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Across advanced economies, public health systems were designed primarily for episodic, acute care.

That model made sense 80 years ago, when the dominant needs were short-term and hospital led. It is far less suited to today’s reality: chronic conditions, long-term management, prevention and continuous support, delivered across multiple settings, not within a single institution. These pressures are no longer cyclical that rise and fall. They are structural – embedded in underlying design and system constraints.

For policymakers and system leaders, healthcare has become inseparable from wider economic and social priorities. Workforce participation, productivity, fiscal sustainability and public trust increasingly depend on whether health systems can deliver timely, effective and accessible care. The link between health and national productivity is set out clearly in Sir Charlie Mayfield’s Keep Britain Working review (November 2025).

The obstacles aren’t insurmountable, but they must be addressed deliberately.

Realising a shared vision for ambient healthcare requires a roadmap for scaling digital health safely and fairly. That means open dialogue, partnership and a clear set of guardrails: patient and clinician confidence, clinically governed safety standards, and an understanding that digital care is not an “add-on”. It is core infrastructure.

The benefits of digital healthcare are already well evidenced: greater choice and autonomy for patients, earlier intervention and better outcomes, more personalised care, and more efficient use of scarce clinical capacity.

But these benefits only materialise when digital services are integrated into end-to-end pathways - from navigation to resolution - and offered in a multimodal way that reflects real life: asynchronous messaging, live chat, video consultation, and in-person care when needed. At the centre – no matter the mode of care - sits clinical excellence and accountability.

This paper sets out the barriers that prevent digital health from scaling, and the practical steps required to overcome them. Only if we confront issues with solutions as partners, can we build a healthcare system that simplifies access, supports clinicians, and improves lives