately improving job satisfaction.

[Success would be] I don’t have to sit and do hours of typing including logins (biometrics are in place) discharge letters (AI generated).

(Staff deliberative event participant, Midlands)

A selection of ideas for change shared on the theme of technology enhancing workforce productivity

The NHS needs to reduce unnecessary admissions when tech at home can be used either in the community or at home. This will also help to reduce outpatient appointments freeing up the consultants and doctors to treat those who need it. Using tech isn’t a replacement of a human instead it is something extra which can help to monitor and detect symptoms and understand people’s behaviour.

(Public Change NHS website participant)

Improve the wifi and update the computers. The IT systems in our hospital aren’t keeping up with the technological demands of our job.

(Staff Change NHS website participant)

Enabling the delivery of enhanced care

Although they prioritised getting the basics right first, staff in the deliberative events and on the Change NHS website expected that technologies such as AI and robotics would allow them to deliver enhanced care to patients. After being prompted with examples of AI reviewing scans, public participants in the deliberative events agreed with this benefit. Ultimately, both audiences shared an expectation that enhanced care would lead to benefits such as earlier diagnosis and improved patient outcomes.

Machines to help with diagnosis, because we’re quite outdated. It will help diagnose people sooner.

(Public deliberative event participant, North East and Yorkshire)

Staff and children and young people in the community engagement also expected that AI could be used to deliver more personalised care to patients - for example, by supporting clinicians with summarising not just previous treatments but personal preferences.

AI can summarise notes, not just about the patient’s health, but about the patient’s preferences, how they like to be communicated with, hobbies, etc […] This could help the medical professional prescribe personal treatment.

(Community engagement, children and young people)

Finally, staff on the Change NHS website and health system leaders thought that technology would support research and innovation by enabling better and quicker data analysis. This expectation was shared by people with a learning disability and/or autism who took part through the community engagement, who hoped that AI could be used to help identify patterns to improve autism diagnosis.

Empowering patients to take ownership of their health

The potential for a shift to digital to empower patients to take greater responsibility for their health through greater access to their patient information and digital tools (for example, period tracking apps) was a strong theme among staff in the deliberative events and in the partner organisation engagement. Staff felt patients would have the tools to make informed choices, increasing their engagement with their health and ultimately supporting the shift to prevention.  

If patients had one digital system on their phones they’d have more ownership and be better informed and involved.

(Staff deliberative event participant, South West)

Although having access to information about their care and appointments appealed to public participants in the deliberative events, this was not linked by the public to a benefit of empowerment. That said, in the community engagement, those with learning disabilities and/or autism and those with experience of drug and alcohol dependence did see potential for digital tools to promote greater engagement with their health, allowing them to feel more ‘in control’.

Moreover, when tested specifically on the Change NHS website and in the nationally representative survey, empowerment was recognised as a benefit. When asked about the top 3 things that would help them stay healthy, 50% of participants on the Change NHS website selected ‘easier access to your health record with personalised information about any risks to your health and how you manage them’. This compares with 45% in the nationally representative sample. This was the third most selected option overall on the Change NHS website after ‘easier access to tests’ and ‘regular check-ins with a healthcare professional’.

5.2 Concerns about making better use of technology

Among all audiences, the most significant concern expressed about this shift was about the NHS’s ability to deliver it. Staff and partner organisations were most sceptical, often pointing to perceived historical underinvestment in this area and to what they described as the NHS’s failure to deliver large-scale change in the past.

Beyond this, there were 3 further concerns that were widely shared across audiences.

Firstly, participants felt that this shift has the potential to widen health inequalities. Seldom heard audiences in the community engagement were especially concerned about this, based on their needs and current relationship with the NHS.

Secondly, there was concern that this shift might lead to the loss of the ‘human touch’ within the NHS. This concern was most strongly expressed by the public who felt that human interactions are the cornerstone of patients’ relationship with the health service.

Finally, smaller numbers of public participants, and particularly seldom heard audiences, raised concerns about privacy and security and the potential for AI to be biased and inaccurate.

Figure 14: chart showing public participants on the Change NHS website’s main concerns with an increased use of technology in the future

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘What, if anything, concerns you about the idea of increased use of technology in the future?’

	Percentage
The depersonalisation of care or loss of human contact	19%
Unequal access to services or increased health inequality	18%
Cyber security, data breaches or hacking	15%
Data security or maintaining patient privacy	14%
Poor IT infrastructure, reliability or resilience	13%

Base: all those who answered this question in the ‘Start here’ survey (number equals 63,048). The survey was live between 21 October 2024 and 14 April 2025.

Figure 15: chart showing the main concerns with making greater use of technology in the nationally representative survey

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following do you think are the biggest concerns?’

	Percentage
The cost of implementing new technology and delivering value for patients	39%
Less human contact with health professionals	38%
The unreliability of IT infrastructure and performance	37%
Some people or groups may be less able to access digital services	37%
Data protection and maintaining patient privacy	28%
Technology may not be fit for purpose or meet patient needs	27%
Staff may not be able to use new technology effectively, or need lots of support or training to do so	22%
Patients and staff may be resistant to change	16%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 12 and 17 December 2024.

The NHS is not set up to deliver this shift

The most significant concerns about the shift from analogue to digital across the engagement related to how well the shift could be delivered in practice. The public, staff and partner organisations shared this concern across all strands of the engagement. Staff at deliberative and online events were particularly likely to emphasise it and had more specific concerns than those raised by the public.

Most of the staff and a minority of public participants emphasised the magnitude of the challenge the shift to digital is trying to address. This was also reflected by some partner organisations. Past experience of technological change meant staff lacked confidence in the NHS’s ability to deliver this shift effectively in the next 10 years. Partner organisations noted that previous underinvestment in technology has created a ‘backlog’ in digital infrastructure which needs updating. For the public, the 10-year timeframe meant that some participants in the deliberative events were concerned that technologies would be out of date by the time they were successfully rolled out.

To integrate that data, who would do that? The sheer amount of information is enormous and scary, and I cannot conceptualise how that would happen.

(Public deliberative event participant, North East and Yorkshire)

All audiences were concerned about the funding required to deliver this shift. Staff, public participants in the deliberative events, and health system leaders emphasised that funding needs to be ring-fenced and long term. In the public deliberative events, participants were initially concerned that the cost of this shift would be too high and that the NHS would underinvest in other areas of the system to fund it. Over the course of the day, however, views evolved and participants came to the view that investment in technology is essential and the greater risk is that it may not be prioritised.

Beyond funding the relevant technologies and programmes, staff in the online and deliberative events saw a need for investment in 2 areas.

Firstly, funding to ensure staff have time to pick up transformation initiatives on top of their current workload. This was a practical concern for staff in deliberative and online events who felt that the frontline workforce in particular is very fatigued from managing demand. Many said that without additional resource, the workforce may lack the capacity and resilience to deliver this shift.

Secondly, the resources to address the skills gaps in the current workforce. Staff said that they will need to be trained on any new technology to ensure it is implemented successfully. They emphasised this would require both funding and protected time out of their daily tasks to learn how to operate new systems. Staff also stressed that funding for IT support should be maintained over time.

Staff will need to be trained to a level where they are confident in using technology and supporting others to use the technology.

(Staff deliberative event participant, South West)

Another major concern among staff and health system leaders was that the current procurement processes in the NHS are a barrier to the shift being delivered well. This included:

• a concern among health system leaders that the procurement processes are too complex for suppliers - this means fewer suppliers choose to bid for contracts, leaving the NHS with limited choice
• an emphasis on the cost of acquisition, rather than value, risks procurement teams choosing the cheapest supplier rather than the one which is best for the job

For this shift to succeed, staff in the deliberative events and health system leaders emphasised that it would need national leadership and strategic direction. They felt that this national leadership would enable the system to leverage the co-ordinated purchasing power of the NHS as a whole (rather than of specific services or settings). They also expected that this leadership would provide the skills and expertise to identify which technologies to invest in, as well to guide the efficient ‘scale up’ of successful technologies.

Without national leadership, staff assumed that local departments and services would focus only on their own needs rather than thinking about what is best for the NHS as a whole.

Alongside national leadership, staff in the online and deliberative events emphasised that staff on the ground must be engaged with potential change. They believed clinical and ‘user input’ will be vital in ensuring the systems that are implemented are fit for purpose.

[The shift has been hard to achieve in the past due to] no consultation with actual users of the technology.

(Staff online event participant)

Finally, a minority of public participants in the deliberative events were worried about the competence of the NHS to deliver a successful transition between legacy and new systems. In particular, participants were worried that information may be transferred inaccurately, leading to errors in their care. They wanted reassurance that sufficient time will be given to staff to manage the transition carefully.

The risk that digital exclusion could widen health inequalities

Staff, public and partner organisations were concerned about the risk of digital exclusion. There was a fear that, if not implemented carefully, the shift may widen health inequalities by creating a 2-tier system where access to high-quality care is based on ability to use digital tools. The fear of exclusion was particularly acute among many people from seldom heard audiences who participated through the community engagement; this was the greatest concern in relation to this shift for the majority of these groups.

Staff and the public identified 3 potential drivers of digital exclusion.

Firstly, patients may lack the tools and/or infrastructure to access the NHS digitally. This includes access to devices such as smart phones, as well as the ability to access a reliable WiFi connection. Among public participants this was a particular concern for those living in coastal areas, the Gypsy, Roma and Traveller community, those with experience of homelessness and victims of modern slavery.

Secondly, patients may lack the confidence or capability to access the NHS digitally. Public and staff participants noted this could be for a variety of reasons including confidence using digital tools in general, and difficulty communicating through digital methods. It was a particular concern for public participants who do not speak English as a first language, the Gypsy, Roma and Traveller community, those with low or no literacy, victims of modern slavery, those with experience of hypertension and those with learning disabilities and/or autism. Participants across these groups felt they may have to rely on support of carers and family members to access care in the future.

Thirdly, advanced technologies (for example, AI) may not be equally distributed across England. Public participants in the South West deliberative event and those living in coastal communities in the community engagement were concerned that their areas would be left behind, meaning they would have to choose between travelling a long distance to receive advanced care or accepting poor-quality care closer to home.

A lot of technology benefits rely on effective infrastructure such as wifi. Rural and coastal communities are disproportionately affected by this issue.

(Community engagement, those living in coastal communities)

Staff in the deliberative and online events and partner organisations emphasised the need to engage with marginalised groups and to design inclusive systems and services. For example, they discussed enabling proxy access for carers and loved ones, working with the third sector to engage those who may be digitally excluded, and offering access points for the NHS App in the community.

Recognise the users who may be disadvantaged by technology and provide support to them. It’s not a ‘one size fits all’.

(Staff deliberative event participant, South East)

Overreliance on technology risks losing the human touch

Public, staff and partner organisations placed a strong value on the relationship between healthcare professional and patient. There was a widespread belief that this relationship, coupled with the sensitive nature of healthcare, makes the NHS fundamentally different from other services where interactions are more transactional (for example, financial services). Public, staff and partner organisations were concerned that an overreliance on technology at the expense of care delivered by people might jeopardise this relationship.

This concern was expressed particularly strongly by public participants, especially children and young people with intensive needs. In the deliberative events and the community engagement, the public stressed that it is important to ensure the relationship between healthcare professional and patient is at the heart of care for 3 reasons.

Firstly, to ensure sensitive issues (for example, a diagnosis) are appropriately communicated. Participants in the public deliberative events, some of those with learning disabilities and/or autism and those with experience of cancer care felt that communication in person allows for greater use of body language to communicate sensitive issues in an empathetic manner.

Secondly, to ensure signs and symptoms are not missed - for example, by an AI scanner. This was raised as a concern by participants in the public deliberative events and those with experience of maternity services in the community engagement. It was also reflected by staff in the deliberative events who felt that in-person care allows them to see the ‘whole person’ and identify other issues which may be affecting patients’ health.

Thirdly, to encourage patients to seek help from the NHS. Less commonly, participants in the public deliberative events and those with experience of drug and alcohol dependence in the community engagement worried that overuse of digital may put some people off accessing the NHS if they could not speak to a person.

I’m not an advocate for replacing face-to-face appointments ever with the telephone. I’ve heard of people who’ve been told their cancer spread to their brain and that there’s nothing more can be done, over the telephone.

(Community engagement, experience of cancer)

Public and staff were also worried that an overreliance on technology to deliver tasks may mean the workforce lose important skills. The public worried about this from the perspective of resilience if systems were to go down, whereas staff worried about it from the perspective of potential job losses and the risk of less rigorous decision making.

[I have a fear of] not feeling that you as the clinician is needed or adds value.

(Staff deliberative event participant, Midlands)

Privacy and security

Both staff and public audiences were concerned about the security and privacy risks that the shift to digital would introduce. However, concerns were greatest among the public, particularly seldom heard audiences who participated through the community engagement.

Participants in the public deliberative events and seldom heard audiences in the community engagement had concerns about the privacy of their information in systems which share data more readily. Participants in the public deliberative events and sex workers in the community engagement were worried about the risk of their information being shared outside the NHS with third parties such as their employer. These audiences were worried that third parties would use their medical information against them.

In addition, some participants in the public deliberative events, sex workers, those with experience of drug and alcohol dependence and those from the Gypsy, Roma and Traveller community in the community engagement were also concerned about the extent to which their information would be shared within the NHS. Although these participants recognised the benefits of sharing information to facilitate joined-up and holistic care, they worried about the risk of bias and stigma due to their status or medical history. For example, some women in the public deliberative events worried about some healthcare professionals seeing that they may have had an abortion and sex workers in the community engagement felt staff had made assumptions about their work related to their health and were concerned that this might become more frequent as data is shared more widely.  

I worked for the NHS and wouldn’t dare during that time go to a sexual health clinic in case they somehow made my employer aware of what I was doing with the sex work.

(Community engagement, sex worker)

In this context, most public participants in the deliberative events expected their information to only be available to professionals directly involved in their care. A minority preferred a more restrictive approach and said professionals involved in their care should only have access to relevant information.

The security of NHS systems was also a major concern for the public and staff. However, concerns varied by audience.

Public participants in the deliberative events and on the Change NHS website were concerned that a more integrated NHS would open the system up to a greater number of cyber attacks. They were worried that these attacks might lead to sensitive patient information being leaked into the public domain. For example, just over a quarter (28%) expressed concerns about data sharing and data privacy if they were to make greater use of the NHS App to access services. A minority of more sceptical participants in the deliberative events also pointed to media stories about previous data leaks and cyber attacks from across government as evidence of the risk.

On the other hand, while staff in the deliberative events emphasised the importance of security, they were more likely than the public to take a pragmatic approach. They were concerned that too much governance would limit the potential benefits of introducing technology. Staff therefore tended to emphasise the importance of striking an appropriate balance between protections and realising the benefits.

Inaccuracy and bias in AI

Both public and staff were concerned about the risk of inaccuracy of AI and the risk of bias in AI models. For some in the public deliberative events, reviewing the risks and benefits associated with new technology increased their level of concern.

Public participants in the deliberative events were concerned that AI may make the ‘wrong decision’ and, if there was not strong enough oversight, may lead to poorer-quality care. Staff in the deliberative events recognised this as a concern but were more likely to focus on who would be accountable and ultimately liable for decision making if AI had been used. The risk of AI making an error was less of a concern for participants in the children and young people workshop who trusted AI would be thoroughly tested before being used in the NHS.

Both the public and staff were concerned about bias in AI models resulting from incomplete data contributing to health inequalities. This concern was raised most strongly by participants from ethnic minority backgrounds in the deliberative events, and those from the LGBTQIA+ community, the Gypsy, Roma and Traveller community and those with learning disabilities and/or autism in the community engagement. 

The bias - I think it is really important the AI is fed every colour, creed, and age, babies too.

(Public deliberative event participant, South East)

5.3 Public recommendations for the delivery of the analogue to digital shift

Public participants’ key recommendation for ensuring this shift is successful was to prioritise the basics, which they hoped would lead to more co-ordinated, efficient and holistic care.

Public participants emphasised the importance of this shift not worsening health inequalities, recommending that choice should remain at the heart of the system. They also cautioned against the shift to technology resulting in the loss of a human touch. Finally, they wanted the implementation of this shift to be efficient and high quality, including proper privacy measures, making sure that AI is trained on complete data sets and avoiding any wasteful spending.

Start with fixing the basics

Participants in the public deliberative events most commonly recommended that change should start with the basics. This was also important for public participants in the community engagement, albeit these participants were more likely to identify the mitigation of digital exclusion as their priority.

For the public, the basics included up-to-date devices, a reliable WiFi connection for staff, and a single patient record. The public saw this as essential in facilitating better communication and collaboration across the health and care system, as well as helping staff to work productively and freeing up time to care.

In addition, after participants in the public deliberative events considered how technology is currently used in the NHS, the idea that more advanced innovations such as AI can be implemented across the system without updated machines and basic systems was not seen as credible.

Prioritise technology which will help care feel more co-ordinated

Participants in the public deliberative events, on the Change NHS website and in the community engagement emphasised that technology should be used to promote co-ordination across the NHS. The public hoped this would lead to more efficient communication from the NHS and avoid patients having to repeat themselves to different healthcare professionals. Those with multiple long-term health conditions and seldom heard audiences in the community engagement were particularly likely to emphasise this priority.

The public felt that a single patient record would be the cornerstone of delivering more co-ordinated care. Participants on the Change NHS website, across all demographics, most commonly selected ‘staff having access to all your records from across different services so you don’t have to repeat yourself’ as the benefit to prioritise when rolling out a single patient record. 

Figure 16: chart showing public priorities for rolling out a single patient record on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘What do you think should be prioritised when it comes to rolling out a single patient record?’

	Percentage
Staff having access to all your records from across different services so you don’t have to repeat yourself	42%
Saving staff time and freeing up staff resources by making processes more efficient	27%
Giving you access to your entire record, tailored health advice and access to testing and diagnostics on the NHS App or website based on your health and any health risks	20%
Being able to choose to integrate the record with other apps and wearable technology to help you manage your own health	3%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,214). The survey was live between 24 February and 14 April 2025.

The shift to digital must not exacerbate health inequalities

Public participants across all strands of the research were clear that this shift must be delivered in a way that avoids exacerbating existing health inequalities. They recommended that this be done in 3 ways.

Firstly, by respecting patient choice. This was a dominant theme across all strands of public engagement. While participants recognised the benefits of digital access, they thought it does not work for everyone or in every context (as noted in section 5.2 of this chapter). In this context, participants in the deliberative events and community engagement wanted:

• the continued provision of offline alternatives such as face-to-face appointments
• a choice about whether to use digital tools such as virtual appointments and the NHS App

Secondly, by focusing on the accessibility of digital tools - for example, through user-centred design and ensuring patients can interact with tools in multiple languages.

Thirdly, by providing digital hubs where those without devices or regular internet connection can access the NHS.

At the moment, many are excluded from making appointments with their GP […] People have to use an e-consult form and [GP practices] expect people to ring if they don’t have access to complete the form over the phone. This puts many people off, leading to great health inequalities.

(Community engagement, those with learning disabilities and/or autism)

It is important to note that when discussing the importance of being able to opt out of digital access, some participants in the public deliberative events said they were happy to accept consequences as a result (such as having to wait longer for a face-to-face appointment). It was clear in the discussion, however, that participants did not expect consequences to be considerable. There was an assumption that greater uptake of digital tools would ‘free up’ capacity for face-to-face care, meaning that for those who wanted to use this option the waiting times would be shorter than they are at present.

Humans must remain at the heart of healthcare delivery

Participants in the public deliberative events and audiences in the community engagement were keen to preserve the ‘humanness’ of healthcare.

In practice, this meant that when discussing which technology to prioritise, participants were more likely to prioritise non-clinical uses of innovative technology which supports professionals to deliver care more effectively (such as AI reviewing scans), rather than technologies which were seen to replace the patient-clinician relationship (such as AI chat bots).

This focus on the role of the healthcare professional also meant that public participants stressed the importance of human oversight of, and accountability for, any use of AI, including when it has been used to read scans and tests and summarise patient notes. Participants felt that this was essential to deliver patient-centred care and prevent mistakes.

The prospect of healthcare professionals working more closely with technology meant that a minority of participants in the public deliberative events and those with experience of cancer care wanted reassurance that staff would receive adequate training. They felt this was important for staff to provide strong oversight.

AI should never be left to its own devices. It should always be under [human] observation.

(Public deliberative event participant, North West)

Put effective privacy and security controls in place

While most public participants across the engagement supported greater sharing of their data, they wanted effective privacy and security controls to protect their information. Participants did not want to increase the risk of cyber attacks or data leaks as a result of this shift.

Importantly, a theme in the public deliberative events was that access to their patient information by third parties must be strictly controlled.

[I’m concerned about] Cyber-attacks and who is going to access my data.

(Public deliberative event participant, North West)

AI should be trained on diverse and complete data sets

To avoid the potential for bias and inaccuracy, participants in the public deliberative events and audiences in the community engagement, including those from ethnic minority backgrounds, children and young people, people with learning disabilities and/or autism and those from the LGBTQIA+ community, emphasised that AI should be trained on diverse data sets. This included diversity across demographics (gender, ethnicity and age) and also health conditions.

A minority of participants in the public deliberative events said that the NHS should be transparent about how AI models are trained to provide reassurance to the public.

Will AI clinical bias be eliminated, for example. Scenarios around pain relief where women are less likely than men to receive pain relief and black women are less likely to receive pain relief than white women.

(Community engagement, mixed group)

The shift to digital should not be wasteful

Participants in the public deliberative events feared the NHS may waste money and resource pursuing technology for no real benefit - they were opposed to innovation for its own sake and stressed that all changes must deliver real benefits to the NHS and its patients. In this context, they wanted transparency and accountability for how resource is used.

5.4 Staff recommendations: what needs to change for the shift to be a success

Like the public, staff’s strongest recommendation was that the basics should be fixed first, although their definition of what this meant was wider ranging and more detailed. They emphasised the importance of strategic implementation, led at the national level, to ensure success, and wanted to see staff put at the centre of the change process. In particular, they pointed to the necessity for protected time for staff to get the necessary training and support to use new systems and processes effectively.

Finally, like the public, staff emphasised that this shift must not exacerbate health inequalities. However, their suggestions focused not just on maintaining a face-to-face option but on ensuring that patient-facing technology is easy to use and digitally upskilling key groups.  

Start with fixing the basics

Consistent with the public, staff in both the online and deliberative events said that the shift to digital needs to start with upgrading basic technology. Those working in primary and community care emphasised this most strongly.

Staff took a wider ranging view of ‘the basics’ than the public. In the deliberative events, they saw the basics as including:

• a sufficient number of up-to-date devices for team members
• reliable connectivity on the NHS estate and when working remotely
• fewer systems and logins, and ideally a single log-in
• a single patient record
• secure, instant messaging between departments and settings

In the online events, staff were most likely to rate ‘consistent upgrade of staff IT infrastructure’ and ‘single digital health records’ as the ideas which had the greatest potential to achieve this shift.

Good wifi, clear and standardised approach to patient records, with an understanding of how to record communication.

(Staff deliberative event participant, North West)

Figure 17: chart showing staff views on potential ideas to deliver the shift from analogue to digital

Shows the average (mean) score of each answer to the question: ‘Based on your experience, rate each idea below on its potential to help achieve the shift out of 10’

	Average (mean)
Consistent upgrade of staff IT infrastructure	9
Shared digital health records	9
Automated and digital systems for patient registration and appointment booking	8
Leveraging AI and advanced technology to aid treatment and care, as well as streamlining administrative processes	7.4
Remote appointments	7.3
Wearable devices which can share data with the NHS	6.3

Base: all those who answered this question in staff online events, which took place between 19 November and 3 December 2024.

Despite the majority of staff recommending starting with the basics, staff in managerial and executive roles in the deliberative events and health system leader participants at the roundtables wanted to balance this with a focus on innovation, including AI technology and advanced analytics. There was a concern among this group that without this focus, technology may move on at such a pace that the NHS will fall further behind comparable sectors or organisations.

Implementation must be strategic and led at the national level

Staff in the deliberative events said that this shift needs to be led at the national level. They called for strong strategic leadership and a clear vision. They described a need to learn from past mistakes where they described a tension between the overarching vision of transformation and the practicalities of implementation. Staff in management and executive roles in the deliberative events said that the vision needs to be deliverable.

Staff - in particular health system leaders - said that this national leadership would be essential to tackle the current fragmentation of data and technology across the NHS. To ensure success, they called for leadership to focus on 2 issues.

Firstly, standardising the systems and policies regarding data sharing across settings, including primary care. Staff felt this is particularly important to deliver a single patient record.

Secondly, national co-ordination of procurement. Health system leaders believed this would support integration and deliver economies of scale when purchasing systems.

We need to prioritise staff and leadership - a more positive approach, a clearer ‘sell’ that is understood by all.

(Staff deliberative event participant, North West)

Invest in staff capability through protected time for training and support

Staff in the deliberative and online events emphasised that if the shift is to be successful, they need the skills and expertise to deliver it. Therefore, staff said that comprehensive training, with protected time, will be required to support implementation. Staff identified 2 types of training that they felt would be necessary.

Firstly, formal training to learn about the rationale for new technology and how to use it. This training should be tailored to their role and setting - for example, frontline staff were more likely to say they wanted practical training, whereas managers said they would benefit more from training regarding the strategic delivery.

Secondly, staff in the deliberative events suggested an informal network of ‘digital champions’ to support their less confident colleagues.

Staff and health system leaders also wanted to see investment in IT support staff and specialists within the NHS. This was both to support staff to use new systems, and to suggest further developments to strengthen the shift to digital.   

[Staff need] better training and implementation of new software systems. Not just a ‘one off’ teaching session but repetitive education and support.

(Staff deliberative event participant, South West)

Put staff at the centre of the change process

Staff in the deliberative and online events were concerned that technological changes may not be designed with sufficient consideration for those who will be using the new systems. Many felt this had been an important barrier to previous attempts at reform. Workforce participants therefore placed a strong emphasis on an ongoing programme of staff engagement to support the design and implementation of digital change.

Staff in the deliberative events said that engagement should:

• start early in the process, so staff across the NHS buy in to the overarching vision for change
• test any new systems with users to ensure they are easy to use and genuinely provide benefits
• be ongoing, with a continuous feedback loop to resolve any challenges as they arise

Staff felt this programme of engagement would be essential to overcome scepticism and fatigue among the workforce and create a culture that feels positive about innovation and change.

Staff engagement is key; it is necessary to ensure every department and staff group are involved to avoid missing key parts of the pathway.

(Staff deliberative event participant, London)

The shift to digital must not exacerbate health inequalities

Consistent with the public, staff worried that a more digital NHS risks widening health inequalities. Staff in the deliberative events made 5 recommendations to manage this risk.

Firstly, all patient-facing technology (such as virtual appointments or the NHS App) must be developed in a user-centred way. Staff emphasised that technology should be simple and easy to use if it is to be inclusive and encourage uptake. They also said tools should be continually tested, particularly with disadvantaged groups, to ensure they are working well.

Secondly, there should be multiple ways to access digital services. This includes community support models (such as access points in libraries, a network of community digital champions) and tailored approaches for those with different needs (such as proxy access).

Thirdly, clearly communicate the benefits of digital technology to ensure it is not perceived as ‘less than’ offline options. Staff suggested advertising and showcasing stories of success to support this.

Fourthly, work collaboratively across the system, including with the voluntary, community and social enterprise (VCSE) and social care sectors, and promote approaches that are working well to engage disadvantaged groups.

Finally, make sure addressing digital exclusion is a core part of any transformation strategy.

Make sure there are alternatives to technology for excluded or vulnerable groups and offer support to them to use the technology.

(Staff deliberative event participant, South East)

AI should be used as a tool with clear lines of accountability

Staff in the deliberative events were open to the use of AI within the NHS but wanted to see it used as a tool to support rather than replace them. In particular, staff emphasised the importance of preserving the clinician-patient relationship and avoiding overreliance on AI for decision making.

Staff in the deliberative events said that humans should always have oversight of AI and there should be clear lines of accountability if AI has been used in patient care.

[The NHS should embrace AI] Very enthusiastically. It should be primarily a tool to reduce administrative burden and free up clinicians to spend more time face to face with parents. My fear is using AI in place of people to try and give health advice or provide reassurance. […] People want to feel listened to and special, an Al interface may may not achieve this.

(Staff deliberative event participant, London)

Long-term and strategic funding

Funding was seen as essential to the successful delivery of the shift to technology. Staff in the deliberative events and health system leaders said that funding needs to be long term (multi-year) and strategically focused.

Funding is needed to maintain a new system, not just for an allocated time.

(Staff deliberative event participant, North East and Yorkshire)

See a list of all chapters