NHS England - Transformation Directorate

Understanding the digital health landscape

In order to create a National Strategy for AI in Health and Social Care, we must understand what is currently happening within digital health as well as learn from previous programmes in the UK and around the world.

As part of our efforts to "learn from experience" we reviewed various cross-sector strategies and digital transformation programmes to identify drivers, barriers, and enabling factors that should be taken into account in the National Strategy for AI in Health and Social Care. This helped us determine seven core factors for a successful technology-driven programme:

  1. Engagement - knowing what good looks like for different stakeholders, understanding needs and priorities.
  2. Infrastructure - the basic physical and organisational structures that underpin the system.
  3. Mindset - established assumptions, attitudes and perceptions held by an individual or group.
  4. Workforce - the role of people and human resources.
  5. Leadership - the practice of bringing people together to work in pursuit of a common goal, using vision and strategy.
  6. Governance - the structure and processes for decision making, responsibility and accountability.
  7. Evidence - the rationale and factual drivers for change.
Graphic showing  seven core factors for a successful technology-driven programme
The 7 core factors for a successful technology-driven programme


Engagement helps us to understand what good looks like to different people. This means building an AI strategy that meets the needs of doctors, carers, people receiving care, and the health and social care system as a whole. For engagement to be successful it needs to be started early, be continuous, and involve a diverse group of people.

Successful and meaningful engagement is not easy. Finding the groups of people that need to be engaged with, and determining how and what to engage them on, is a bit of an art. It is not possible or desirable to engage everyone on everything. For example, a member of the public may be more concerned about their outpatient appointment happening on time rather than the AI-driven technology used to make that happen.

Engagement is not a one-way street. It is not only about listening to people but also demonstrating that their ideas have been heard, considered, and acted upon. This is why we hold various types of engagement activities while developing the strategy and will continue to do so to ensure that it reflects the views of people on the frontline of health and social care services, as well as patients and innovators.


Resources are key to the success of digital transformation programmes, including finances, computer systems, and software. Not all parts of the health and social care system are at the same level of digital maturity. Some still heavily rely on paper whilst others can use information collected electronically and apply AI to triage the list of patients waiting for treatment. Taking these differences into account is crucial to make sure that we don’t exacerbate health and care inequalities.


People’s mindset and attitude towards change can make or break a digital transformation programme. Framing change in a way that is meaningful to doctors, nurses and people receiving care is crucial. How will this new technology help improve care? How will it help reduce a nurse’s workload?

Clinicians and directors in hospitals and care homes do not always know how to achieve long term change within their organisations as they are focused on the pressures of the day to day. This is why it is important for teams like the NHS AI Lab to speak about change in a way that resonates with frontline pressures.


The health and social care workforce is huge and diverse. Digital skills are in demand in many sectors and finding people with the right skills and experience to be able to support digital transformation and the adoption of technology is not easy. The problem becomes even more acute when looking for people with the skills to implement AI technologies. This highlights the clear need to upskill the workforce.

The workforce needs to be empowered and have a sense of ownership over the digital transformation process and adoption of AI technologies. It should be something they do rather than something done to them. This is why the NHS AI Lab is looking at how the workforce can be empowered to use AI through our Ethics Initiative.


Good leadership enables clarity in pursuing a common goal, using vision and strategy. Health and social care leaders play a crucial role in articulating a clear vision of how the project will deliver practical benefits for communities and empower the workforce. It is leaders that set the tone for an organisational culture that is conducive to innovation. The NHS AI Lab needs to help leaders set that vision for how AI can be used through the National Strategy for AI in Health and Social Care.


The health and social care landscape is complex. Clarifying who is responsible for what is crucial to delivering a digital transformation plan. A lack of clarity can lead to confusion and disjointed implementation. Digital transformation programmes need to be realistic, have clear objectives, targets and timelines to evaluate progress. It is vital that they are seen as more than just IT projects: fundamentally, they are about organisational change.


In order to drive change, the evidence and value of using technology needs to be clearly set out. Interestingly, the impact of digital transformation can be dispersed and difficult to quantify. It is not always immediate as the benefits take time to realise. Evaluation is central to building evidence of impact and effectiveness. This is why evaluation plays such an important role in the AI in Health and Care Awards.