What are the biggest challenges facing the health system in meeting national ambitions for digital transformation?
In this HTN survey, sponsored by Restore Information Management, we explore digital transformation to date, the barriers and practicalities of driving innovation, and whether national ambitions can be delivered.
We heard the common issues with funding, resource, and capacity; but also about fragmented systems, data in siloes, duplication, and differing levels of digital maturity. In particular, respondents painted a picture of a mismatch between ambition and reality, with only two percent considering national ambitions to be “highly deliverable” for their respective organisations.
Current realities
Considering whether national ambitions can be delivered, a lack of digital leadership emerged as a potential contributing factor, with the majority (57.1 percent) not believing the NHS currently has sufficient digital leadership capacity to deliver on its reform ambitions. The same pattern emerged when respondents were asked to consider their own digital roadmaps, with only 2.6 percent reporting feeling all of their local ambitions were genuinely achievable within the next three years.
Exploring further, 36.4 percent of respondents considered current progress to be too slow to meet expectations, with a further 19.5 percent expressing concern that much of this progress relates to rearranging analogue processes in digital form, and 19.5 percent reflecting we are “over promising and under delivering”. In contrast, 24.7 percent shared thoughts that the NHS is making “steady, sustainable progress”.
Overcoming the challenges
When it comes to challenges, the most common themes were digital still being seen as IT’s problem (27.3 percent), time spent on legacy systems preventing progress on building the future (26 percent), a lack of digital skills (22 percent), and governance preventing things moving ahead rapidly (14.3 percent).
Sharing insights into what needs to change in order for their organisation to meet the directives of the NHS plan, respondents noted the need for more funding, resource, and capacity, as well as clear leadership and more staff training. Others mentioned factors such as increased joined-up working and sharing of learnings, as well as infrastructure changes around integration and interoperability.
“Realising and embedding that digital transformation is everyone’s issue, not just IT’s,” one respondent noted. Another said: “By 2028, I think organisations will need to move beyond viewing digital transformation as a separate programme and instead embed it into everyday operational delivery, workforce planning, and patient care.” One suggested: “Everyone working in the same direction with lots more mandating and standardisation or the fragmentation is too big a risk to achieving delivery.”
Other feedback talked about the need for “clear multi-year funding” for digital, a more collaborative approach to ensure digital system compatibility, and increased public trust through better transparency. Data was another theme, with respondents picking up on issues with accessing information, duplication in data entry, and the potential for the controller of patient data to sit across organisations.
Bottlenecks and data sharing
When asked where delays or bottlenecks were most common in their organisation, many respondents highlighted issues with disparate systems and challenges with transfer of data across organisational boundaries or between systems. One noted that staff having to check multiple systems led to delays in decision-making, and another said: “…there are still many areas where systems don’t communicate seamlessly with each other, meaning staff have to manually transfer information, duplicate entries, or follow up through email and phone calls. That creates delays, increases workload, and can impact the speed at which patients move through pathways.” A further response acknowledged problems arising from the use of “lots of different systems for different tasks” with a lack of consistency in level of skills or training.
Manual entry or administrative tasks were also cited by a number of the respondents, also waiting for clinical sign-off, manual processing of letters, clinical documentation having to be retyped, and the lack of an effective messaging system for follow-up actions. Respondents highlighted governance processes as often being the cause of delays, with mention of “rigid” sign-off processes, and “too many Boards with the same people attending, limited agility, too little understanding of pace required”. One respondent noted: “Digital projects frequently require input from multiple stakeholders, operational leads, IT, IG, communications, finance, and clinical teams; which is important for safety and compliance, but can sometimes make progress slower if priorities or timelines aren’t aligned.”
The need for “digital solutions to effectively support patient flow and insight on delayed discharges is essential,” one respondent stated. Another respondent highlighted: “I’ve also seen bottlenecks occur when digital transformation is introduced without enough operational input early on. If workflows haven’t been fully mapped with frontline users, teams can end up creating workarounds after go-live, which reduces efficiency and delays the intended benefits of the change.”
76.8 percent of respondents felt unstructured clinical correspondence like discharge notes or one-off documents represented either a “major” or “moderate” barrier to their digital communication goals. For clinical correspondence such as outpatient letters and discharge summaries, the greatest source of operational friction was identified as variability in quality or completeness. Also noted were delays between consultation and a letter being issued (20.8 percent), duplication across systems (19.5 percent), limited ability to extract unstructured data (16.9 percent), and manual re-keying or formatting effort (15.6 percent). Only 5.2 percent said current processes supported staff “very well” in accessing the right information at the right time.
Further insights
Respondents were given the option to offer their comments on the one thing they wished the wider NHS truly understood about digital transformation. A major theme to emerge was funding and resource, or a lack thereof. 19.5 percent mentioned challenges with funding, available resource, or both. “We need the resources to complete the change management activities to support staff on the shop floor, who barely have time to read their emails, let alone learn a new system or digital solution,” one respondent said. Another answered: “That there still aren’t huge digital, clinical transformation teams in organisations, most are singular with little support from execs as they still feel its all about front line and that is where the finance and resource goes.”
Elsewhere, respondents talked about a lack of interoperability or integration hampering digital transformation progress, with nine percent highlighting this in their answer. One mentioned “one system for all and if not for systems to talk to each other”; while another noted a lack of interoperability with EPRs as being “the crux of most of our digital issues”, suggesting “NHSE should mandate them integrating”. A respondent offered: “That the system (NHSE/ICSs/Trusts/ GP/Community) – have to design IT systems to work together – and actually hold suppliers to account to interop with each other so that the right information and workflows support our frontline staff in doing their difficult jobs. We need to start collectively holding suppliers to account to deliver to standards.” Until systems are joined up between primary and secondary care, another stated, “we won’t make enough progress”.
Another theme was around people and culture, with one respondent stating: “Digital transformation, despite its name, is mainly a people-centred issue. Decisions need to be made by staff that perform the daily tasks, and their local managers need to be supportive of it. Agreement and encouragement from senior management/C-Suite is fundamentally useless without local engagement or the right people making the specific decisions for workflow and interfacing.” Another suggested that rather than being led by digital or IT teams, digital transformation should rely on clinical and operational leadership with “strong buy-in” from key stakeholders across the organisation.
“It takes time to engage with clinical teams. To build rapport and get them invested in the change,” one response reads. “To introduce a digital project is a mixture of pressure, fear, mass confusion, patient care taking priority, uncertainty etc. etc. Higher ups focus on the time to deliver a project, without actually allocating time to embed and reinforce the change.” Another respondent echoed this, saying: “Everyone has to come with on the journey as part of the planning and execution rather than having a system implemented.” Successful digital transformation is “far more about people, culture and processes than it is about technology itself”, one respondent commented. “The NHS doesn’t struggle because staff are resistant to change, most frontline teams want systems that make care safer, faster, and less frustrating. The challenge is that transformation often happens to services rather than with them. When staff are involved early, listened to properly, and given the time, training, and support to adapt, digital change becomes something empowering rather than disruptive.”
Elsewhere, responses highlighted the importance of not seeing digital implementations as a “one-off”, and recognising the need to see them as a continuous process of ongoing improvement. One respondent said: “There’s a misconception that digital transformation is a one-off implementation. In reality, it’s continuous improvement, listening to feedback, refining processes, supporting users after go-live and recognising that transformation doesn’t end once a system is switched on.”
Other comments covered the need for training, the importance of considering patient safety, and the need for recognition that not all organisations are able to move at the same pace with digital transformation.
Stefan Chetty, director of digital services from Restore Information Management, commented: “We partnered with HTN to understand the realities of digital transformation across the NHS, and the role better patient communications can play in that journey. This research brings the challenges facing NHS teams to the forefront, helping us focus on the practical changes needed to turn digital ambition into sustainable progress.”
Download Restore Information Management’s survey findings report for further insights.
