Could the NHS leapfrog the rest on public sector digital work?

For a long time there’s been an uncomfortable irony in UK government digital circles: the NHS is the part of government with the most to gain from the digital age, but it has been one of the least well-equipped to realise those gains.

This is not to say there is no good work happening. On the contrary, the NHS has some of the best digital work I’ve seen in the public sector. Look at the NHS App, with its 15 million monthly users. Or platforms like NHS Notify, or initiatives to manage vaccinations in schools, record vaccinations, check patient eligibility, and make referrals. Behind this work, there are teams using best-in-class digital approaches, supporting everything from breast cancer screening to eliminating cervical cancer.

The challenge is that these ways of working remain exceptions. Digital-era working is far from the norm, and the lack of a suitable operating environment has kept the potential of digital work out of reach. One reason is that there has been an absence of senior executive leadership with a deep understanding of what a digital-era environment looks like. The NHS has never had a native digital leader at Director General-level or above.

This all changed this month with the arrival of Rob Thompson as Chief Digital, Data and Technology Officer. Rob joins with a strong track record from the Home Office. (For background, read his post on the Home Office 2030 Digital Strategy and this follow-up.) It would be foolish to think that one person can turn around a system of this scale on their own. But a new role like this can and should mark a new chapter in the NHS’s digital maturity, and a new commitment from the entire leadership — official and political — to finally create the conditions needed.

So what could we see, if the next few years go well? In large part, of course, the answer is: delivery. There will be a huge push for improvements to the patient experience and value for money. But of course we can only get so far just by revving an outmoded machine harder. So the drive for delivery has to run alongside those efforts to modernise the operating environment.

It’s this question of the operating environment that I want to focus on. How should this work be approached? And what could it mean for the next chapter of public sector digital reform more widely?

Some will say the most optimistic story is one in which the NHS catches up to other parts of the public sector. The NHS lacks many of the basics: vibrant DDaT professions; enabling functions — finance, governance, procurement — that ‘get’ digital ways of working; a proper funding settlement for in-house products and platforms; an appropriate operating model in which mixed discipline teams are held accountable for real-world outcomes, and have the autonomy they need to deliver them. Achieving these basics will be difficult.

I want to argue, however, for a more ambitious framing: that over the next five years, the NHS could leapfrog others in the public sector, and start to define what next generation public digital work looks like. I say this because the same things that have made the NHS tough terrain for digital work so far— the complexity of the environment and of the work itself, the decentralised nature of the system — now make it well-placed to become the frontier. This does not mean ignoring the basics. It means doing the basics in service of an ambitious vision; starting small, thinking big.

What would that look like in practice? Here are four examples, shared in a spirit of open debate.

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1. A digital-era operating model

The operating model in keystone organisations like the Department for Health and Social Care (DHSC) has to be made fit for digital work. Even today, in 2026, DHSC and other key institutions run to an old-school bureaucratic org-chart. They are structured in silos with an organogram that reflects administrative functions and provider interests (primary care, secondary care; functions like finance, policy, clinical assurance), with digital itself also treated as a silo. This contrasts with a contemporary operating model, built for mixed discipline teams organised by things that matter to patients (e.g. services, products, care pathways, prevention outcomes). Today’s system also uses outmoded processes: hierarchical sign-off, output-oriented business cases, old-school project management.

An outmoded operating model is a huge drag on digital work. It often makes it literally impossible to work in the iterative way that is needed (e.g. a digital team may have to wait for sign-off from a neighbouring policy team, or clinical assurance function). It also means digital teams have to constantly re-litigate arguments, debating again and again with support functions — governance, finance, project and risk management — why traditional processes won’t work, and will only increase risk, waste money, and harm patients. This throws sand in the gears, wasting time and money and burning out staff, who eventually leave to work in more contemporary organisations.

The arrival of a DG-level digital leader could start to draw a line under these arguments. With the backing of the top team, it should now be possible to permanently establish a digital-era operating model, starting in the places where this matters most: in the ‘digital first’ parts of the department’s portfolio. This includes enduring funding for products and platforms and proper outcome-based and devolved accountability. In 2026, this should all be taken for granted.

Does this leave space to be more ambitious? The reason I think it does is that, in the NHS, there is no choice but to be ambitious when it comes to the setup of mixed discipline teams. Even more so than elsewhere in Whitehall, it is vital in healthcare for mixed discipline teams to also integrate clinical assurance and policy. There is little point having an agile multidisciplinary team if each iteration to a service has to wait for sign-off from a colleague in a separate policy team, who sees even small changes— e.g. new wording on a letter — as a change to policy.

Good NHS digital work therefore has to integrate disciplines like policy and clinical assurance. And this then puts the NHS at the heart of today’s most promising movement for public service reform, Test & Learn.

The Cabinet Office Test, Learn & Grow initiative is supporting mixed discipline teams to work on complex problems across the public sector, integrating digital disciplines but also people from policy and operational professions, and domain experts. I wrote recently about how these Test & Learn methods can be used in the NHS, unpacking why they are so well-suited but also how they can be adapted for the NHS context.

Of all parts of government, the NHS is one of the best placed to benefit from Test & Learn methods. And the wider philosophy of TLG as a reform initiative — especially the ‘grow’ element — is also tailor-made for the NHS. It is an alternative to the long-running and disastrous reliance on top down restructures. If we apply the logic of TLG instead, reform is driven from the bottom-up. A network of small teams would work at the edges of the NHS, and drive change up and through the system.

How could we advance this reform agenda? DHSC could step closer to a digital-era operating model, while also preparing the ground for a deeper transformation, by setting up 5–10 Test & Learn teams, in collaboration with the Cabinet Office TLG programme. These teams could work on outcomes that are complex but achievable. (See the examples in my previous post, including diabetes prevention, reducing the admin burden for cancer patients, and developing home blood tests as an end-to-end service.) Each team would integrate digital, policy, design, clinical assurance, from a mix of local and national NHS organisations, including frontline staff. The teams would work in the open, with a direct line to senior leaders to help remove blockers, and regular Show & Tells with the Perm Sec and Ministers. This would be part of a wider learning architecture built around the teams (the ‘Grow’ part of TLG). Usefully, the TLG programme is already working with DHSC via two local health ‘accelerators’ in Liverpool and Plymouth, linked to the National Neighbourhood Health Improvement Plan (NNHIP), so there are existing relationships.

As part of this work, the NHS could also define contemporary versions of its key professions, including the NHS policy profession — describing their role in the multidisciplinary team. This would see DHSC playing a leading role in Whitehall’s wider efforts to modernise the policy profession.

The goal of all this is better outcomes for patients. But as with the GDS exemplars, the Test & Learn teams would also help to win an augment, proving the power of the method by showing it in action. In time, we might even see GDS learn from Test & Learn methods in the NHS; for example, the lessons from this work could inform revisions to the delivery phases of Discovery, Alpha, Beta, which these days are often rather too linear.

2. Digital-era devolution

This might already sound like enough to be getting on with, but let’s turn to another area where the NHS could leapfrog. This relates to what devolution looks like in a digital age.

Much of the best public sector digital work in the last 15 years has focused, understandably, on building a strong digital centre. This was true of GDS’s early efforts, which built national platforms, like GOV.UK and Notify, and transformed high volume transactional services, like applying for a passport. It remained broadly true of the subsequent period, too, when digital work spread into government departments. Most departments started with central work to modernise services, like tax self-assessment, even if they engaged with local organisations.

Building digital maturity in the centre has been important, and you can see why we started here. It was hard enough to overcome Whitehall inertia, let alone transform wider local and regional systems. In recent years, however, as digital teams have made headway at the centre, attention has turned outward. For obvious reasons MHCLG was an early leader in this work, and has learned a lot about what it takes to support good digital work in a devolved system; indeed, some of the best thinking on decentralised digital work is now happening there. More recently, GDS itself has turned outward, setting up GDS Local, which I must say is a very good idea.

What about the NHS? In the past, the decentralised nature of the system was seen as a negative. I suspect it was high on GDS’s list of reasons for deciding, in the early 2010s, to put the NHS in the ‘too difficult’ box. Today, however, I wonder if the prospect of doing great digital work in a decentralised system might have gone from being terrifying to tantalising. Indeed one could argue that there is no part of government better placed than the NHS to prove the power of devolved systems in a digital age, and to help us develop this playbook.

What do I mean by this? For the last few months Kinship Works has been working with Richard Pope at Platformland on a concept we call digital-era devolution. We contrast this with ‘dated devolution’, in which devolution plays out as a series of binary arguments (‘should this be local or national?’; ‘should this be mandated, or should we allow local discretion?’)

With digital-era devolution, the system is more dynamic. People in local, regional, and national roles collaborate on an evolving portfolio of shared challenges, and the centre enables this by supporting a series of what we call ‘operating patterns’.

The operating patterns are ways to get work done collaboratively in a decentralised system, and together they function as a new grammar of devolution. Examples are: common platform, curated local services, collaborative capacity, and modular assembly (we will publish more details on the patterns soon, illustrated by case studies). The goal is to get beyond debates about ‘national or local’, or ‘mandate or don’t’, to a world in which diagonal teams work openly, all across the system, on shared work, on behalf of everyone. In this world, good work can originate from anywhere and spread everywhere, and collaborating across boundaries is normal.

The point to bank here is that the NHS could lead this agenda. This is not to say DHSC should skip building a mature digital centre, but just that the NHS is especially well-placed to prove the power of digital-era devolution. Indeed one could argue it is impossible to deliver the NHS’s existing agenda without doing so (consider how regional teams have already been given new accountabilities for digital delivery; and digital devolution will be vital to the success of neighbourhood healthcare).

Even small steps in this direction could make a big difference. In our upcoming paper on the operating patterns, for example, we describe some ways DHSC could support the operating patterns, including: establishing a seed fund for local digital work; setting out explicit strategies for the role of platforms and curation; establishing frameworks for local collaboration; and creating an NHS equivalent to GDS Local (in collaboration with DSIT).

Done right, this could boost the morale of innovators across the NHS, retaining talent and unlocking new capacity and ingenuity. It would also show that digital work is not a centralising play, as it is sometimes seen by local NHS actors; it is about helping better work to happen all across the system.

3. Market-shaping

So far I’ve talked as if all digital work is delivered by the public sector. But of course the private sector also plays a huge and frankly very problematic role in the software market around healthcare.

If a film was made about the public sector’s relationship with private providers of software, it would be a disaster movie, and the NHS would be the epicentre of the disaster. The NHS is still the part of government worst affected by vendor lock-in, legacy systems, market power and duopolies, and over-reliance on expensive contractors with low digital competence. It is hard to overstate the costs to taxpayers, NHS staff, and patients.

This might not sound like a promising starting point for ambition, and it would be understandable, when it comes to fixing the software market, if leaders focused on incrementalism and putting out the worst fires. There is a lot that could be done, for example, by using the new powers to shape software markets in the Data (Use and Access) Act 2025, especially by enforcing interoperability standards. There is also no-brainer but difficult work needed to modernise procurement to support small and innovative suppliers, including via more agile processes like competitive dialogue. And it should be possible to get help from DSIT on this work, thanks to their investment in digital innovation and commercial capabilities.

Even here, however, there is a case for being bolder. Precisely because the NHS software market is so broken, and because the state’s role in healthcare is so dominant, there is a recognition of the need to act, as well as the power — if the political will is there — to do so.

DHSC should start to develop a market-shaping strategy, and should begin to build the capability to deliver such a strategy. This includes using tools like strategic acquisitions and open-sourcing; building public options to break duopolies; setting standards through software and APIs (as opposed to publishing ever more complex data standards as PDFs); and being far bolder on interoperability.

This work could have a huge impact quite quickly, and it would be another case of the NHS leading the way, showing how market-shaping is now a vital part of public sector digital capability.

4. Movement-building

I’ll end with a suggestion that might sound less interesting, but which I think could leave the biggest legacy. This is about reinvigorating the NHS DDaT community.

In the early days of GDS in the 2010s, some of the biggest and most lasting impact was delivered not by developing products or digitising services, but by building vibrant communities in disciplines like design, content, product, delivery, and engineering. This attracted digital talent to the public sector, fostered excitement, helped to boost people’s skills, and raised the coherence of the work by defining shared professional ethics and principles. The people in these communities did great digital work but they also then went on to be agents of change across Whitehall.

There is a lot here for the NHS to learn from, and catch-up on. Although the NHS has some support for the DDaT workforce (regional Digital Skills Development Networks, a DDaT graduate scheme), it would be a stretch to say there is currently a mature or lively NHS-wide DDaT community.

Partly as a result, the NHS has struggled to attract and retain digital talent, driving high vacancy rates and over-reliance on consultants, which run at 80% of headcount in some areas (in part due to counter-productive hiring freezes and headcount reduction targets). It also means the NHS is missing a trick for morale, personal development, and the cohering force of strong professional identities. This matters even more in the NHS context, where there are powerful clinical professions, many with mentalities that run counter to good digital work (e.g. compliance-driven management practices). As a consequence, DDaT practitioners often end up being sidelined, and work gets tangled in old-school requirements (e.g. governance, risk management). Indeed the historic lack of digital leadership is partly a symptom of this; many senior digital roles in the NHS are filled by people from clinical or programmatic backgrounds — this is very valuable experience, but it means there is a lack of native digital leadership.

This all speaks to the value of investing in an NHS DDaT community, with training, career pathways, NHS-specific codifications, and communities of practice. It would also be wise, at least in the short-term, to bring private suppliers into this culture — the over-reliance on contractors will not end any time soon — building a ‘one team’ culture in which people leave their lanyards at the door. The goal is for members of digital disciplines to do great digital work, but also to advocate for the right conditions, and then to become agents of change across the system as a whole.

So far this all feels quite basic. But that last point about system-wide change hints at how a revitalised DDaT profession could help the NHS not just to catch-up, but leapfrog other parts of the public sector.

One thing the rest of government has not yet managed to do is build truly system-wide DDaT communities. A system in which DDaT professions reach far beyond central government into local and regional institutions, so that everyone feels part of — and is able to work like — a single collaborative community. Certainly initiatives like One Team Gov have got close to this, as have other meetups — go to events like Camp Digital, and you will meet many people from local government. But this has never quite gone beyond a sense of community to building a genuine, ongoing system-wide architecture for collaboration on a shared portfolio of work.

In the NHS, there is the potential to do this, building a genuinely NHS-wide DDaT community. Imagine NHS-wide communities of service designers, developers, content designers, and data scientists, not just feeling a shared sense of mission — pride in their discipline, multiplied by the pride we all feel for the NHS — but working together on shared challenges. Picture people from local NHS Trusts, ICBs, and primary care networks, working on projects alongside DHSC colleagues. And imagine if these communities also linked into other thriving NHS networks for collaboration, from the Q Community to GIRFT to Health Innovation Networks.

So here too, we can see a case for starting small — re-energising the NHS DDaT community — while having a bigger ambition mind.

Conclusion

When I was working in Number 10 many years ago, I met a very senior NHS boss at a drinks reception. I asked them how on earth anyone does a job that big, with so many people and so much risk sitting under them. They leaned in towards me conspiratorially, and whispered in a theatrical fashion: don’t look down!

I often think of this joke in the context of perilous public sector jobs, like DHSC’s new digital Director General. To even think about doing a job this big, overseeing a system this messy, is almost nauseating. So I’m certainly not arguing for adding more work to the in tray.

What I am suggesting is that sometimes aiming big is the best way to deliver the more urgent priorities. But also that a bold medium- to long-term vision can change the way you do the foundational work in the short-term, which means it’s worth asking these questions now rather than ‘starting with the basics’, and later turning to bigger ambitions.

In each of the four areas I’ve described, it should be possible to start small — achieving some early wins, putting out some fires, and of course releasing noticeable value to citizens — while also starting the journey to a more radical destination. That could re-energise reformers in the NHS and across government, but it could also start to define what next generation public digital work looks like, setting an example for others to follow.

For more on this theme, see this recent post on Test & Learn methods in the NHS. Or this post on the wider question of how we can save bureaucracy from itself. You can follow my writing on Blue Sky, Medium, or Substack. If you’d like to work together on these topics, drop me a line at Kinship Works — we support more adaptive, contemporary, and human approaches to government.