Following the RCP’s submission to the government’s 10-Year Health Plan, RCP officers set out their thoughts on the three ‘shifts’ proposed in the plan: sickness to prevention, hospital to community, and analogue to digital. In this piece, Professor Tom Solomon CBE, Royal College of Physicians academic vice president, focuses on the analogue to digital shift.
The government’s 10-year plan for the NHS proposes a shift from analogue to digital – it is welcome, and long overdue, but it will by no means be an easy feat. This is not merely a technical upgrade – it is a profound transformation that requires robust investment, thoughtful design, and collaboration with those at the heart of the NHS: patients and clinicians. The failure of the NHS National Programme for IT, launched in 2002 and abandoned in 2011, should serve as a warning for the size of the challenge.
Currently, IT systems across healthcare settings are often plagued by inefficiencies, lack of communication across platforms and outdated hardware. Too often, a task that takes one step in one system may require five steps in another. For example, at the secondary and tertiary care hospital where I work in Liverpool I must renew multiple passwords every 4 weeks, but at the specialist centre where I am based it is one password for everything, which changes every 3 months. These shortcomings not only frustrate clinicians but also jeopardise patient safety. Physicians routinely report poorly functioning IT systems, with our 2023 census of UK consultant physicians showing that this ranked among the top three factors most negatively affecting their wellbeing at work (the other two being clinical workload and workforce availability).
This is why the Royal College of Physicians is calling on the government to invest in well-functioning, interoperable IT systems, NHS equipment, facilities, estates and digital infrastructure with an ambitious multi-year capital funding settlement. The importance of getting the digital basics right cannot be overstated. Functioning IT is central to improving patient care and the working lives of clinicians. There are already good examples of how transformative this can be, such as the NHS app, and electronic patient records. But each of these can do so much more if we get it right.
Digital transformation must streamline workflows and improve patient care. This requires redesigning workflows based on user experience. Digital systems should be developed in alignment with NHS design principles, which prioritise input from both patients and staff. Iterative improvement, informed by patient-facing clinicians, ensures that systems evolve to meet the needs of those using them daily. Moreover, consistent data capture at the point of care – by clinicians and patients alike – is crucial. Such data should drive continuous improvement, support research and inform evidence-based decision making.
When it comes to introducing new technologies or digital tools, we need to make sure that these come alongside proper training. This requires sustained investment in training, alongside a commitment to valuing clinical feedback. Clinicians must feel confident and competent in navigating new digital systems. When staff are equipped to use technology effectively, they can realise its potential as a tool that enhances their work and patient care rather than it being an additional barrier.
And alongside the proposed shifts, the RCP is clear that research must be at the heart of the 10-year plan – something about which, as a clinical academic myself, I am passionate. Almost everything we do in the NHS today was developed through clinical research. Research is vital for driving medical innovation, improving patient care, and contributing to economic growth. The RCP has for some time been campaigning for clinicians to be given more opportunities to contribute to clinical research, for example through our 2022 joint position statement with the National Institute for Health and Care Research on Making research everybody’s business. However, our latest census of UK consultant physicians showed that over a third (36%) want to participate in research but are unable – a lack of ringfenced time in job plans is the main thing stopping them. Scope for resident doctors to engage in research is also greatly diminished. The government needs to support clinical academia at all career stages and doctors must have protected time for clinical research; points I emphasised in a recent meeting at the Department of Health and Social Care (DHSC) with Baroness Gillian Merron, the minister responsible for health research, and Lucy Chappell, chief scientific adviser to DHSC.
While digital tools offer opportunities to enhance care, there is the risk of deepening inequalities among patients. We know that 13% of the UK population lacks access to a smartphone or internet connection. Digital exclusion often correlates with social exclusion, and understanding this relationship is key to ensuring equitable healthcare advancements. Strategies to address digital exclusion must be integral to this shift and the NHS’s digital transformation.
Government investment in improving the usability of digital systems is critical because clinical adoption of innovation and artificial intelligence (AI) will likely be low while the ‘digital basics’ are still seen as a significant barrier to good clinical care.
AI holds transformative potential for healthcare. It is already being used in diagnostics and imaging, (eg analysing MRIs and biopsies), predictive analysis (eg of readmissions and of sepsis) and administrative efficiency (eg speech recognition transcribing consultations, and chatbot triaging of patients). However, future success hinges on several key factors. Firstly, AI development in the NHS must begin with clinician input to ensure that real-world challenges are being addressed; this collaborative approach will ensure that AI tools enhance clinical workflows and patient outcomes. Then for AI implementation to be successful, it needs access to large, accurate volumes of patient data (so it can be trained on these) and be part of interoperable systems that mean it can be integrated into live clinical systems at the point of care. Above all, to fully realise the promise of AI, we need a dedicated strategy from government and NHS England – set out in the 10-year plan – that provides a clear vision for AI’s role in the NHS – from design to testing, implementation and evaluation.
The shift from analogue to digital is an opportunity to redefine healthcare delivery in the UK. It can only be achieved through robust investment, thoughtful design, and collaboration with clinicians and patients. By focusing on interoperable systems, clinician and patient involvement, and addressing digital exclusion, we can create a digital NHS that enhances care and supports the wellbeing of both patients and clinicians.