The NHS was founded on a simple promise: comprehensive care, free at the point of use.

But across the UK - and increasingly across other advanced economies - public systems are now characterised by fragmented pathways, variation in access, long waiting lists, and workforce pressure that have become persistent rather than seasonal.

Recent analysis by the BMA^[I] shows that it will take years to clear backlogs, with workforce pressures amplifying the problem as demand continues to rise. In a YouGov survey of NHS^[II] staff from March 2025, the top three problems identified were: insufficient funding, increasing demand and staff shortages.

For patients and families, the experience can feel like navigating a maze at precisely the moment they are least able to do so. Multiple touchpoints, disconnected booking systems, and unclear next steps force people to join up their own care, creating stress, delay and avoidable escalation into urgent settings.

These issues are not only frustrating; they are operationally expensive. When pathways break, demand shifts to the parts of the system that are least able to absorb it: GP practices, A&E departments, and ambulance services. Disconnected records and data silos compound the problem, driving duplication, repeated history-taking, avoidable follow-ups and ultimately unfinished care.

Despite living in a digital world, too much care still defaults to in-person appointments even when not clinically necessary. Of course, in-person care remains essential for many needs, but making it the default for everything is not sustainable when clinical capacity is finite and demand continues to rise. The result is the familiar “8am rush” to get a GP appointment, delays to access, and the widening knock-on impacts on wellbeing, workforce participation and productivity.

But it’s not just primary services that benefit from digitalisation, with hospitalisations decreasing by around 5% because of telehealth services.^[III]

There will be no single moment where the system “clicks” into place. Building a next generation model will take investment, coordination and sustained commitment. But the alternative is to continue treating symptoms while the underlying mismatch that is the cause itself grows even larger.

Recommendations:

• Commission end-to-end pathways, not isolated point solutions.
• Make interoperability and shared records a baseline requirement.
• Fund digital care infrastructure on parity with physical estate.
• Align incentives to completed care and outcomes, not activity alone.

Scaling digital-first care is not primarily a technology challenge. It is a leadership, coordination and infrastructure challenge.

Across government and the health system, responsibility for healthcare delivery, workforce productivity, data, digital policy, and regulation is spread across multiple departments and agencies. The consequence is predictable: no single owner with the mandate and accountability to drive system-wide change at pace.

At the same time, digital access gaps remain real. Rural, low-income and older populations are more likely to face barriers to using digital services, whether through connectivity, device access, confidence or support. If digital care is treated as optional, these gaps widen. If it is treated as core infrastructure, they can be actively designed out.

Connectivity should be viewed as a prerequisite for modern care not a “nice to have.”

Coverage and performance remain materially lower in many rural areas than in urban ones. In its latest ‘Connected Nations’ report,^[IV] UK communications regulator Ofgem reports that while gigabit-capable broadband coverage for residential premises has increased, it still lags for rural communities, with 81% of urban communities having access to full fibre and 91% having access to gigabit capable network coverage. This compares with 61% and 62% respectively for rural communities. If we’re to create a truly equitable, ambient healthcare system that works for all patients, the UK cannot let geography determine who has access to timely care.

Public systems also remain cautious about working with independent providers, even as demand pressure grows. Done badly, this can create fragmentation. Done well -under shared clinical standards, shared records and clear outcomes - structured partnerships can add resilience and expand capacity without compromising equity.

Digital-first care needs visible leadership, cross-government coordination, and a published roadmap that makes “safe scale” real.

Recommendations:

• Appoint a Minister for Digital Health and Data with a clear mandate and cross-Whitehall authority.
• Establish a Digital Healthcare Taskforce involving industry, clinicians and patient groups.
• Publish a five-year roadmap for interoperable records and digital-first standards.
• Treat digital inclusion and connectivity as part of health infrastructure.