Key takeaways:

• Innovation in public sector healthcare services is not the problem. The challenge is turning promising pilots into repeatable system-wide improvement
• Digital tools gain traction when they improve frontline work, reduce friction and are backed by proper training, funding and workflow redesign
• Scaling success will require stronger procurement capability, better interoperability and clearer pathways for proven innovations to spread

Anatomy of Success: Digitising the NHS by 2035 was launched during a panel discussion in Parliament, where speakers explored the report’s findings and the future of NHS digitization.

There is no shortage of digital ambition in healthcare. The harder question is what it takes to turn ambition into system-wide improvement.

That is the central challenge running through Anatomy of Success: Digitising the NHS by 2035. The report is optimistic about the potential of data, AI, digital tools and connected services. But it is equally clear about why progress so often stalls. Innovation exists. Good pilots exist. Strong ideas exist. What has too often been missing is the ability to implement, resource and scale them effectively.

That practical focus came through strongly at the report launch. Sasjkia Otto, Senior Researcher at the Fabian Society and author of the report, argued that the NHS must move beyond diagnosing what has gone wrong and instead “adopt a solutions-focused mindset.”

That is the right frame for the next phase of the digitization of the UK’s National Health Service (NHS). The real question is no longer whether technology can help. It is whether the system can make the conditions for success repeatable. The report argues that doing so will depend above all on two priorities: making technology synonymous with good work and backing innovators to work with the NHS at scale.

The problem is not invention. It is implementation

The NHS already contains examples of excellent innovation. The report highlights MediShout, the operational app created after cancelled surgeries exposed a simple but costly failure in frontline workflows. It cites NHS Trusts reporting 44% fewer cancellations and £1 million in efficiency savings.

This is not unusual in one sense. Across the NHS, teams are creating and testing smart ways to improve care, productivity and staff experience. What is unusual is when those innovations move cleanly from local success to broad adoption. The report notes that 80% of projects fail to scale beyond the pilot phase. That is not simply the normal attrition rate of experimentation. It is a sign of systemic weakness in the route from testing to rollout.

That is why one of the most memorable lines from the panel landed so well. Alex McIntyre, UK Member of Parliament for Gloucester, remarked that “the NHS has more pilots than the RAF.”

His point is that a system full of pilots but short on scale is not short on ideas. It is short on pathways.

Technology must feel like better work

The report’s second priority is to make technology synonymous with good work. That is an important test, because frontline adoption is often treated as a communications exercise when it is really a design and delivery issue. Staff don’t embrace digital change because they are told it is strategic. They embrace it when it solves real problems in their daily work.

The report explains what happens when it doesn’t. After changes intended to improve access in general practice, 75% of GPs surveyed reported higher workload, 68% reported more stress and 55% said patient care had worsened. More broadly, 96% of health professionals report workforce pressures as a barrier to digital progress.

These numbers matter because they reveal a recurring implementation failure. Poorly designed systems create extra tasks, increase friction and add pressure. Change programs underestimate staffing and training costs. Transition periods are under-resourced. New tools arrive before workflows are ready for them.

During the panel, Otto described the failure mode clearly. Reflecting on past top-down programs, she said staff felt “like the technology became the enemy.”

The issue is not resistance to innovation. Instead, it is the experience of being handed systems that don’t reflect clinical reality, don’t fit local contexts and don’t come with the support required to embed them.

Alan Flower, Executive Vice President - CTO & Global Head, AI & Cloud Native Labs at HCLTech, noted that digital transformation accelerates when “the frontline worker gets to see the benefits that the technology brings.” Drawing on examples with HCLTech’s work with clients in the US, he said the most consistent response from clinicians using AI support in the consultation room was simple: “I’m not going to burn out.”

Flower’s wider point was equally important. Technology works best when it removes what he called “the drudge work” that pulls clinicians away from patients. In one HCLTech deployment he described, AI support gave an average of three minutes back to every patient consultation. In a system where clinical time is scarce, those are not marginal gains. They are the difference between digital adding pressure and digital creating space for better care.

That is why the report insists that technology must be designed around staff reality. If tools can’t make work better, safer or more sustainable, they are unlikely to improve care at scale.

Good deployment needs money, time and discipline

The report repeatedly warns against false economies. Digitization is often discussed as a route to efficiency, but too many programs are undermined by underpowered delivery models.

The challenge is not just buying the technology. It is funding hardware upgrades, workflow redesign, skills support, maintenance, transition periods and the operational disruption that comes before the benefits are fully realized. The report is clear that digital transformation requires substantial human and financial investment, often before the full gains can be seen.

History offers a sharp warning. The National Programme for IT ran for nine years, cost taxpayers £7.3 billion and delivered only £3.7 billion in benefits before it was dismantled. The report argues that the consequences of getting digitization wrong today could be even greater, with the broader shift from analogue to digital estimated to cost £21 billion over five years.

Otto made the same point during the panel, warning that even “the best technology in the world” will underdeliver if deployment is not properly resourced.

This is where digital transformation often becomes strategically overambitious and operationally thin. It tries to do too much at once, without enough local capacity to do any of it well. The report’s argument for prioritizing the highest-impact initiatives is therefore critical. The NHS doesn’t need more disconnected activity. It needs sharper choices and better follow-through.

Backing innovators means fixing the route to scale

The report’s fourth priority is to back innovators. This is not just a question of celebrating innovation. It is about removing the barriers that stop the best ideas from reaching patients.

Even after meeting regulatory requirements, innovators still face fragmented procurement pathways, varied trust capabilities, different risk appetites, limited budgets and the reality that what works in one setting may not transfer neatly into another. This is why scale should be understood as a capability, not an event. The barrier is rarely the absence of a promising idea. It is the lack of shared governance, relationship-building and implementation support needed to move from isolated proof points to broader adoption.

The panel surfaced the same frustration. Sarah Russell, UK Member of Parliament for Congleton, argued that there should be a realistic budget and pathway for rollout before a pilot begins, otherwise the system creates “immense frustration” among professionals who prove something can work and then watch it die.

The problem moves beyond a workforce issue and into a missed-value issue. Every stalled pilot represents not only wasted time and investment, but delayed benefits for patients.

Flower added that because of AI, innovation is now easier to productize because the barrier to entry is “pretty much on the floor” for anyone with a good idea. In his view, the harder challenge is no longer whether solutions can be built, but “how do I make it consumable” for a large organization such as the NHS. That observation aligns closely with the report’s fourth priority. The UK doesn’t lack health innovation. The real challenge is whether the system can absorb it.

Commercial capability is now a strategic issue

Another important contribution of the report is its focus on the supplier landscape. The conversation about NHS digitization often centers on what technologies to adopt. Just as important is how the NHS buys, governs and evaluates them.

The report argues that too much of the market remains concentrated among a relatively small number of large suppliers. Some are delivering reliable products and services. But consolidation can also limit flexibility, reduce supplier diversity and make it harder for newer solutions to enter the system. That can leave trusts locked into costly or inflexible arrangements that slow improvement.

Just as significantly, the report identifies capability gaps inside the NHS itself. Through a Freedom of Information request, the Fabian Society found that most NHS Trusts don’t centrally track digital contract spend and performance.

Otto underlined that point at the launch, explaining that “most NHS Trusts don’t systematically track their kind of spend and impact” and that “we do need a kind of coherent process that works locally and nationally.”

This suggests that one of the biggest barriers to better digital outcomes is not simply supplier behavior or policy design, but the system’s uneven ability to evaluate what it is buying and learning from. Commercial capability, in other words, is no longer a back-office concern. It is part of the transformation agenda.

Scale still depends on systems working together

The report’s fifth priority, making services work as one, highlights that innovation can’t spread through a fragmented system. Proven tools don’t create system-wide value if they remain trapped in isolated settings.

Here the report states that progress depends on stronger standards, better coordination and more effective interoperability. It notes that 13% of hospitals still don’t share information with patients through the NHS app and that compliance with interoperability requirements remains below 50%. Those are not just technical shortcomings. They are barriers to adoption, spread and consistency.

In that sense, systems working as one is what turns isolated digital wins into repeatable system capability.

The next phase of digitization must be built to spread

The NHS has already shown that innovation is possible. What it now needs to prove is that success can be made repeatable.

That means focusing on the priorities that matter most for delivery: making technology synonymous with good work, backing innovators who can solve real problems and ensuring the system can spread what works. It means designing digital change around workforce realities, funding deployment properly, strengthening procurement and performance tracking and creating clearer pathways from pilot to practice.

The report doesn’t ask whether the NHS should innovate. It asks what conditions make innovation stick.

That is where the next decade of digitization will be won or lost. Not in strategy documents or pilot announcements, but in whether good ideas can move reliably from promise to practice across the system.

Download the full report here.