The latest NHS shakeup: what will it mean for digital transformation and patient care?
- Shoshana Bloom
- Apr 29
- 3 min read
Thursday brought the shock announcement that NHS England will be abolished, alongside a 50% reduction in Integrated Care Board (ICB) overheads and headcount—a move framed as an effort to streamline operations and reduce bureaucracy. The Health Foundation has described this as a “watershed moment” in NHS governance, with potentially profound implications for service delivery.
Once again, the NHS faces major structural upheaval, just as the health system was beginning to stabilise after its last reorganisation. This further disruption will be keenly felt by the digital health community, and raises some urgent questions:
Who will now lead the national digital strategy?
What happens to existing digital transformation programmes? Will funding commitments hold—or become another casualty of restructuring?
After the workforce culls, ICSs have the leadership and resources to drive innovation, or will we see more inertia?
The Slow Pace of Digital Transformation
Digital transformation is a critical enabler for improving productivity and efficiency within the NHS. It underpins sustainability, streamlines workflows, and enhances patient outcomes. However, widespread workforce cuts could cripple the NHS’s capacity to modernise, perpetuating existing inefficiencies, waiting times, and health inequalities. Patients in digitally lagging regions will continue receiving suboptimal care compared to those with well-integrated digital systems. The 2021 Frontline Digitisation Programme, designed to transition trusts from paper-based to digital systems, has already progressed slowly. Many NHS trusts still lack fully integrated Electronic Patient Records (EPRs) and interoperable systems.
The Perpetual Digital Skills Gap
One of the biggest barriers to digital progress remains the severe digital skills gap across NHS staff. A Coventry University report highlighted continuing skills deficiencies at every level—from frontline workers to senior management—particularly in those leading digital transformation.
The lack of digital transformation skills is exacerbated by workforce competition: the NHS struggles to attract and retain digital professionals, as private sector roles often offer better pay and career prospects. Consequently, NHS digital initiatives frequently rely on third-party suppliers, reducing internal capability. ICB workforce cuts will likely make this worse, further undermining investment in digital leadership, training, and implementation.
Funding Uncertainty & Financial Constraints
Funding challenges are mounting. Frontline Digitisation Programme funding has already declined, from £2.045 billion in 2021 to £1.98 billion. Meanwhile, the 2024 Spring Budget promised £3.4 billion for NHS technology and digital transformation, set to begin April 2025. However, will these funding streams survive? Or will financial pressures force trusts to prioritise short-term operational needs over digital investment?
Budget constraints threaten the deployment of critical projects, including EPR systems, which form the backbone of digital transformation. These systems often require substantial upfront investment, with cost savings only materialising years down the line as efficiencies that the systems release take time to materialise and embed. This makes them a hard sell when NHS finances are under strain, leading some trusts to stick with inefficient paper-based processes rather than commit to long-term digital investment.
The NHS Digital Transformation workforce faces an uncertain future
NHS teams responsible for driving digital transformation now face a precarious reality. They are expected to accelerate innovation while simultaneously managing budget cuts, workforce reductions, and organisational instability—all while fearing for their own job security.
This increases the risk of paralysis in digital decision-making. With fewer digital champions at the helm, transformation efforts may stall, leaving trusts operating in a fragmented, patchwork system of IT infrastructure. Patients stand to be the ultimate loser in all of this.
As reported by The Health Foundation:
"history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect. Scrapping NHS England completely will cause disruption and divert time and energy of senior leaders at a time when attention should be focused on improving care for patients"
What Next?
While the restructuring may aim to reduce bureaucracy, it also introduces substantial risks to the NHS’s digital future. The extent of the damage remains unclear, but if digital transformation is to remain a genuine priority, urgent clarity is needed on three fronts:
1. The development of a National Strategy to ensure digital progress does not stall.
2. Extablishing greater certainty over funding for digital initiatives, enabling NHS organisations to make informed investment decisions.
3. Develop clear and skilled leadership to drive transformation efforts, preventing further fragmentation.
Without sustained investment and strategic oversight, the NHS risks stalling its digital evolution, ultimately leaving both staff and patients to pay the price.
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