Transformation Directorate

Additional information

Guidance methodology

A number of approaches were used to develop the content for this guidance. These include:

  • researching into national and international exemplar organisations and case studies
  • horizon scanning of emerging trends in healthcare and other industries
  • gathering collateral from recent RPA deployments in the NHS and internationally
  • gathering subject matter experts' (SME) input into RPA best practices

To co-produce the guidance with SMEs, we engaged and collaborated with a number of organisations across the health and care system. This includes working closely with representatives from the NHS acute trusts, mental health trusts, community, ambulance, social care and primary care. The Atos SMEs and other 3rd party suppliers have also shared their view on how to effectively and safely implement RPA in the health and care.

The guidance was also reviewed by a number of subject matter experts and regulatory bodies such as medicine and health regulatory agency (MHRA) and care quality commission (CQC). Other organisations who have collaborated in production of this guidance include

  • Number of care commissioning groups (CCGs) and integrated care systems (ICSs)
  • Academic Health Science Networks and NHS care commissioning groups (CSU)
  • NHS shared business services (SBS) and NHS business services authority (BSA)

Join the NHS National Community of Practice for RPA to access additional information.

NHS vision for RPA and automation in healthcare

This guidance supports the health and care system in achieving the automation vision set by the NHS England (NHSE) Transformation Directorate in its 2021 RPA in Health and Care Plan. This will support the Elective Recovery Plan and the Secretary of State’s mission to increase capacity by automating tasks such as patient registration and data uploads to enable staff to spend more time with patients.

Increasing productivity to deliver care to more patients, improving the quality of care, patient safety, the financial, operational and clinical efficiency, as well as improving patient and staff satisfaction can result in automation capability across all health and care systems by 2023 and leveraging on intelligent automation to transform service delivery by 2025.

Over the next 5 years, enabled through RPA, the aim is to deliver a more connected health experience that is fit-for-purpose.

Year of structure (2021 - 2022)

At this stage, the aim was to improve and share automation knowledge, capability and expertise across health and care. This was achieved through the development of RPA guidance, toolkits and best practices, alongside collaboration with various care settings and capital support to level-up automation adoption to inform RPA strategy.

Year of acceleration (2022 - 2023)

At this stage, the aim is to accelerate automation adoption across health and care by building on evidence-based approaches. This is achieved by choosing the right architecture and right choice of tools, open source for current processes, developing an automation standard, and expanding resources and capital support for RPA regional adoption.

Year of growth (2023 - 2024)

At this stage, the aim is to enable safe and rapid growth by providing continued support and setting direction for future years. This is achieved by continued capital support for both RPA and IA adoption, evaluating performance, capturing values and sharing key learning across the system.

Year of sustainability (2024-2025)

At this stage, the aim is to embed self-sustainability in continuing and developing the technology. This is achieved by employing a targeted and tailored approach, incorporating machine learning, monitoring performance, sharing values, and maintaining evidence-based activities with high ROI.

To support the realisation of the vision, a collaborative approach based on shared learning and insight is required.

Across the NHS, there are multiple RPA projects and programmes that have started to establish maturity across their organisations.

The health ecosystem can use the current expertise within the system to not only build upon their initial pipeline but to help them identify and understand any relevant pitfalls early in the process. Additionally, organisations should showcase, promote and publicise their own use cases, solution design and RPA journey to benefit the wider RPA community across the NHS.

Therefore, organisations can leverage current RPA expertise in the health and care system by following 3 steps.

1. Discover

Has someone done this before within the NHS and social that can be leveraged?

What business areas, functions or use cases have proven potential?

2. Adapt and adopt

Can existing solutions, codes or assets be repurposed or adapted to fit our requirement, making our implementation faster and cheaper?

3. Promote and share

What channels can we leverage to promote, share and publicise our programme and solutions so other projects can find them when needed?

Global trends in RPA

Global trends show increasing investment, adoption and broadening use of RPA across all sectors and a shift away from its perception as an IT-led solution. 

  • Cost

    RPA will become more affordable as vendor market saturates and supply increases.

  • Customer

    Nearly half of all new RPA clients will come from business buyers outside of the IT industry by 2024.

  • Scalability

    Move to cloud-based solutions enabling on-demand scalability and expansion beyond HR/ Finance/ Accounting into core and customer facing processes.

  • Data privacy and secuity

    Frameworks, policies and processes to ensure privacy and security are being developed as usage expands into core business functions.

  • Process intelligence and cognitive automation

    28% of those scaling RPA are also implementing cognitive automation, while only 6% implement cognitive automation without RPA.

  • Technical integration

    Complimentary emerging technologies such as computer vision, process mining and form creation are improved upon and increasingly integrated with RPA suites.

  • Focus on process improvement

    Focus on process improvement, before investing, to avoid the automation of broken processes.

  • Spend

    Global RPA software revenue is projected to grow to $1.89 billion by the end of 2021 (an increase of 19.5% from 2020).

  • Adoption

    90% of large organisations globally will have adopted RPA in some form by 2022.

  • Capacity

    Organisations are expected to triple the current capacity of their RPA portfolios by 2024.

Global trends show increasing investment, adoption and broadening use of RPA across all sectors and a shift away from its perception as an IT-led solution. Within healthcare globally, there is a clear opportunity for driving value from RPA, which is reflected in increasing investment, application and benefits realisation.

  • Setting strategy

    Healthcare organisations are shifting the primary use of RPA to becoming a strategic tool to drive decision making.

  • Financial impact

    According to a study by CAQH, the use of RPA could save the healthcare industry £10billion from admin costs alone.

  • Growth

    According to Gartner, in the next three years 50% of U.S. healthcare providers will invest in RPA (increased from the current estimate of 5%).

  • New opportunity

    According to McKinsey, an estimated 33% of tasks can be automated in healthcare with the potential to extend into clinical care and front-line service.

  • Beyond the back-office

    RPA is expanding applications such as workforce management, and this trend is predicted to continue until 2028; according to Gartner, there will be a 30% increase in the front-office use of RPA by 2023.

  • Designing new models of care

    RPA is driving the design and delivery of new models of care with care provision outside of hospitals walls in order to release capacity to care and improve patient experience.

  • Intelligence automation

    According to Accenture, 47% of healthcare executives state they extensively use RPA combined with AI technologies for customer interactions.

  • Global maturity

    Automation maturity is at its highest in the USA whilst the Asia Pacific region is expected to grow the fastest, with most contributions coming from India, China and Japan.

  • Spend

    Market size is projected to reach USD 1.83 Billion by 2028 (compound annual growth rate of 6% from 2021 to 2028); approximately 13% of RPA spend globally.

  • Benefits

    Increases efficiency, improves patient experience, reduces risk to data accuracy and security, amongst others.

Insights from the national survey

A pattern of increased use of RPA is emerging; however, delivery is often siloed leading to missed opportunities for efficiencies at scale.

Read the full report.

Designing capability

A pattern of increased use of RPA is emerging; however, delivery is often siloed leading to missed opportunities for efficiencies at scale.

Survey findings
  • 50% plus of respondents indicate RPA is being used in their organisations.
  • 42% of other respondents indicate they are considering using RPA.
  • Implementations range from immature (0 to 3 automations) to mature (25 plus automations).
  • Implementations have been undertaken largely in isolation of one another.
Survey insights

RPA is becoming more prevalent, leading to increased capability and experience. This experience though is largely siloed. There is a need to raise awareness of how to apply the technology and to look at efficiencies and benefits of a more joined up approach across the system.

Designing capability – challenges

Defining and understanding RPA

  • Varying definitions of RPA lead to misconceptions of what RPA is, what it isn’t, its benefits and how it should be implemented and sustained creating uncertainty amongst stakeholders.

Investing in RPA

  • High upfront costs for procurement, mobilisation and implementation lead to the true total cost being underestimated; multiple and complex frameworks through which organisations go-to-market and engage with suppliers delay investment.

Buy-in and consensus

  • Due to competing priorities and differing strategic objectives gaining buy-in and building consensus from leadership and across departments is complex.

Vendor engagement

  • Complex organisational structures within the NHS and a lack of well defined policies and processes create challenges for vendors to access and support organisations.
Designing capability – opportunities

Enhanced governance

  • To improve consistency through the introduction of a set of frameworks, policies and processes for implementing RPA across NHS.

Learning from experience

  • To drive wider options with a coordinated and structured approach to lessons learned and sharing good practice from those organisations at varying stages of their RPA journeys.

Use the technology to its full capability

  • To get the best benefit impact by leveraging full scale of technology capability. RPA is a proven technology. Use the projects as an opportunity to push the envelope on the solution design to maximise process efficiency.

Delivering capability

A capability gap exists to enable delivery at scale while technical complexity and varied governance arrangements create delivery challenges.

Survey findings


  • Only 2% of respondents consider themselves subject matter experts in the RPA field.
  • 28% indicated they are highly skilled and 33% with a basic skill level.
  • ~ 2% of organisations are delivering RPA in-house.
  • Common areas of capability deficiency identified include lack of business analysts and developers.
  • Commonly found that developer skilling up takes more-than-anticipated commitment.


  • There is a mix of cloud and on-premise implementation of RPA.
  • Test environments for multiple systems (ESR included) do not fully replicate production, therefore causing issues when promoting to live.
  • Numerous RPA implementations facing access management or smart card issues.
  • Some environments (test and prod) face CPU or memory issues when too many accounts access them at the same time (robotic accounts included).


  • Governing structure for RPA within the NHS varies
  • 15% of organisations have a dedicated Centre of Excellence (CoE).
  • 22% have provided governance through an already existing framework.
  • There is no overarching institution exist to share best practice.
Survey insights

There is a need to raise awareness of the basics, in relation to RPA and its application across the system. Capability gaps mean that options for accessing skills need to be considered by joint working within the sector and with partners. Experience from established CoEs should be shared freely across the healthcare ecosystem to benefit those organisations facing challenges relating to technology and governance models.

Delivering capabilities – challenges

Capacity and capability

  • Defining the required skills, technical expertise, level of resourcing, capacity and effort required for the implementation of RPA and ongoing support.

Technical complexity

  • Complexity regarding interoperability, solution architecture, solution hosting, bot development, licensing arrangements and traffic requirements require deep SME.
Delivering capabilities – opportunities

Knowledge transfer

  • Working closely with more digitally matured organisations and partners across the sector to build capability within teams.

Delivery models

  • Working with NHS organisations, and partners to deliver in a joined up approach that reduces duplication and minuses investment.

Sustaining capability

Process efficiency and accuracy are the primary benefits being realised whilst support is needed in navigating the vendor market.

Survey findings


  • Over 20% of respondents highlighted improved process efficiency, increased accuracy and productivity as key benefits from adopting RPA.
  • 19% indicated that there would be cost and time savings as a by-product of increased productivity.
  • Lack of clarity on if RPA is the most appropriate solution for certain situations rather than other tools such PEGA or system integration.
  • What ‘good looks like’ has been defined on a per-implementation-basis.


  • 45% of respondents listed Blue Prism as an already existing or potential vendor, 20% of respondents listed UiPath, 14% indicated NDL.
  • Some other providers listed include Automation Anywhere, Medxnote and NICE.
  • Most or all licensing and service agreements have been agreed at an individual trust, practice or organisation level.
  • Lack of clarity on what licences or packages are required by organisations.
Survey insights

Benefits are being realised across the sector however support is still needed in identifying the appropriate technical solution. The market is competitive with multiple vendors providing services to the NHS however investment has been localised potentially missing opportunities for added value at scale.

Sustaining capabilities – challenges

Decentralised automation operating model

  • Limited central coordination has resulted in siloed working, a lack of shared expertise and experiences between organisations and reduced the effectiveness of change management activities.

Data quality, security and privacy

  • Securely managing and processing high volumes of data, including patient data, generate significant security and privacy concerns.
Sustaining capabilities – opportunities

Teamwork and collaboration

  • To eliminate silos and improve collaboration, communication and teamwork across organisations.


  • Sustaining improvement and exploring new opportunities for delivering value through partnerships with international healthcare exemplars, cross industry working and with the start-up community.

Build momentum and scale

  • To drive business benefits more widely at NHS. RPA is a local technology with ERP reach. It’s secure, can be applied quickly and has already been proven at NHS.

Observations from the national survey

  • RPA is widely experimented with across the NHS
  • Most organisations already on the automation journey are between designing and delivering on the maturity model.
  • Predominant usage is in ‘traditional RPA’ targets of HR, finance, accounting – clinical usage is immature.
  • Usage in acute care and supporting organisations is most advanced compared to other care settings.
  • There is a limited usage within other care settings such as primary care, social care, community and mental health.

Example use cases

The practical application of RPA within the health and care sector can be understood through the concepts of ‘front’, ‘middle’ and ‘back’ office.

Front office

Here we focus on applying RPA, and digital solutions to free up time to focus on the most important activities: providing best in class care to our patients.

Middle office

Here we maximise the value to be achieved from our data to inform strategy and improve effectiveness in our budgeting, reporting and programme functions.

Back office

Here we drive out efficiency gains in high volume repetitive processes that can be delivered more efficiently and securely.

Join NHS National Community of Practice for RPA to access examples of Benefit Case, Benefit Framework and ROI.