By Stephen Sutcliffe, director of innovation & technology solutions and finance & accounting, NHS Shared Business Services
The NHS has no shortage of promising health technology. Pilots succeed, tools demonstrate value in individual teams, and there is rarely a scarcity of ambition.
The harder challenge is what happens once the pilots conclude. Too many innovations that work in one setting struggle to move beyond it, and the reason tends not to be the technology itself.
The barrier is more often the operational environment it enters: disjointed finance, procurement, payroll, and workforce systems that make adoption harder, data interoperability and governance patchier, and scaling across organisational boundaries more difficult.
From our work across NHS operational services, one lesson has stayed consistent. When these foundations don’t work, even strong technology can stall. When they do work, innovation has somewhere stable to land.
That is the central argument of a new report published this week, ‘Futureproofing the NHS’, which draws on a review of existing research and conversations with healthcare leaders.
It makes the case for treating operational infrastructure as part of the NHS’s innovation capacity and the current reform agenda.
Shared services as innovation infrastructure
Stephen Sutcliffe
Shared services are still often framed purely in terms of efficiency.
The more important question for those working in health technology is what shared operational platforms make possible.
The Health Foundation’s analysis of 467 studies on technology implementation found that outcomes depend less on the technology itself than on how it is embedded into practices, through workflow redesign, staff engagement and ongoing support.
That pattern is the same whether the tools and technologies are automation, AI, or a new clinical system.
Common workflows, comparable data and stronger governance create a repeatable route for improvement. Which is more effective than each organisation solving the same operational challenge independently.
Shared services allow the system to test once, learn, and extend what works.
Otherwise, a promising tool in one trust can remain trapped, if the surrounding systems are different, the data is inconsistent, or if implementation is dependent on local workarounds.
Shared operational infrastructure gives local leaders a reliable base from which to adopt new tools, while preserving the clinical judgement and community relationships that rightly stay local.
The functions that look essentially the same across every NHS organisation, such as payroll, invoice processing, procurement, and workforce administration, do not need to be solved hundreds of times.
AI readiness starts before AI
The debate around AI in healthcare moves quickly to regulation, and risk and those questions matter, but AI readiness begins well before procurement or deployment.
AI amplifies the systems, data and governance it is connected to. Where data standards are inconsistent, workflows are poorly understood, or accountability is unclear, AI will inherit those weaknesses, making existing variation harder to see and manage.
This matters because operational data is what most NHS AI applications will actually run on.
Where definitions vary between organisations, where data sits in silos, or where governance is unclear, AI inherits those inconsistencies and the result is tools that work in pilots and struggle at scale.
The lesson from implementation
We have learned that technology adoption depends as much on workflow design as on the technologies being implemented. The evidence bears this out consistently.
At Central and North West London NHS Foundation Trust, automating a single consent process freed 56 clinical hours a day for patient care. The benefits came from redesigning the workflow first, then applying technology to reduce the administrative burden. Digitising a broken process embeds friction rather than removing it.
Building for scale
The NHS is in a period of major digital investment, with up to £10 billion committed to digital and technology transformation by 2028/29.
The return on that investment will depend on whether operational infrastructure is in place to absorb and build on it.
Where shared operational foundations have been deliberately extended, costs fall, staff time is freed, and the capacity to adopt further improvements grows. Where investment flows into disjointed structures, the same problems recur, and returns diminish.
For the health tech sector, that creates a clear opportunity. The NHS has the scale to build shared operational foundations that no individual organisation could sustain on its own.
Shared platforms, consistent data, and collaborative governance are what turn isolated pilots into system-wide progress.
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