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Reflections on the Spending Review

Paul Gilliatt

16 June 2025

Opportunity, Complexity and the Road Ahead.

The significant boost in funding for the NHS and the planned £10 billion investment in technology over the next three years is undoubtedly welcome. But as always, the devil is in the detail.

A Step Forward. But What’s Behind the Headline?

Additional investment in NHS technology is essential if we’re to meet the growing demand and modernise services. However, several important questions need answering before we can understand the real impact:

1. Is the £10 billion truly “new money”?
It’s important to distinguish between fresh investment and the ongoing cost of maintaining existing digital infrastructure. The NHS’s foundational technology requires substantial support just to keep running, and that shouldn’t be underestimated.

2. What’s the strategy?
In the previous Spending Review, we saw a clear direction: digitise the frontline, strengthen data infrastructure and expand citizen access through the NHS App – the “three big bets” championed by Tim Ferris. Broadly, this remains the right approach. But will this new investment follow that same path, or are priorities shifting?

3. New tools vs optimising what we have
How much of this investment will go toward new, innovative technologies and how much toward optimising the systems already in place? Equally important is understanding the capital versus revenue split, and how much funding will go into people and skills, rather than technology. Often, the biggest gains come not from new tech, but from helping people use existing tools better.

4. National vs local investment
There’s a balance to strike between national-level programmes and frontline innovation. In many cases, we can achieve more, faster, by investing at the local level, empowering teams who are closest to patients and challenges.

5. What about social care?
Any meaningful transformation of health services must include social care. Investing in NHS technology without a system-wide view risks reinforcing silos. Health and care must evolve together, not in parallel.

6. The Single Patient Record. Vision or ambition?
A health record, owned and controlled by the individual, is a powerful vision. But it will be one of the most technically and politically complex undertakings in our system. Building this from scratch is unrealistic. A better path is to evolve from the digital foundations we’ve already laid.

Turning Policy into Progress

Having experienced several Spending Reviews during my time in the NHS, I know that behind the scenes, many dedicated professionals are already working to translate policy into strategy, investment cases and programmes. But this takes time, especially in the midst of another major structural change to the NHS.

What’s needed now is transparency, engagement and collaboration across sectors. Stakeholders at every level, from government departments to frontline staff, local leaders to innovators, should have a voice in shaping these plans.

A Future Built on Collaboration

Despite the complexity, I remain optimistic. Technology alone won’t solve our challenges, but when paired with the right investment in people and process, it can be transformative.

At SmartCo Future Health, we’re proud to play our part in shaping the future of healthcare, working across health and care to turn this vision into reality.

About Paul

Paul works in partnership with healthcare organisations to deliver people- centred transformation that improves services for patients and staff. He has 25 years’ transformation experience, with 15 years leading national programmes and services in the NHS, including Frontline Digitisation. He is a graduate of the Major Projects Leadership Academy, a High-Risk Review Team Leader for the National Infrastructure and Service Transformation Authority and a Mental Health First Aider.

About SmartCo Future Health

SmartCo Future Health is an award-winning consultancy shaping the future of healthcare. We bring a best-in-class team and future-focused approach; empowering clients, programmes and partners. We are a people first business, prioritising employee well-being, flexible working and equal opportunities for all.

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