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Analysis

Digitising the NHS and adult social care
What could it cost?

Published 8 May 2025
Time to read clock icon About 20 mins
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Key points

  • A shift from analogue to digital is at the heart of the government’s ambitions for NHS reform in England. The forthcoming NHS 10-year plan and the 2025 Spending Review, as well as the Casey Commission into social care, offer an opportunity to achieve a step-change in digitisation, improving productivity, patient experience and outcomes, and staff experience.
  • We commissioned PA Consulting to estimate what investment will be required to make the shift to a digital NHS and social care system. The research made estimates for NHS services across all care settings as well as publicly funded residential adult social care in the four UK nations.
  • This research found that significant investment will be needed in the UK over the next 5 years and beyond. Over the next 5 years, this includes around £8bn capital spending (of which £5bn is for England), £3bn one-off revenue spending (£2.25bn for England) and £2bn recurring annual revenue spending each year (£1.5bn for England). Recurring costs will be ongoing beyond the 5-year period that was the focus of this research.
  • Direct financial investment in technology is only part of the story. It needs to be accompanied by investment in implementation and ongoing support for training, maintenance and optimisation.
  • While it may be possible to cover some of this from existing budgets, it’s highly likely that the government will need to commit additional funding in order to successfully realise the shift from analogue to digital.  
  • Debates about digitisation often assume the resources required will be capital spending, but these findings highlight the importance of revenue spending – not just to support initial implementation, but also for ongoing software subscriptions, maintenance costs, staff training and optimisation work to realise the full benefits of technology.

•    We set out three key actions for government and policymakers:

  1. Set out a clear, transformative and durable vision for digitisation in health and social care
  2. Support the vision for digitisation with the required funding
  3. Alongside funding, develop a plan for realising the benefits of digitisation.
  • Policymakers will also need to address the significant gaps in information on the costs and benefits of digitisation that this research has highlighted. It will be critical to know how much is being spent on digitisation in the NHS and social care, whether these resources are being well spent and whether the potential of technology is being realised in practice.
 

Introduction

The potential of technology to transform health and social care is significant, from improving the quality of care and enabling new approaches to service delivery and to streamlining operations. Recent advances – particularly in machine learning and generative AI – have created high hopes that technology can help the NHS tackle the challenges it faces and meet ambitious productivity targets. In England, the government has signalled that a shift from analogue to digital is essential to its NHS reform ambitions.

Technology could also bring opportunities for social care, having formed a key part of the previous government’s reform plans in its 2022 White Paper, People at the Heart of Care. The current government has committed to create standards for technology in social care and to improve the joining up of health and social care data, while the Casey Commission provides the chance to set out how technology can support reform of the sector. 

Digitisation is central to creating a more technologically advanced health and social care system. This means putting in place the digital foundations critical for capitalising on technology, such as AI. These foundations include elements such as electronic patient records (EPRs), digital social care records (DSCRs), interoperability, hardware and software, cyber security, processing power, cloud storage, connectivity and Wi-Fi, and more. 

While there has been some progress on digitisation, the pace of change has consistently fallen short of policy ambitions. Ahead of the 10-year plan for the NHS, the Casey Commission and the 2025 Spending Review, the Health Foundation commissioned PA Consulting to estimate what further investment will be needed to deliver existing policy ambitions on digitisation. 

In this analysis we set out the findings of PA Consulting’s research, outline the methods behind the estimate, as well as the limitations, and put the findings in context. We conclude with the implications for digitisation policy and delivery. 

 

‘Missed opportunities’: a recent history of digitisation in the NHS and social care

Digitisation has long been seen as an opportunity to transform the quality of care in the NHS. And while there has been some important progress made – such as increasing national EPR coverage, rolling out the Electronic Prescription Service and providing access to health information through the NHS App in England – reviews by the National Audit Office (NAO) and the Health and Social Care Select Committee have found that progress has generally fallen short of expectations and policy ambitions. The government’s National Programme for IT aimed for every NHS patient in England to have an EPR by 2010. 15 years on, some trusts still do not have an EPR and few providers have tapped into more advanced EPR functionalities where many of the benefits to patient care and productivity can be found. Many trusts still use technology no longer used in other sectors, such as fax machines and pagers. Estimates suggest clinicians lose over 13.5 million hours a year due to inadequate or malfunctioning IT.

Reflecting on progress, the Darzi review argued that the past decade was a ‘missed opportunity’ for the NHS to prepare for the future, and to embrace technology that can enable a shift towards predicting and preventing ill health. 

In social care, technology has played an important role in care delivery, for instance through remote monitoring and management to help keep people receiving care safe and independent. There has also been a push to roll out digital social care records. In England, as of January 2025, 75% of CQC-registered adult social care providers had a digital social care record – up from 62% in 2024. However, there is much further to go to digitise social care, with significant numbers of providers still paper based, a workforce skills gap, funding constraints and poor digital infrastructure. 

Why is digitisation complex and challenging?

Delivering change of any kind in health and care can be hard, but technology-enabled change is a particularly difficult undertaking. In addition to the infrastructure and skills required, success depends on how the technology interacts with people, processes and the wider work environment, which can be complex. Consequently, work is often required to redesign workflows and pathways and to allow for iterating and improving ways of working over time. Learning from the rollout of technologies at scale, such as virtual consultations, shows that action will be required at a range of levels, from national and local, to ensure successful adoption.  

Ultimately, digitisation should enable transformation. Too often, however, technology is simply ‘bolted on’ to existing processes and pathways rather than used to improve them. As recent Health Foundation research finds, technology can sometimes have a negative impact on staff time, making existing tasks take longer or creating additional work. 

Often, technologies need to interact with each other. As the 2016 Wachter review noted, creating a functioning interoperable system is particularly difficult and needs the right technical standards, investment, training and leadership, as well as an appropriate balance between patient privacy and information sharing. 

Large IT projects, whether in the public or private sector, can be notoriously challenging to implement. In England, the experience of attempting to roll out EPRs through both national top-down procurement and more ‘hands-off’, locally led procurement has demonstrated that regardless of the delivery model, digitisation is fraught with challenges. These include setting a clear direction, getting governance and accountability arrangements right, ensuring realistic delivery timeframes and setting appropriate scope for contracts, providing resources and support for local implementation, securing sufficient staff buy in, and mitigating the risks of digital exclusion.

Ensuring digitisation ambitions are met this time round

The development of a 10-year plan for the NHS, the Casey Commission and the 2025 Spending Review provide a significant opportunity to address these challenges, and to set the NHS and social care on a trajectory to being fully digitally enabled. 

A review of NHS digitisation led by the Health and Social Care Select Committee’s Expert Panel found that one of the key reasons digitisation has fallen short of expectations is that funding has not been sufficient. And where funding has been committed, it has subsequently been cut. Previous Health Foundation research, and subsequently the Darzi review, found a capital shortfall of £37bn if the NHS had matched peer countries’ levels of capital investment since 2010. Over the same period there were repeated transfers from capital budgets to support the day-to-day running of the NHS. To ensure digitisation ambitions are met this time round, they will need to be properly funded, meaning the government needs a clear understanding of how much funding will be required. We believe it is crucial that the government produces such a figure – and regularly updates it – to ensure that plans are adequately resourced and that digitisation is delivering value for money.

In social care, Health Foundation analysis shows that relatively few previous reviews of the sector at a national level have focused on the potential of technology. This underlines the importance of the Casey Commission considering how technology can underpin social care reform.    

 

How was the research conducted?

The four UK nations have each set out ambitious digital plans for their NHS and social care systems, with common overarching goals around: 

  • digitising health and care records
  • increasing the digital capability of both the workforce and the people using health and care services, by making sure the right digital tools, skills and capabilities are available and accessible
  • giving people more control over their health and care through digital technologies. 

The researchers compared existing ambitions for digitisation in the NHS and publicly funded adult residential care across the UK, set out in policy documents from 2021 to 2024, with existing capabilities. (Note that the research did not take a view on whether the current policies on digitisation are the right ones.) The researchers then calculated the cost of closing the gap over the next 5 years. While the bulk of the analysis of policy documents was undertaken before the Labour government came into power, there has so far been no indication that the current government’s digitisation goals will be less ambitious – quite the reverse, with the new government’s rhetoric suggesting that they plan to deliver what previous governments have failed to achieve. 

Specifically, the research took a three-stage approach.

Figure 1

To make sense of these digital ambitions across the four UK nations and to understand the associated investment requirements, PA Consulting grouped the various digital policies into broad ‘cost themes’ – such as foundational infrastructure, patient records, corporate IT and cyber security. They then identified the separate ‘cost items’ that would need to be procured to deliver these themes – such as local networks, data centres and EPRs. The research then estimated what investment would be required to close the gap between the current state of digitisation and recent policy ambitions. 

Box 1:

  • Foundational technical infrastructure
  • EPR and specialist EPR
  • Digital social care/shared care record
  • Remote and virtual care
  • Primary care
  • Public facing solutions and systems
  • Digital skills/confidence and digital inclusion
  • Data and analytics solutions and platforms
  • Corporate IT
  • National platforms and programmes
  • Digital leadership and governance
  • Safe practice and cyber security
  • Sustainability and net zero
  • Other.

Full details of the approach and methodology is set out in the report published by PA Consulting, although we summarise the approach and some of the key limitations below (Box 2). The assumptions behind the research were also tested, validated and improved through a series of expert workshops and in-depth conversations with policymakers and health and care staff with a digital technology remit in England, Scotland and Wales during summer 2024.

Box 2: Approach and limitations

While a plethora of individual policies and announcements have been published over the years, there is no clear and consistent vision for digitisation in the NHS and social care. In many cases, policy documents are unclear on the specific standards of digitisation that need to be achieved. In some cases, such as for domiciliary care, there are virtually no published policies at all. The research therefore required some interpretation and piecing together of these policies, as well as drawing on data and experience from the NHS and social care, as well as other sectors. 

To make sense of these digital ambitions across the four UK nations, PA Consulting grouped the various digital policies into broad ‘themes’ such as foundational infrastructure, patient records, corporate IT and cyber security. They then identified the separate ‘items’ that would need to be procured to deliver these themes, such as local networks, data centres and EPRs.

It is also important to note that the research estimated the cost of delivering the four UK nations’ existing digital ambitions. It did not consider questions such as whether these are the right set of policies, or whether the delivery infrastructure is designed in a way that will achieve the promised benefits or value for money. 

As well as a lack of a clear and consistent vision for digitisation, the research also identified a lack of good-quality, publicly available data on the current state of digitisation. This was especially true of community health, mental health and adult social care services. There was also a paucity of comparative data to benchmark progress across the four UK nations and the regions within them.

To form a judgement on the present state of digitisation, PA Consulting therefore drew on a raft of individual documents, including England’s Digital Maturity Index, What Good Looks Like guidance (a framework to guide digital transformation) and integrated care system (ICS) digitisation plans to establish a starting point. They supplemented this by drawing on a range of sources, including evidence on:

  • what digital solutions and technologies were already deployed and being used by the workforce and/or public
  • what proportion of the NHS had completed, deployed or adopted technology (such as the proportion of trusts which had adopted EPRs)
  • speaking to stakeholders and professionals to get their views on maturity, where information was unavailable or insufficient, eg for digital capabilities.

PA Consulting used a sample of cost data and published statements to estimate the cost of bridging the gap between existing levels of digitisation and recent policy ambitions in the UK for each of the components of digitisation they had identified. So, for example, this might mean using the average cost of existing EPR systems in trusts to estimate the costs for those trusts that would need a new EPR system to meet the government’s digital ambitions.  

Again, the researchers were confronted by a lack of publicly available information. The majority of cost estimates were therefore derived from published ICS digital strategies and plans from England, backed up by data from other sources. This approach assumes that the information published in the ICS plans reviewed were broadly representative of what was required across England as a whole to achieve national ambitions. 

There were no comparable cost data from the devolved administrations, so PA Consulting had to extrapolate from data for England. Regional health boards in the devolved nations typically have much smaller populations than ICSs in England, so PA Consulting specified a range of estimates for Scotland, Wales and Northern Ireland. These reflect the uncertainty over what proportion of the costs of digitisation are relatively fixed, irrespective of population (such as designing an app) and those that vary with population size (such as laptops for staff).

Cost data was particularly scarce for adult social care, where the bulk of the evidence has come from a single ICS plan and was purely for the residential adult social care sector.

To turn the individual cost estimates into a realistic aggregate figure for delivering the government’s ambitions, PA Consulting made three further adjustments. 

  • First, complex and novel projects, such as those involving IT and new technology, can involve an ‘optimism bias’ towards project costs and duration, risking an overspend. Treasury guidance recommends increasing initial estimates by up to 200% to take account of this. PA Consulting divided each of the components of digitisation into low, medium and high risk of optimism bias – and adjusted the cost estimates accordingly. However, this approach only relates to project costs – not whether benefits will be realised (where optimism bias may be greater because of the mismatch between expectations for benefits realisation and reality.)
  • Second, the phasing of implementation is unclear, so PA Consulting present estimates in 2024/25 prices that do not take account of inflation beyond this timeframe. In reality, governments have consistently been optimistic on timescales for implementation. There are also risks that the lack of competition in some sectors (such as suppliers of EPRs in primary care), the capacity of suppliers to deliver to time and specifications, and shortages of a suitably qualified digital workforce, could lead to sector-specific inflation. All of these could lead to costs higher than estimated here.
  • Third, PA Consulting made assumptions about which costs of digitisation would count against capital budgets, which would be one-off revenue and which would represent ongoing revenue cost (such as software licences). These costs are to some extent fungible and the balance may vary over time as technology changes (eg cloud computing replacing data centres) or with procurement methods (whether you are buying equipment or buying a service). In the absence of data on either existing levels of revenue spend or what proportion of this could be redeployed, it is impossible to know the extent to which the PA Consulting revenue estimates represent an increase on what is spent on digitisation now. And without data on the revenue savings that could result from the adoption of digital technologies, we cannot say whether the net benefits are positive.  
 

What will it cost to deliver on digitisation ambitions?

The research found that digitising the NHS and adult social care in the UK would require significant investment over the next 5 years and beyond. PA Consulting’s estimate suggests:

  1. The NHS and adult social care would need around £8bn of capital investment (of which £5bn would be for England) over the course of the next 5 years to put in place the digital infrastructure and capabilities needed across the UK. This estimate assumes a baseline of zero capital investment, so this is the total cost to close the gap between where we are now and recent policy ambitions for digitisation.
  2. £3bn of one-off revenue investment(of which £2.25bn would be for England) would be required to design, implement and transition to new digital technologies. This includes cost items that have been categorised as revenue because they tend to occur only once, such as resources to install and deploy technologies or for initial training of staff to use them. The phasing of this revenue investment over the course of the next 5 years would depend on the phasing of new capital investment (described above) and the planned rollout of technologies, such as EPRs. We have no data on existing levels of revenue investment, but it is likely that some existing capacity could be freed up to support the design and implementation of new technologies. For instance, staff involved in design and implementation could move on to work on new technologies once previous innovations have been successfully adopted.
  3. A further £2bn of annual revenue investment (of which £1.5bn would be for England) would be needed to maintain, sustain and improve digital operations. PA Consulting hypothesises that a significant portion of these costs could be covered by existing revenue funding, such as existing resources for the support and maintenance of technologies, the operation and improvement of digital solutions, and digital skills and knowledge. 

Box 3:

Capital funding is used for long-term investments, such as buildings and equipment. For digitisation, this might be for tangible items such as network cabling and computers, or intangible items such as certain software.

Revenue funding is used for the day-to-day running costs. As far as digitisation is concerned, this is often needed alongside investment in capital to support the use of new equipment or digital systems. This funding can be:

  • One-off revenue, such as initial training costs to help staff adapt to new systems
  • Recurring revenue, to cover ongoing costs such as for resources needed to effectively use and optimise technology, subscription costs for software and continued staff capability building.

Figure 2:

While this research has several limitations (see Box 2), it gives an indication of the scale of investment needed, as well as the type of investment – in particular the requirement of revenue investment (both one-off and recurring) to ensure that the benefits of investment in digital technologies can be fully realised. This is often overlooked in debates about digitisation, but will be critical.

Breaking this estimate down by cost theme and cost item highlights several important points that may have a bearing on how future digital spending could be apportioned.

Figure 3:

First, while attention is often focused on the cutting-edge possibilities of digital technologies, this analysis underscores that significant investment is still required to ensure the basic building blocks of digitisation are put in place. This includes investment in: 

  • Foundational technical infrastructure, such as networks and connectivity, software and hardware, and data storage solutions.
  • Ensuring all trusts have an up-to-date EPR in place – not just for the small number of trusts still using paper records, but for the 55% of trusts that this research estimates may need to replace or upgrade their EPR system over the next 5 years.
  • Digital social care records to enable CQC-registered providers to meet and then progress beyond the current target of 80% (originally set for 2024 and then pushed back to 2025), and shared care records.
  • Corporate IT, covering systems and tools for internal business functions (such as HR and finance) and supply chain management, allowing staff to collaborate virtually, and tracking assets and resources.
  • National platforms and programmes, including for the NHS App, Federated Data Platform and cyber security.

Second, achieving policy ambitions to deliver more technology-enabled remote monitoring and virtual care will require substantial funding – close to £1bn capital investment alone (see Figure 3). This includes telecare as well as the rollout of technologies through hospital at home (previously known as virtual wards), for which there has been a strong push since COVID-19. 

Finally, while a detailed exploration was beyond the scope of the research, it became clear that there will be important interdependencies between investments in digitisation and other major policy ambitions. For example, for the NHS to meet its commitment to become net zero by 2045, for the emissions it controls as well as its wider supply chain, it will need to take several actions that relate to digitisation. This includes making existing digital systems more sustainable and ensuring that new technology meets net-zero goals as set out in the NHS Net Zero Supplier Roadmap. It also includes digital solutions that will enable the NHS and social care to become more sustainable, such as lower carbon digital infrastructure and energy management systems.

Is the estimate plausible?

The research provides an estimate of the cost of implementing recent policy ambitions for digitising health and adult social care, in the absence of an official figure. PA Consulting’s report sets out full details of the data and methodology used.

The estimate is broadly in line with some other recent work. For example, in 2020 the NAO estimated that the updated digital transformation strategy for the NHS in England would at the time cost £8.1bn to deliver. This included £2.2bn total of revenue funding. The NAO estimated a further £1.6bn would be required between 2019/20 and 2023/24 for the maintenance of core IT systems and services that support the day-to-day running of the NHS (sometimes called ‘live services’). They drew on an NHS England cost model based on data for 14 trusts. By drawing on published digital strategies and plans from several ICSs, PA Consulting’s research covers a wider sample.  

PA Consulting’s estimate of costs, if broadly correct, would strongly suggest that the pace of digital spending would need to increase from recent years to deliver recent digital ambitions – although we cannot say exactly how large the difference is, as robust spending figures have not been published. When previous governments have made budget announcements, it is not always clear whether they include both local and national spending or both capital and revenue. But existing data – such as those included in the Darzi review and in the 2024 spring Budget announcement that £3.4bn investment in NHS technological and digital transformation over 3 years would double ‘central spend’ – suggest that present spending levels would definitely need to rise.

Similarly, on adult social care, PA Consulting’s estimate is significantly higher than the £150m over 3 years for ‘digital transformation’ announced in England in 2022, even though PA’s estimate only covers the residential care part of the adult social care sector. 

Gaps in data and policy for digitisation

This research highlights significant gaps in publicly available information on the costs and benefits of digitisation. Given the focus across the UK’s nations on ensuring value for money in public spending, it is crucial to know not only how much is being spent, but whether NHS and social care resources are being well spent and whether the benefits of technology are being realised in practice. In order to make this assessment, gaps in data must be addressed by policymakers across the UK, if they are to secure value for money through digitisation. Significant gaps include:

  • Data on current digital and IT investment: governments need to know whether they are spending enough on digitisation to secure value-for-money improvements in the NHS and social care budgets. This research has shown that the paucity of data on current digital spending makes it hard to understand the overall costs of digitisation in a precise way. It is also impossible to estimate how much of this will need to be on top of existing spending, compared with existing budgets or spending that may be reallocated from existing commitments. 

    To improve this picture, policymakers must collect and publish data on what is spent on digitisation, including both capital and revenue expenditure. Relatedly, a more comprehensive and clear definition of digitisation would help to identify what categories of data to collect.
     
  • Data on the productivity impacts of digital technology: government needs to know whether it is securing the promised productivity benefits from its investment in digitisation in practice. This research focused on the total costs of achieving government digitisation aims, and did not attempt to calculate the benefits of these technologies, or the resulting cost savings. Fully assessing the value of digitisation and its impact on NHS and government budgets will require a detailed view of where digital technologies are being used and an assessment of their benefits and costs. This includes the productivity impacts of digital technology, including taking account of how long these might take to materialise.
     
  • Policy and data gaps for social care: PA Consulting’s assessment of recent policy ambitions revealed big gaps around both what social care digitisation policy is and how it is being implemented. While this assessment was largely based on policy made by the previous government, there is limited detail on the current government’s approach, beyond committing to set standards for care technologies and joining up health and social care data in England. When estimating the cost of digitising social care, there were significant challenges in understanding the current and desired state of digitisation based on policy documents, and a lack of data to estimate the associated costs. PA Consulting’s modelling relies largely on the data from one ICS plan, and includes only residential adult social care due to lack of data and clear policies covering domiciliary care (which makes up around 40% of adult social care providers). The estimated cost to digitise social care is therefore likely to be a significant underestimate. 

This partly reflects complexities of the social care system as a whole, with no nationally set budget for adult social care (as in the NHS) and a mix of public and private funding and provision – as well as inadequate funding, which has left the system with large numbers of vacancies and high staff turnover. Further, existing levels of connectivity, digital social care records and staff digital literacy within social care are generally behind those of the NHS, posing further challenges for digitisation. 

This highlights the need for:

  • greater clarity on the targets for digitisation in social care (including domiciliary care, where there is a major policy gap), who is responsible for implementation and how these improvements will be funded
  • vastly improved data on the existing state of digitisation in social care and the costs involved to reach government targets.
 

Implications for digitisation policy and delivery

This research required an exploration of digitisation policy and an appraisal of progress to date in the NHS and adult social care. Doing so involved drawing on independent reports from the NAO, the Health and Social Care Select Committee and the Darzi review of the NHS. This was then synthesised with insights from our expert stakeholder workshops, as well as wider Health Foundation research and funding programmes related to digitisation. 

Here, we offer three key recommendations for government and policymakers across the UK that will be critical to make progress on health and care digitisation:

  1. Set a clear, transformative and durable vision for digitisation in health and social care
  2. Support the vision for digitisation with the required funding
  3. Develop a plan for realising the benefits of digitisation.

1. Set a clear transformative and durable vision for digitisation in health and social care

There needs to be a clear and durable vision for how digitisation can enable transformation within the NHS and social care – in terms of improving the front-line care that patients receive, and the administrative and operational functions that ensure services are efficiently delivered. This vision needs to be realistic, learning from the experience of digitisation efforts to date, where there has been a mismatch between ambition and reality. 

The vision also needs to set out how care will look and feel different for both care providers and care recipients. There is a risk that digitisation efforts will simply convert the status quo into digital format, rather than enabling more radical transformation of health and care services to provide better and more efficient care for patients, as well as more manageable and satisfying work for staff. For England, this vision should be reflected in the 10-year plan, the Casey Commission and the 2025 Spending Review.

Once a vision has been set, it will be important to stick to it. The approach to delivering digitisation in the NHS in England has swung between national delivery (2000s), local autonomy (early 2010s) and ‘national standards, local decision making’ (the ‘portfolio’ approach from the mid-to-late 2010s). National bodies charged with oversight have repeatedly been restructured creating uncertainty – with NHS England the latest example. Priorities have shifted between the most advanced trusts (eg the Global Digital Exemplars) and the least digitally advanced trusts. As the 2020 NAO review of digital transformation found, this changeability has made achieving current ambitions more difficult. 

2. Support the vision for digitisation with the required funding

Several independent reports, including the Health and Social Care Committee’s Expert Panel, have found that insufficient investment and support has hampered progress on digitisation. Policymakers will need to align the vision for digitisation with a realistic assessment of multi-year funding (both capital and revenue), building on the findings of this research. This funding should allow health and care providers to use funding flexibly to tailor digital transformation to local needs while meeting national standards. 

Technology should help increase productivity in a range of ways, including freeing up staff time – though recent Health Foundation research suggests that not all time saved through introducing technology may go towards direct patient care, so policymakers should be realistic about how productivity savings are estimated. 

The level of investment over 5 years estimated by this project would require productivity savings of around 2–3% per year to offset the costs, which is two to three times the long-term productivity trend for the NHS. This underlines the importance of a clear plan for realising the benefits – discussed in more detail below.

Alongside the vital importance of capital investment, effective digital transformation requires revenue funding. This is worth emphasising as subscription-based software hosted in the cloud becomes more prevalent, requiring a different balance of investment in equipment (capital) versus day-to-day spending (revenue).  Revenue funding will also be important to support benefits realisation, including ongoing investment in staff training and capacity.

3. Develop a plan for realising the benefits 

Digitisation is not ‘done once’ but rather is an ongoing process. Despite this, there has tended to be a focus on getting new technologies in place but less focus on developing the new ways of working required and optimising the use of these technologies. This work is required to realise the benefits of technology and unlock productivity gains, but can take considerable time and effort. This is another reason why getting ongoing revenue investment right will be so important. 

Without a clear plan for realising the benefits of digital technologies, it will be a challenge for health and care providers to identify what actions they need to take or be held accountable for progress. Such a plan should have the needs of patients and staff at its core, and include actions that will drive transformation, rather than simply initial milestones for procurement and installation. 

EPRs are a case in point. As the bedrock of digitisation, EPRs – and the range of functionalities they can offer – will be critical. Although getting EPRs in place has taken longer than expected, acquisition of these systems is only the start. Recent Health Foundation research shows the extensive effort required to get EPRs working properly and capitalise on the more advanced functionalities they offer (such as clinical decision support and quality improvement tools) and calls for a strategy to make the most of these systems. 

The recent Darzi review found that many staff perceived IT as an additional burden. Realising the potential of digital technologies in health and social care will require sustained commitment to ensuring technology works well for staff. This includes ongoing training and support to accompany capital investments; the financial and technical support to manage these complex change programmes alongside operational pressures; and ensuring flexibility to respond to local conditions.

Achieving digitisation goals will require action at national, regional and local levels. It will therefore be important for digitisation policy and strategy to set out who is responsible for making what happen at these different levels of the system. Clear accountability will require greater clarity on what standards are to be achieved, and better data on what is being spent and what benefits are being delivered by technology implementation.

 

Conclusion

This analysis gives a sense of the amount and type of investment required to digitise the NHS and adult social care across the UK to meet recent policy ambitions. This will require significant one-off capital and revenue investment, as well as recurring annual revenue investment. The research also underlines that direct funding is only part of the story. Lessons from previous digitisation efforts suggest this investment needs to be accompanied by a clear and durable vision, and a plan to realise the benefits of digitisation. 

This research has several limitations, but it marks a step forward in estimating the cost of digitisation that we hope can be built on and improved over time. As we emphasise, the estimate also needs to be tempered with realism about the time and effort needed to achieve the benefits.

Further research is needed, particularly to develop a more comprehensive picture of current spending and to analyse the extent to which current spending could be redirected, as well as research to quantify the benefits of digitisation for both productivity and care quality. 

The 10-year plan for health, the Casey Commission and the Spending Review provide an opportunity to achieve a step-change in digitisation in England, and to set the NHS and social care on a realistic path to get there. But achieving the desired gains from digitisation – higher quality care, better patient experience, better staff experience and improved productivity – will require significant investment to make them a reality.

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