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We are now embarking on a transformative programme of reforms that will make sure the NHS is set up to meet the challenges of 2048, not of 1948, when it was first established, and also to make the vital changes that are so urgently required in social care.

The long-term sustainability of health and social care is dependent on having the right digital foundations in place, and so digital transformation must be the linchpin upon which all of these reforms are based.

This landmark document shows how we will take forward the brilliant advances that we have made during the pandemic, along with our acquired learning from decades of attempts at digital transformation before COVID-19.

We’ve already made huge progress. Over 28 million people now have the NHS App in their pocket, over 40 million people have an NHS login, and most NHS trusts have an electronic patient record system in place. This is on top of unprecedented investment in the digitisation of adult social care, including £150 million of funding for digital adoption that we announced in our recent white paper.

This plan sets out that health and social care will be delivered in a fundamentally different way, taking forward what we have learned from the pandemic, and from tech pioneers across the world. The aim is something that we can all get behind: a health and social care system that will be much faster and more effective, and deliver more personalised care.

The NHS App will be at the heart of these plans. We saw during the pandemic how people grasped the opportunity to have healthcare at their fingertips.

I am determined to make this app the front door to NHS services, and this plan shows how we will add an array of new features over the coming years, with new functionality and more value for patients every single month. My vision is one in which the app is an assistant in your pocket.

That plan includes a raft of other initiatives – £2 billion of funding to support electronic patient records to be in all NHS trusts, and help over 500,000 people to use digital tools to manage their long-term health conditions in their own homes.

Just as we are putting the right technology in place, we also need to make sure that people are confident and supported in using it. The plan also shows how we will relentlessly focus on digital skills and leadership and culture, at all levels, so we can make transformation durable right across the board.

The opportunities offered by digital transformation are huge, with benefits over the next decade running to billions of pounds in efficiencies, economic growth and private investment.

This agenda matters more than it did when this pandemic began. I am determined to use the power of technology and the skills, leadership and culture that underpins it, to drive a new era of digital transformation. So our health and care system, and our country, will thrive long into the future, delivering vast benefits for patients.

If it wasn’t the case before, COVID-19 has shown us that having the right digital and data tools at the NHS’ disposal can be as important as having the right medicines in our formularies.

Whether through underpinning the initial operational planning, clinical research into treatments, and then the rapid, highly targeted NHS COVID vaccine roll-out, data and digital technology has played a central, but largely hidden, role in how the health service has responded to the biggest public health threat in a century.

The same must also now be true of how we tackle the wider challenges of the coming years: recovering our services, reducing health inequalities and building resilience for the future.

While it will often be true that much of the important work the NHS does in this space won’t ever be noticed by people and their families – especially if it’s working well – there is also a huge opportunity in the coming years to provide vastly improved and more integrated health and social care services, building on the progress already made over the last few years.

At-home monitoring, virtual wards and outpatient video consultations have already brought more services into people’s homes over the course of the pandemic. And through expansion and improvement of the NHS App and NHS.UK over the coming years, services will increasingly be in people’s pockets too.

The NHS has always been, and will always be, a people business.

But it is also the case that the NHS has always been at the forefront of innovation and utilising new technology to improve outcomes and experience for patients – whether through pioneering new surgeries or rolling out new drug therapies.

Putting digital technology to work for people and their families – making more information accessible at their fingertips, enhancing access to the services they need, and giving them more power and control over their own care – should be seen as a continuation of that history.

This plan sets out both a vision that is ambitious for those we serve, and a credible roadmap for how the health service – working with our partners in social care, the life sciences and MedTech industries – can achieve it.

Digital transformation of health and social care is a top priority for the Department of Health and Social Care (DHSC) and NHS England (NHSE). The system’s long-term sustainability depends on it. We are directing this document at leaders in the health, social care and technology sectors so that together we can succeed in laying the foundations of a brighter digital future by 2025 and beyond.

Taking the right national and local decisions on digital now will put the health and social care system in a position to deliver the 4 goals of reform identified by the Secretary of State. The system will be equipped to:

This document consolidates the different national digital goals and investments detailed in separate sector strategies and guidance into one single action plan for achieving these goals on 4 complementary fronts.

Strong digital foundations are a platform for long-term transformation and they need investment. Our priorities are:

Enhanced national digital channels will give people more control over their lives. They will be able to interact easily with different health and social care providers, and access more resources for meeting their health and care needs when and where they choose.

Digital transformation that focuses on building trust with people and their families will enhance but not entirely replace the health and social care system’s offer. For those who cannot or prefer not to access digital services, traditional services will remain.

putting NHS services in people’s pockets through digital channels – over the next 3 years we will increase the functionality of the NHS App and website to offer features that help people stay well, get well and manage their health

scaling digital health self-help, diagnostics and therapies – we are supporting rapid uptake across the health and social care sectors of proven, easy-to-use and safe digital products

A brighter future depends on a stream of transformative technologies being developed and spreading fast through the health and social care system.

To guide all ICSs towards required levels of digital maturity by 2025 and help them go further, digital transformation needs to be embedded in oversight arrangements.

There have been many attempts to digitally transform the health and social care system over the last 20 years, from which we have a wealth of learning. This – combined with the glimpse of the future we have witnessed through the health and social care sector’s extraordinary deployment of digital technologies during the pandemic – gives us a great foundation for change. We fully understand technology’s potential to transform health and social care in applications ranging from virtual wards to vaccine records on a smartphone.

New and emerging technologies can support flexible, tailored services that promote people’s health, wellbeing and independence. They can tackle the huge challenges the sector faces by offering people timely access to physical and mental health services, helping them manage their own health and care. Digital technologies can reduce pressure on our overstretched workforce, giving them more time for the treatment and caring that only people can do, and help target disparities in access and outcomes. They can help to shrink the sector’s carbon footprint and improve its resilience to the effects of climate change and future pandemics.

For all these reasons, achieving digital transformation of the health and social care sector is a top priority for DHSC and NHSE. Our main tools for driving progress to date have been published guidance and investment.

Our digital goals are spread across a large number of existing strategies and guidance publications. Recently we have also defined digital maturity for ICSs in What good looks like. We have reviewed the integration of primary care through the Fuller stocktake report. There will be more digital elements in forthcoming strategies and 10-year plans – in particular those covering dementia, health disparities, mental health, cancer, urgent and emergency care, and women’s health – as well as in the updated NHS Long Term Plan and the Secretary of State’s ambitions for health and social care.

And alongside this document, we have published a strategy for data-enabling the health and social care sector, Data saves lives, which draws on lessons learned about the power of data from the response to the coronavirus (COVID-19) pandemic. This data strategy includes a range of commitments that will help connect systems, and details how we will use data flowing through the digitised health and social care system to continually improve services while maintaining the highest standards of privacy and ethics.

We are making investment in the digital underpinnings needed for a sector-wide digital transformation, in particular:

However, for digital technology to reach its vast potential to help people lead a good life, the health and social care sectors need to make progress towards digital transformation together, as a connected system.

There are 3 main barriers in the way:

To speed system-wide progress to digital transformation, this document therefore addresses the first 2 barriers. Its purpose is to inform the decisions that ICSs, their constituent members in local health and social care systems, and their tech industry partners are taking now.

This is so that, by 2025:

‘Section 1: embedding digital technologies’, summarises central actions underway to ensure that digital technologies are integral to the whole of the health and social care system by 2025.

‘Section 2: our vision for a digital future’, is a vision of what the digitally transformed health and social care sector means in practice. It follows the care journeys of 3 people in 2028 to illustrate the control that a digitised, connected system gives them to meet their care needs. We hope this shared vision will help you to shape local plans for digitally transformed services tailored to your population’s particular health, care, support and wellbeing needs.

Appendix A consolidates the different digital goals and investments detailed in separate sector strategies and guidance for the health and social care system into one single action plan for achieving the vision. The digital content woven through all these planning documents forms the entire content of this consolidated plan: it makes no ‘new asks’ of the health and social care sectors.

Appendix B sets out in more detail the plan for our national digital channels – the NHS App and NHS.uk website.

The main goals the action plans are designed to achieve are shown below.

By March 2025, constituent organisations of an ICS have:

This document provides a vision for the future of health and care while summarising the commitments that will help both systems digitise, connect and transform.

Digital services give people more control over their lives. They allow people to decide when and where they connect with their health and social care providers. They also give people access to resources for managing more of their own health and care when and where they choose.

At the same time, a range of digital technologies working in the background can help health and social care systems to improve the quality of all their care and prevention services, online and otherwise. Together, these developments free up staff to spend more time with those most in need of human care. In short, they create a virtuous cycle.

Scaling and sustaining that cycle is essential if health and social care services are to manage capacity and continue to provide high-quality care, given our workforce challenges. Along with learning lessons from the past and building trust with people, it is the key to making health and social care services sustainable. For the cycle to gain momentum, there needs to be a faster flow of approved, high-quality digital solutions from industry into services; and regulatory mechanisms need to enable its acceleration.

Below, we describe actions we are taking to drive digital transformation across the health and social care system.

We are furthering the uptake of digital technologies that ensure people have access to the right data at the right time. Our plans for key technologies are outlined below.

We have already invested significantly in supporting the adoption of electronic patient records (EPRs), primary care records (GPIT) and shared care records (ShCRs), and more recently digital social care records. In secondary care, EPRs are a critical attribute of digital maturity. We know that digitally mature providers operate with approximately 10% improved efficiency compared with their less digitally mature peers.

At present, only 20% of NHS organisations are digitally mature, although 86% have a form of EPR in place. Only 45% of social care providers have any form of digital care records.

Our goal is for all ICSs and their constituent organisations to have all the attributes of digital maturity, including electronic records and other critical systems, by March 2025. We have set this out in What good looks like. We are also exploring how to converge on fewer EPR products, which will make it simpler for staff and service users to interact with them.

Meanwhile, increasing the spread of digital social care records, with the aim of achieving 80% coverage for CQC-registered providers by March 2024, will allow carers to spend less time on administrative tasks and more time with the people they care for.

We are also providing national support, including funding, for locally led digitisation of frontline health and social care services. This includes defining the baseline systems providers should aim for in What good looks like as well as providing funding, advice and guidance for local oversight and specific funding to support uptake of digital social care records.

Details are in Appendix A.

Digitising separate health and social care records will help create a functionally single, life-long digital health and care record for each person. Digitising and connecting records provides access to the right information at the right time, which can improve the quality, safety and productivity of care.

When all the people involved in meeting a person’s health and social care needs – including that person, their family and unpaid carers – can see what each of them has done and is doing, in real time, they can co-ordinate as one team to meet that person’s needs and preferences.

Our expectation is that, by March 2025, all clinical teams in an ICS will have appropriate and secure access to a complete view of a person’s health record, including their medications and key aspects of their history. Non-clinical staff in social care settings will also be able to safely access appropriate information and input data into digital records in real time.

To address clinical needs, record-sharing through EPRs should be available to relevant staff in all settings, including community midwives and health visitors. In particular, primary care networks (PCNs), including their partners in third-sector organisations, pharmacies, high-street optometrists and community diagnostic centres (CDCs), will benefit from the seamless flow of data between frontline teams.

Details are in Appendix A.

Current constraints on sharing diagnostic images and pathology records mean diagnostic tests and images are often repeated. Digitally enabling diagnostic services avoids this needless repetition. It can also:

Our planned investment in new diagnostics capacity, especially in CDCs, aims to deliver these benefits, in particular through image-sharing and clinical decision support based on AI. This investment will also help to streamline planned urgent and emergency pathways, and support elective recovery.

AI also has great potential to help with waiting lists, productivity and levelling up under-served areas, as shown by the NHS AI Lab’s AI Health and Care Award recipients. With its ability to analyse large data sets, AI can support health and care professionals to make better informed decisions, especially in NHS screening services where the technology could speed up the diagnosis and treatment of conditions including cancer, stroke and eye disease.

The NHS AI lab is already helping to determine the areas where AI has the most potential to be deployed and scaled. The lab is setting up the regulatory frameworks and ethical assurances to help ensure it can be adopted safely and effectively, including ensuring data sets used to train AI reflect the diversity of the UK’s population to avoid bias in decision-making, and appropriate quality control and transparency of algorithms to avoid bias and unintended consequences.

We will continue to explore how AI and machine learning can supplement the decision support systems already used for triaging patients on urgent and emergency care pathways. Details are in Appendix A.

We are also using robotic process automation (RPA) to emulate human actions and interact with digital systems. As we automate basic manual and repetitive tasks to save time for staff, we will ensure that the way and reason automated decisions are made are understood by humans.

Many clinical and non-clinical roles within the health and social care workforce will evolve as AI and other digital technologies permeate clinical disciplines, such as radiology, pathology, cancer, surgery and also administrative functions. Emerging examples in mental health demonstrate how digitally enabled interventions can be used to augment care pathways to provide productivities to release clinician time for care, while enabling a more personalised and responsive care offering in between traditional care contacts.

We will ensure our health and social care workforce have the right skills to apply these technologies successfully and our organisations have cultures that foster innovation. This is happening through a number of initiatives, including a long-term workforce plan as well as short-term measures to expand the supply of specialist digital skills in the workforce.

Details are in Appendix A.

We are doing this by expanding and improving the 2 national digital health channels and through measures to increase the uptake of proven, high-quality, easy-to-use and safe digital products.

We have 2 principal national digital channels (NDCs), the NHS App and NHS.uk, the NHS.uk website.

The NHS.uk website now has an average of 80 million views a month and is the largest source of health information in Europe. The NHS App, through which people can interact conveniently with the services they need, now has over 28 million sign-ups, with the app being used by people an average of 2.7 million times a week. It is poised to become a ‘front door’ to health and care services generally.

Our vision is to use our national digital channels (NHS App and NHS.uk website) to help people stay well, get well and manage their health. Over time we would also expect to make key social care information viewable via the app for people and their carers. Over the next 3 years, we will increase the functionality of both these channels so they become platforms through which people, their families and unpaid carers can:

Our initial focus this summer and autumn is going to be on helping people manage their health – giving users access to their health record, the ability to manage their hospital appointments, receive notifications and messages, and amend their contact details and preferences.

Looking beyond the management of NHS interactions, our ambition is to support people throughout their life, providing an ongoing connection to their health and care. We will move towards a holistic and inclusive offer – starting with giving parents or legal guardians access to their child’s record from birth, through to tailored prompts for early mental health support, the opportunity to participate in relevant clinical trials, and accessing support following a new diagnosis such as stroke or dementia.

If we get the offer right, informed by what users tell us they want and embedding best practices, our national channels can prevent needs from arising or escalating, and provide access to tailored advice and care when they do. Our initial prevention priorities focus on blood pressure management and vaccine bookings and reminders, and this will be followed by targeted digital health checks. We expect our prevention offer, over time, to reduce demand for traditional NHS services and allow for a more efficient use of estates. Full details of the action plan for the NHS App and NHS.uk website are in Appendix B.

Enhancing access to digital health channels raises the risk of excluding people who can’t afford a digital device or mobile data, don’t have ready access to WiFi or who lack confidence in using digital tools. Lack of trust in the security and reliability of digital technologies is another barrier to digital uptake. The risk of digital exclusion is particularly high among those who already face health inequalities and have difficulty accessing traditional health and care services.

We will continue to work with the Department for Digital Culture Media and Sport (DCMS) and other partners to lower the barriers to digital uptake, especially for those most at risk of exclusion. Digital services will always be part of a multi-channel offer that includes in person, phone and online services.

We are supporting the rapid uptake across the health and social care sectors of proven, high-quality, easy-to-use, safe and effective digital products that offer value for money. To speed progress, working with the Medicines and Healthcare products Regulatory Agency (MHRA), National Institute for Health and Care Excellence (NICE) and the tech industry, we are devising clearer policies for accrediting digital health technologies (DHTs) that are likely to be adopted nationally by the NHS.

NICE will pilot a new early value assessment (EVA) through summer and autumn of 2022, initially focused on cardiovascular and mental health products. This process will streamline evaluation of evidence for the clinical and cost-effectiveness of products that address NHS priorities. NICE will conditionally recommend promising products to be available to the NHS, enabling their developers to collect more data before submitting them for full NICE assessment. These products will be available for local procurement via a single national framework. Products that pass the bar at the full assessment stage may be approved for wider use in the NHS.

The EVA builds on a project to assess digitally enabled therapies (DETs) used in IAPT services (NHS talking therapies), which will continue to run through summer 2022. We will extend access to DETs to more people, widen the choice of therapies, and offer more personalised treatment and opportunities for people to manage their own care better, all of which will improve service productivity, experience, safety and outcomes.

Following our departure from the EU, the MHRA is also developing new regulations for medical devices, including software and artificial intelligence as medical devices. The MHRA’s future regime for medical devices is aimed at increasing patient and public safety, transparency of regulatory decision-making, and alignment with international best practice. Importantly, the MHRA hopes to achieve more flexible, responsive and proportionate regulation of medical devices. The new regulations will come into effect in July 2023.

While these initiatives primarily address digital health technologies, others support adoption of transformative technology in the social care sector.

Details are in Appendix A.

We are spreading good tech through the health and social care system faster by supporting research and development partnerships and better tech procurement.

The UK has a vibrant health tech innovation sector, with many teams working to solve prevention, diagnosis, treatment and operational challenges faced by the NHS. However, we know innovators still find the NHS a hard market in which to scale. This is partly because of a disconnect between innovators and those frontline teams well placed to identify the most promising technologies.

That said, a few NHS trusts and primary care groups have developed strong processes for partnering with innovators and venture builders on developing and configuring sustainable solutions, and generating the high-quality evidence needed to demonstrate their impact. This evidence is crucial for rapid uptake of these technologies.

We are committed to supporting and systematising this good partnership practice. We are also working with regulators to speed the spread of well-evidenced technologies across the NHS. And we are supporting NHS organisations in their commercial negotiations with industry and funders to align the interests of all concerned behind products that make a real difference to people, staff workload and system productivity.

Similarly, we are making it easier for NHS organisations to collaborate with industry on researching, developing and mainstreaming tech-enabled service innovations that improve health and care outcomes, reduce staff workload and mitigate health inequalities.

In these collaborations, we will ensure data shared, accessed or hosted by researchers or industry partners will only be used for clinical, research, managerial and planning needs to deliver better patient care and prevention.

Details are in Appendix A.

NHS and social care buyers of digital technologies need to be sure they buy products that meet technical standards that ensure:

Tech sellers need to know the technical standards their products must demonstrate to win NHS accreditation. We are setting and enforcing clear technical standards (see the section ‘Enforcing standards’ below), including open standards to avoid challenges in changing suppliers. We are also working with suppliers to champion climate-resilient and low-carbon standards, as well as business models with a ‘circular economy’ approach.

In line with the government’s priority to buy once and use many times, and also to contain system-wide tech costs, we are leveraging the system’s purchasing scale more often, as we have done recently with the N365 deal and do routinely in medicines.

Building on guidance for trusts in Procurement Framework Strategy Recommendations, which we will keep updated, we will consolidate digital and IT procurement frameworks. Our aim is to:

Currently, similar products or services are often covered by multiple framework agreements, which has disadvantages for both buyers and vendors because:

We are equally committed to helping adult social care providers buy appropriate technology for social care records and other priorities, and to scale technologies that have proven benefits. We have already published a list of assured suppliers and draft standards and capabilities for digital social care records, which we will expand to cover other technologies. We will also work with sector partners to help local authority commissioners become confident and capable purchasers of care technology.

Details are in Appendix A.

As noted above, current levels of digital maturity vary widely and no ICS is yet making full use of the transformational potential of digital technologies.

To make and sustain the progress we expect over the next 3 years, we need to include our expectations of digital transformation in oversight arrangements for trusts and ICSs.

We also need to define and communicate how we will support compliance and intervene where compliance proves difficult to achieve.

At present, there are limited formal mechanisms for overseeing delivery of NHS digital priorities. Digital does not yet feature in the provider licence, System Oversight Framework, or CQC assessments. We are exploring options for filling this gap in discussions between NHSE and the CQC, and through a review and consultation with system leaders and frontline staff.

We need to use our regulatory levers to:

For social care, we will support the sector in understanding and meeting defined standards of digitisation, and explore how we can use incentives and levers to encourage providers to accelerate digital adoption.

This work will build on What good looks like and planned digital maturity assessments (from autumn 2022) to help ICSs prioritise actions in their local digital plans, and make sure those plans are robust.

In particular, we are helping ICSs to understand their levels of digital debt, the consequence of not addressing or investing in digital properly, and help them quantify expected benefits from digital investments by providing examples.

Details are in Appendix A.

Getting health and social care providers and their tech suppliers to adopt the same technical standards will ensure useable data can flow between IT systems in different organisations. It is the key to making systems interoperable.

We have been developing and publishing the necessary standards, and in social care we have published a standards and capabilities roadmap for digital social care record solutions that assured digital social care records suppliers will need to comply with.

In the NHS, we are currently working on how to make clear which standards are ‘musts’ for the sector and how we plan to enforce them.

Our legal powers to enforce technical standards among healthcare providers were originally set out in Section 250 of the Health and Social Care Act 2012. These powers have been strengthened in the Health and Care Act 2022 to ensure that all health and adult social care providers comply with any standards that we publish as information standards notices (ISNs). Their compliance with ISNs is mandatory.

These changes will result in data being in a standard form, both readable by and consistently meaningful to any reader anywhere in the health and social care system.

Service providers’ ability to meet mandatory standards is partly a function of their IT suppliers’ conformity to the standards. We are therefore working with the DCMS to include in the forthcoming Data Reform Bill further changes to Section 250 of the Health and Social Care Act 2012.

These will include a power to apply technical standards to suppliers of IT systems and services equivalent to those applied to health and social care providers. They will provide a power to enforce these standards through compliance notices and financial penalties, along with a power to establish and operate an accreditation scheme.

Details are in Appendix A.

We know from engagement with the social care sector that some of the biggest barriers remaining to digital transformation in social care are the levels of digital skills and basic digital foundations, including connectivity. Over 60% of care homes are still using internet connections that will not support full digital transformation.

The adult social care reform white paper, People at the heart of care, announced an investment of at least £150 million over the next 3 years to support digital transformation. We will ensure that all care providers can:

With these enablers in place, we will support 80% of social care providers to adopt a digital social care record, and ensure the 20% of care home residents who are identified as at high risk of falls are protected by sensor-based falls prevention and detection technologies by March 2024. These are important in tackling some of the most common and avoidable causes of admissions to acute care. For example, sensor-based falls prevention technologies are projected to significantly reduce the impact of falls, which cost an estimated £4.4 billion a year.

Details are in Appendix A.

This section presents a vision of the digitally transformed health and social care system in practice. This vision is informed by engagement with over 1,000 people working across the health and social care sectors, people with lived experience of health and social care services, and health and social care specialists in the technology industry. Our expectation is that local versions of this vision will be realised everywhere by March 2028 – 3 years after the health and social care system will be digitised and connected (March 2025).

The vision is illustrated by the care journeys of 3 people, Abdul, Sarah and Kris. Their experiences show how, by 2028, we will have moved from fragmented health and social care services that vary significantly across the country to a seamlessly joined-up system that allows people who use it to continue living as they wish.

A vast amount of technology-enabled, largely automated activity will happen ‘in the background’, allowing the staff working in the system to spend more time treating and caring for the people they serve. Groups and individuals who find accessing digital services challenging will particularly need their support. Some people may always need or prefer face-to-face engagement with health and social care professionals and the future system must continue to meet their needs.

It is 2028. Abdul, Sarah and Kris live in neighbouring communities covered by the same PCN. By 2025, their local ICS, like all others, had succeeded in digitising and connecting systems, upskilling their workforce and developing a strong data, digital and technical team. Since then, their ICS has focused on transforming health and social care services.

This is how Abdul, Sarah, Kris and their local system feel the difference…

Abdul is an 85-year-old man supported by his daughter, home care, and voluntary and community sector support that he pays for with his personal budget.

The home care provider and local authority have developed a care plan with Abdul that reflects his preferences and needs, including living independently at home. To support his independence, the local authority has put a digital medication reminder in his home that produces audio alerts, and he also wears a smartwatch that can alert a remote team in the event of a fall. Data from these technologies is visible to care workers and his daughter via his digital social care record. Abdul’s daughter’s role as an unpaid carer is also recorded in her health and care record.

Abdul falls and fractures his hip. The remote team sends an ambulance to Abdul’s home and he is admitted to hospital. Staff access and update his core health and social care information via his shared care record so his daughter and care workers are notified of the changes in his care.

Although care in the home remains an option, after his hospital admission Abdul and his family decide a care home would be the right place for him to go next because of his increased frailty.

His record is updated with a discharge letter and changes to his care plan, so the care home staff have the most up-to-date information to support his transition. Before he arrives, the care home staff install discreet falls prevention and detection technology in his room to give Abdul and his daughter peace of mind and help him stay safe.

Sarah is a 32-year-old single mother. She has a 5-year-old son, Kyle, and is pregnant with her second child.

Sarah had a miscarriage before her current pregnancy and is experiencing anxiety, nightmares and loss of interest in daily activities. Sarah has been tracking her mood through an app that links to her ICS’s maternity system and it sends a flag to her midwife. The midwife messages Sarah on the app asking her to book a same-day consultation.

During the appointment, Sarah explains her symptoms and mentions she is also worried because Kyle is not feeling well and has been losing weight. The midwife suspects Sarah is showing early symptoms of perinatal depression. The midwife flags a referral to the mental health midwife, who facilitates an e-referral to the Improving Access to Psychological Therapies (IAPT) service and recommends Sarah book a GP appointment for Kyle.

Sarah can choose a telephone, video or in-person meeting for her first IAPT appointment, during which she will be assessed. During her video assessment, Sarah chooses a clinician-guided digital therapy app that she can log onto in her own time, day or night, and is easy to use as it is interactive. She can also choose to have her sessions in her preferred language via chat, audio or video. The outcomes of Sarah’s assessment are securely submitted back to her care-giving team.

Sarah books an in-person GP appointment for Kyle through the NHS App. The GP can see that Kyle’s weight loss has been noted on his health record by Sarah and can see data from Kyle’s school nurse. After taking a full history and examining Kyle, the GP requests some tests. As Kyle’s legal guardian, Sarah will be able to access Kyle’s test results via the NHS App ahead of the follow-up appointment with the GP.

Kris is 56 years old, the only financial provider for their household, and has smoked on and off for the last 35 years. They are worried their health is declining. They are not sleeping and they are getting up frequently at night to urinate.

One weekend, Kris calls 111 about a fever and ear ache. The responder triages Kris using a clinical decision support tool and refers them to a local out-of-hours primary care clinic. At the clinic, Kris is diagnosed with an ear infection. Their other symptoms are recorded, along with their weight, blood pressure, smoking and anxiety levels. This data is automatically added to Kris’s record, which they can see on the NHS App.

The advanced nurse practitioner arranges for Kris to have blood tests to check for diabetes. Kris gets a notification through the NHS App that the results are back, requesting they book a follow-up appointment with their GP practice.

Kris chooses to book a video consultation with their GP. Together, they review the results and discuss treatment options. Kris decides to help manage their type-2 diabetes with the support of an app. Their practice’s social and digital prescriber helps them choose an accredited app that’s right for them.

Kris can also access support for giving up smoking and managing their mental wellbeing, blood pressure and type-2 diabetes through the NHS App. The support tools allow Kris to track changes in their conditions over time. This data is also fed into Kris’s record. Through the NHS App, Kris can continue to check in with their care team via structured questionnaires that can be risk stratified and then responded to in the most appropriate way.

The care journeys above show how digitisation and connection transforms the system’s capacity to deliver the Secretary of State’s priorities for reform:

How this works more broadly across the digitally transformed health and care system in 2028 is explained below.

In 2028, outcomes for individuals, communities and whole populations are being improved by digital tools including:

People are able to live independently and well for longer, supported by technologies chosen to meet their particular needs. Technology is also providing routes of access, as part of multi-channel offers that reflect the needs and preferences of individuals, helping to address health inequalities related to things such as income, geography, specific characteristics such as sex, ethnicity and disability, and social exclusion.

Analysis of data, supported by machine learning plus easy-to-use data visualisation platforms, is identifying population groups who are not accessing health services as readily as they should be able to and whose outcomes are unusually poor.

These technologies also underpin timely, evidence-based decision support for frontline staff, helping them to make sure no opportunity is missed or task accidentally overlooked. They show staff when to take pre-emptive action to prevent care needs arising or escalating, enabling staff to work more efficiently.

National digital channels, the NHS App and NHS.uk website are supporting people to access preventative services such as health checks, vaccinations and screening.

Digital tools help health and social care providers to plan, design and deliver services in a more personalised way while saving time for staff. Services focus on what matters to each person and their families, helping to reduce disparities, and reflecting individual needs and preferences. Using digital tools to access information and services, people can make informed choices and gain greater control over their care.

Similarly, with more granular information and understanding of the populations they serve, health and social care providers are co-designing and delivering services that better respond to people’s needs in the right place at the right time, through multiple channels. They offer care closer to or in people’s homes, including care homes, and online.

Digitised care pathways developed with the tech industry are inclusive and deliver better quality and efficiency at the same time, as well as lower carbon emissions.

Having access to real-time data enables people working in the health and social care system to collaborate better. Their organisations provide everything needed for really useful data and information to flow readily to and between staff:

This has reduced the load for frontline teams. They spend much less time on admin and communication tasks now so many of these are automated. So they are able to spend much more time connecting with and caring for people.

Boards, governance structures and system leaders purchase technology, and make decisions about its use with confidence.

Health and social care staff at all levels have the skills they need to work digitally, making their work more manageable, sustainable and flexible. Using online support tools, they can confidently identify, recommend and use technology that delivers high-quality care tailored to the needs of the people they serve. AI-enabled clinical decision support is cutting the time it takes clinicians to diagnose by up to one third for suspected strokes.

Electronic record systems that meet the required standards are transforming staff experience. Ready access to records for appropriate staff is not only boosting productivity and experience for staff, but also improving the flow of people within and between services. All this is taking a lot of the stress out of providing care.

The joined-up health and social care system is continuously learning and improving to accelerate improvements, including from international examples of best practice. It analyses data to understand variations in key system performance indicators – health outcomes, capacity utilisation, waiting times, financial balance, people and staff experience – and their causes.

Constant tracking of patient-reported outcome measures (PROMS) and patient-reported experiences measures (PREMS) surfaces hidden health disparities and yields real-time feedback and insights that inform targeted action to level up and improve quality, safety, outcomes, service design and planning.

The same comprehensive data tracking and analysis is used to evaluate new digital tools and services. Insights gathered are used to constantly iterate and improve tools and services.

Data captured by digital services is giving organisations deep insights into their operations and impacts. It supports cross-organisational and cross-system collaboration to:

Analysis of the carbon footprint of clinical pathways captures their environmental impact as well as their resource efficiency.

Our strategy for digital transformation over the next 3 years comprises 3 elements:

In this appendix, we set out the action plan comprising our key actions to support delivery.

This action plan is necessarily high level: there are many detailed actions planned for specific pathways and care settings and we could not include them all. Additional published resources where you can find those details, include:

There will be more actions in forthcoming strategies and 10=year plans – in particular those covering dementia, health disparities, mental health, cancer, urgent and emergency, and women’s health – as well as in the updated NHS Long Term Plan and the Secretary of State’s ambitions for health and care. The digital content woven through all these planning documents will be consistent with this vision and action plan.

Many of the actions below still require business cases that require HM Treasury approval.

These actions aim to aid ICSs and providers of social care in achieving the level of core digital capabilities and skills that underpin safe and effective care, and continuing on that upward digital trajectory. We will use our regulatory levers to keep them on track.

We expect the constituent organisations of an ICS to have core digital capabilities in place by March 2025. These capabilities include having:

The NHS Long Term Plan committed all trusts to meet a core level of digitisation and to have an EPR in place by March 2025, reiterated in the operational planning guidance for 2022 to 2023 and the Secretary of State’s priorities for transformation in healthcare. People at the heart of care also committed to 80% of CQC registered social care providers having a digital social care record in place by March 2024.

Annual digital maturity assessments will allow health and care organisations to measure their progress towards the core capabilities set out in What good looks like and identify the areas they need to prioritise. Organisations will be able to access the What good looks like hub, which brings together:

Working with partners in social care, we will expand What good looks like to include the social care sector by September 2022.

Our aim is that all NHS trusts will have an EPR system by March 2025 (90% by December 2023 and 100% by 2025). For social care, 80% of CQC registered care providers should have an assured digital social care record system in place by March 2024.

For mental health and community trusts, many of which already have an EPR, the focus will be on meeting the minimal digital foundations. We will be working with existing EPR suppliers to ensure their products meet our requirements.

GP practices already have digital records in place. However, to ensure GP services are fit for the future, their digital records need to be based on open standards and use cloud native architecture.

The health and social care system must be resilient to cyber attacks to safeguard people’s private information.

Working with ICSs, local authorities and DCMS, we will ensure that health and social care providers can benefit from the latest and fastest connectivity. We will also support the health and social care system to move to sustainable cloud services where it makes technical, commercial and business process sense.

To achieve digital transformation, we need to build general digital literacy, expert digital skills, and digital leadership in the health and social care workforce.

This includes leaders across the sector as set out in Leadership for a collaborative and inclusive future, an independent report into leadership across health and social care in England.

NHSE and Health Education England (HEE) are producing a long-term workforce plan for the NHS, so the actions below delivered by HEE and NHSE detail only our short-term plans for building and sustaining the NHS workforce’s digital skills.

Our short-term actions will expand the supply of specialist digital skills in the workforce by attracting high-potential graduates, apprentices and trainees as well as developing existing and aspirant health and care staff, and digital, data and technology professionals. The aim is to build a culture of digital literacy, expertise and professional information governance across the system to deliver more value more quickly through the use of digital technologies and data.

In social care, recent research showed that 45% of providers express concern that care staff lacked digital skills.

To equip the adult social care workforce with the right skills and support to embed digital ways of working, and align with wider workforce ambitions, we:

Only a minority of NHS trusts have achieved the core levels of digital maturity that are needed for safe and effective care. All of them need to reach those levels fast and keep going further. ICSs also need to be sure that trusts digitise in a way that makes it simpler for data to flow seamlessly between different records.

Given the urgency of these needs, we are exploring embedding digital into wider NHS oversight arrangements to:

Joined-up data is a requirement for joined-up services. These actions comprise what needs doing to enable the ready sharing of information across the health and social care system while maintaining the highest standards of privacy and ethics.

To get more connected, the system needs to share technical standards and certain capabilities nationwide. The increasingly connected system will support lifetime joined-up health and social care records, with all the improvements in quality, safety and experience of direct care these offer.

Data flowing through the connected system will yield insights into population health disparities and dynamics, supporting targeted population health improvement.

Data saves lives sets out how we will make better use of data to improve care for patients and people drawing on social care while maintaining the highest standards of privacy and ethics. The strategy contains more than 100 commitments to meet that requirement.

Our expectation is that, by March 2025, all clinical teams in an ICS will have appropriate access to a complete view of a person’s health record, including their medications and key aspects of their history.

Non-clinical staff in care settings will also be able to safely access appropriate information and input data into digital records in real time.

Digital record-sharing should be available to relevant staff in all settings, including community midwives and health visitors.

Our vision implies a health and social care system underpinned by technical standards that enable all relevant health data to be accessible by those with a legitimate right to access it at the point of need, no matter where it is held.

Specifying ‘must do’ standards will help:

There are some connecting services and functions that it makes sense to build once, either to benefit from economies of scale or to enable everyone to have a holistic experience of the health and care system no matter where they happen to be in England.

During the pandemic, the NHS demonstrated the extent to which data tools and analytics can transform operations, particularly through the NHS COVID-19 Data Store and Platform, which helpe:

Building on these successes, the NHS is developing a Federated Data Platform to support population health and capacity planning across the NHS.

These are actions to promote the transformative changes that will support the system now and help to realise the vision in section 2, which are made possible by digitising and connecting the health and social care system. They comprise actions to support:

Implementing digital enablers will also help to achieve ambitions set out in the Fuller stocktake report of integrated neighbourhood teams within the ICS and a digitally enabled model of access, navigation or triage and care delivery.

Our ambition to make the NHS App a digital front door to the NHS, helping people to manage their health, stay well and get well, is highlighted in section 1 above.

Combined with enhancements to the NHS website (NHS.uk) and readily available proven digital health technologies, this will enable the NHS to provide more support for people through digital services at home and in care homes, including support for managing long-term conditions.

The NHS App and NHS.uk website already offer millions of people in England a fast and convenient way to interact with the NHS – showing their COVID status, ordering repeat prescriptions and accessing their health records.

Our aim is that, by 2024, 75% of adults will have registered for the NHS App with 68% (over 30 million people) having done so by March 2023.

New functionality, such as vaccine booking, appointment management and blood pressure reporting, will ensure that these national digital channels support people with the tools and information that matter the most to them.

To deliver this, we have developed a wide-ranging action plan for both the NHS App and NHS.uk website, including a full review of how these digital channels must evolve to continue meeting user needs in 2025 and beyond.

Details are in Appendix B.

We need more people to get the benefits of the many proven, easy-to-use, safe and good-value digital health products being developed, such as wearable blood pressure monitors and sensors that can help prevent falls. To that end, we are working with NICE and other partners across the health and care sectors and tech industry.

We are taking additional measures to extend the uptake and understand the potential impact of digital technologies among people who use social care.

By increasing digital connection and providing more personalised care, we can support people to monitor and better manage their long-term health conditions in their own homes, enabling them to live well and independently for longer.

Digitising and connecting the health and social care system creates possibilities to radically redesign pathways and care settings. These actions focus on digitally transforming:

We have published digital playbooks to support clinical teams to reimagine and redesign care pathways by showcasing tried-and-tested technologies to solve real-world problems.

Screening services prevent or diagnose conditions early so that people have the best possible chance of living healthier lives for longer. We are working to develop national digital capabilities that will support the transformation of screening programmes for participants and staff.

Improving the invitation processes for participants will improve uptake and help to level up the health status of disadvantaged groups.

We expect advances in medical knowledge will lead to recommendations that more screening programmes should be implemented and that the screening of individuals will be increasingly tailored to their personal risk factors.

We are determined to create digital products that enable us to improve current programmes and to quickly take advantage of medical advances.

To deliver safe and effective care, we need to direct people to the right place in the most appropriate setting at the right time. To this end, frontline teams need to be able to access timely specialist advice and guidance on the decision whether to refer, and to make referrals accurately and efficiently.

By enhancing and extending our national referral platform, the NHS e-Referral Service, we aim to support ICSs to meet their target of reducing unnecessary outpatient appointments and follow-ups by at least 25% by March 2023.

Digitally enabled diagnoses can get more comprehensive results to people faster. To this end, we are investing in CDCs to increase capacity for digitally enabled diagnostics across the NHS.

Digital technology is fundamental to elective recovery, especially because it offers alternatives to face-to-face outpatient appointments. It can also offer people a more tailored elective pathway and release clinical time for other tasks.

Through changing the way a person both perceives and accesses the urgent and emergency care (UEC) system, we will both minimise unnecessary health risks by reducing contact between people and improve services.

Our actions here aim to mitigate the risk of excluding people unable or unwilling to access digital offers, and to design pathways to include all target users – digital and non-digital.

Access to digital solutions can be more challenging for some groups – for example, people on lower incomes who may not have a suitable device or who cannot afford the costs of data or connectivity. Some people may lack the confidence or skills to use digital channels. Others may always prefer face-to-face services.

Lack of trust in the security or reliability of digital technologies can also be a barrier to their uptake.

Mitigating the risk of digital exclusion is one of 5 key priorities that NHSE has asked ICSs to address in its drive to reduce health inequalities.

By May 2023, NHSE will produce a framework for NHS action on digital inclusion with our future plans, and will develop further resources to support systems in practical action.

User centred design is a recognised and effective approach for redesigning services to be more inclusive and meaningfully engaging people in transformation. The NHS digital service manual supports consistent, accessible and useable products and services that put people first.

Planned actions here aim to:

The tech industry has developed a large number of digital technologies with potential to improve people’s care. We want the best of these to be adopted and spread across health and social care. But often these technologies are not configured to the needs of the sector, do not integrate with existing systems and only have anecdotal evidence of effectiveness.

However, some providers are very capable at diagnosing the problems that could most benefit from tech, identifying or building good products, configuring them to the needs of the sector and then building the evidence base of effectiveness.

In addition to the actions outlined above, buyers of technology need to be sure they are purchasing products that meet their needs, and the needs of the people they serve. They must ensure that digital technologies meet NHS technical standards – for instance, on usability, interoperability, data protection and clinical safety.

Sellers need to know the technical standards they must demonstrate to gain NHS accreditation.

Long-term relationships with suppliers of the digital technologies are critical to transforming health and social care by ensuring those key markets remain active and attractive to small-to-medium-sized enterprises (SMEs), innovators and new entrants.

The Life Sciences Vision highlighted the UK’s ambition to be world leading in the development, testing, access, and uptake of new and innovative treatments and technologies. Access to the right data for researchers and innovators is essential to that endeavour.

Through the Data for Research and Development programme we will invest up to £200 million to transform access to and linkage of NHS health and genomic data sets for data-driven innovation and inclusive clinical trials, whose results will be critical to ensuring public confidence in data access for research and innovation purposes.

We aim to signal our interest in research into new vaccines, early diagnostics and treatments that better answer NHS needs to secure early access to innovations.

To fulfil our ambition to make the NHS App a front door to the NHS, extending the functionality and features available through the App and NHS.uk website, we will take an iterative, user-led approach – exploring, testing and refining our offer. Delivery is agile – what we develop depends on what users tell us matters most to them to manage their health, keep them well and get them well.

There is also much we can learn from best practice used in consumer-facing apps, as well as health apps being developed internationally. For example, in the US, Kaiser Permanente uses a multi-channel approach to remind their members to book into routine screening and health checks. In Singapore, the Health Promotion rewards programme incentivises healthy behaviours by offering rewards and vouchers for shopping healthily or exercising. Israel’s largest state-backed health provider, Clalit, combines user-generated and electronic patient record data to predict patient risks of developing serious health conditions and enabling early intervention. The NHS App is already recognised globally as leading the way in terms of uptake – but we will need to innovate constantly to ensure we fulfil its true potential.

To ensure we are fully leveraging the opportunity that the NHS App presents as a mainstream ‘front door’ through which the population can access health information and care – particularly in the face of technological and scientific advancements such as genomics – we are undertaking work this summer to set out a long-term vision and direction, exploring the full potential of the NHS App’s role in:

We are making sure we have access to more sophisticated data on how the NHS App and NHS.uk website are used, so we can make informed decisions to improve our services and understand the impact they have on people’s health outcomes. We will make this data more accessible through enhanced public-facing dashboards by the end of the financial year.

We will also clarify how third-party apps can be integrated, defining what is both appropriate and technically possible.

Our delivery roadmap for the NHS App and NHS.uk website is organised around our triple vision – together they will help people to:

We have a suite of features we are planning now. However, these will be refined, expanded and modified as we conduct more user research, make technical discoveries, and examine usage data to tell us what features really are the most useful and impactful.

Therefore, the roadmap below is an indicative view and will evolve over time.

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To stay well, I can:

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To stay well, I can:

To get well, I can:

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Don’t include personal or financial information like your National Insurance number or credit card details.

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