How do we build a digital-first NHS?

By Dr Harry Thirkettle, Director of Health and Innovation, Aire Logic

Digital transformation is essential for the NHS’s future. The online hospital initiative is a significant step, but its success will come down to delivery. If we get implementation right, it will make a meaningful difference for patients and staff.

The term online hospital has been thrown around a lot recently, when I use it I mean a digital-first model where the default entry point is online or assisted-digital, pathways are redesigned end-to-end, and data moves securely across settings in real time. It complements in-person care rather than trying to replace it.

Getting the foundations right

The NHS has been clear that digital is a core lever for productivity and long-term reform, as outlined in a recent letter by Sir Jim Mackey, chief executive of NHS England. But meaningful change only happens when we build on the right foundations. That starts with cloud platforms that scale reliably, open standards so systems can talk to each other, and a clear approach to identity, consent and audit so people can trust the service they are using. Clinical safety and service redesign must run alongside and inform the technology. Digital inclusion has to be designed in from day one, not added late as an afterthought.

This is not technology for its own sake. It is about creating simpler, safer systems that reduce duplication and free up clinical time. At Aire Logic we have seen this in practice and helped NHS organisations unlock the benefits of technology which was designed for to meet user needs. At Leeds Teaching Hospitals, pre-operative assessments now run through structured digital forms that feed the EPR, cutting unnecessary appointments and admin while improving flow (Read more). At Portsmouth Hospitals University NHS Trust, we supported integration of a low-code forms engine into their in-house EHR to speed up data capture and reduce paper processes (Read more). At Leeds Community Healthcare Trust, moving dietetics processes online has improved access and reduced administrative work (Read More).

The promise of online hospitals

The case for change is straightforward, services are under enormous pressure and we have to do things more efficiently and effectively to keep up with demand. Many contacts do not need to be face-to-face. If routine steps can be completed at home, travel drops, queues shorten and clinicians can focus their in-person time where it is most valuable. Good tools can help people navigate services more quickly and give staff a clearer view of demand, flow and risk. None of this removes human care. It makes it easier to reach the right team at the right time and done correctly should free up NHS staff to do what they do best and provide the human elements of care.

Confronting the digital divide

Digital transformation should widen access, not narrow it. That takes practical choices and careful thinking from the outset. Assisted-digital routes need to sit alongside self-service, with phone support and community access points for those who prefer them. Services should meet accessibility standards, use plain English and offer language support. There must be non-digital fallbacks for people who cannot or do not want to use digital tools. Importantly, we should measure equity, not assume it: track uptake and engagement by deprivation, age, disability and language, and act on what the data shows. In our work, the teams that proactively tackle these issues and put safeguards in early see higher engagement and fewer drop-offs later.

The reality check

This is a large programme of work and the funding and operating model will matter. Sustainable change needs ongoing investment, clear governance and realistic timelines. National teams should set the guardrails through standards, safety expectations and reusable patterns. Provider organisations should choose high-value pathways to redesign first, prove the model locally and then scale what works.  

It helps to define success up front. For example, reducing avoidable face-to-face activity in a selected pathway without any rise in safety incidents, cutting the time it takes to integrate a new service by using standard APIs and event patterns, and maintaining or improving completion rates in the most deprived communities as digital uptake grows.

Moving forward together

Partnerships will be critical. Across the NHS, suppliers and SMEs have a role to play, but the terms should be clear. Prioritise open interfaces, data portability and tested exit routes so trusts retain control and avoid lock-in. Focus on platforms and patterns rather than one-off pilots. Publish API catalogues and integration guides so new services can join the flow without months of bespoke work. In our own programmes we have supported trusts and national teams to adopt FHIR-based interfaces and event-driven integration, which keeps data moving and reduces rework when services change.

This isn’t only about the plumbing. It is about safer, more workable services on the frontline. That is why we advocate pairing technology with pathway design, clinical safety cases and training. It is also why we involve frontline teams and patient advocates early, so what’s built reflects how care is actually delivered and the needs of healthcare professionals, patients, and other stakeholders. We've seen how discharge-to-assess improvements with better information at the point of discharge can shorten delays and improve handovers when community teams are part of the design from the start.

A few pitfalls to avoid

Procurement sprawl is a familiar risk. A flurry of pilots without a shared platform or clear strategy will end in fragmentation and frustration. The NHS should buy with reuse and scale in mind. They should guard against vendor lock-in: require standards-based APIs and full data export, and test the exit route before signing. Safety debt builds quickly when tools arrive without updated operating procedures, so develop the safety case and training plan alongside the technology. Finally we must remember the people, adoption takes time, we have to take a user centred approach to design and implementation and bring people on the journey with us. Protect capacity, build super-user networks, and give teams simple playbooks so changes stick and quickly become business as usual.

Where this leaves us

The NHS has a long tradition of being bold when it matters. An online hospital, built on sound foundations and delivered with inclusion and safety at its heart, is a practical way to make care more accessible and sustainable. The proof points already exist in local services that have digital, data and pathway redesign working together. The task now is to do the basics well, address the digital divide and share the patterns that work and scale with care across the system.