Dr Malte Gerhold is Director of Innovation and Improvement at the Health Foundation, leading their work to support radical innovation and improvement in health and care services. The MTG spoke to him about the promise of the NHS Ten Year Plan, the changes in culture needed to drive adoption, and patient involvement in a time of technological transformation in healthcare. 

You’ve been vocal about the need to fund not just technology and innovation, but also its implementation. Recent research published by the Health Foundation shows just 19% of national innovation programmes also fund spread and adoption. What have you seen in the Ten Year Plan that suggests spread and adoption might improve? How successful do you think these initiatives will be? And what, perhaps, were you disappointed not to see?

To my mind, the Ten Year Plan is the first attempt to set out, at a national level, a vision for the NHS that is moving towards a technology and data enabled – and digital first – model of care. Of course, there are many questions still left open about how to realise such a vision – and what exactly it should look like – but I agree that technology has to play a central role. That doesn’t mean it’s a ‘silver bullet’. It is an enabler of changing our model of care, and how we do that change is the critical question, not the technology itself.

While the plan itself doesn’t answer this change or delivery question – and in that sense it’s probably better to call it a vision or direction, as any government publication of this kind would be – there are aspects of the plan that point towards it. For example, there are proposals to move towards multi-year spending allocations, and to reserve 3% of spend for transformation, both of which will make technology-enabled change, and associated benefit realisation, much easier. 

The government’s spending review also committed £10bn over three years to investment in technology. While it’s yet to be seen how this is allocated, it acknowledges the need for further investment in improving the NHS digital and tech infrastructure. Our own research on the costs of digitisation emphasised exactly this point.

The Ten Year Plan also makes welcome references to the importance of adoption and spread of innovation and technology. For instance, building this into modern service frameworks, including adoption and spread of innovation as a criterion for how providers and commissioners are judged under a regime of earned autonomy, and making it a focus of the new global institutes. Again, though, whether they succeed will depend on the approach they take, so I’m looking forward to seeing and helping with the details underneath these ideas.

The Medical Technology Group is currently developing a report on culture within the NHS, looking at how different components – from meaningful patient involvement to an understanding of value – can drive the uptake of technology and innovation. When it comes to culture and implementation, what actions do you regard as particularly important at a local NHS level, and can you point to any strong examples of best practice you have encountered?

There is an important tension here between the central or national ‘policy levers’ that can support implementation, and the reality on the ground. The best designed policies around innovation passports, agile regulation, or payment incentives, will not do anything if we don’t also pay attention to the motivation, capabilities and resources of staff locally to actually make the change happen. We found this in our recent work on realising the benefits of technology, with the biggest barrier arising from local capability and capacity. National incentives and local capacity need to come together to be successful.

The Ten Year Plan – and the subsequent life sciences sector plan – naturally major on policy levers, and there’s much to commend in both to acknowledge that our biggest challenge aren’t new ideas, but their implementation and spread. That said, much of what this approach to implementation and spread will be still needs working out now.

So when it comes to the local level, the greatest priority, and probably also challenge, is how to create the capacity for change both in and across providers, and the local system. There’s no one size fits all to this question, as much will depend on the local context, including the type of providers, universities, and so on. The Health Innovation Networks have a role to play here, but they also cannot solve it on their own. Regions and systems and care providers need to come together to solve this question for them.

It’s hard to point at any one example here, as I think everyone is grappling with this question to some extent. We are currently doing work with a cohort of ICBs and HINs to help answer this question, and how it’s changing in light of the new expectations of ICBs on the back of the Ten Year Plan. We know from supporting and researching change in the NHS over the past decade, that getting staff buy-in will be particularly critical. The narrative for change will need to acknowledge the challenges that staff face at present, and show in a meaningful way how the changes proposed will support them and align with their professional motivations.

How can we ensure that patients are meaningfully involved in shaping the technological transformation of the NHS, so that innovation reflects their real needs, builds trust, and helps reduce health inequalities rather than widens them?

The first thing to say is that, on balance, both public and staff are broadly positive about technology, and AI in health care, as we found in our annual polling on the topic. But the polling also showed that this differs between groups, however, including women, or certain socioeconomic groups. So we’ve got work to do!

The culture shift that I hope to see is that in speaking to the public, and to some extent also staff, we do not start from the technology, but from the outcome or capability that we want to develop for them – to speed up access to care, say, or to make clinical processes easier – and only move from such an agreement on what we’re trying to achieve towards the role of technology.

Part of this for me is that from the outset we explicitly talk about making care better for everybody, to improve equity and access for all communities. The digitisation of (parts of) care shouldn’t just be about making the status quo easier, or more efficient. It should be about making care better, more equitable, more accessible. I’m really heartened to hear this ambition reflected in various conversations with NHS colleagues since the publication of the plan.

Putting both of those points together, I think there is more room still also to define the problems that we want technology (and AI) to resolve for us, rather than being led primarily where industry has developed an offering. Being demand or challenge driven in this way is something we have been calling for in our work on both AI and technology. This is particularly important where market-based solutions are less likely to emerge for smaller or disadvantaged communities – we have a role here to shape where our efforts are focused.

Alongside all of this, we have to acknowledge that good, meaningful involvement of all communities, to be successful, is a carefully designed process of building relationships and partnerships locally. That requires time and resources – but is absolutely worth it! We know that digital inclusion is about a lot more than being able to use an app, or particular tech. The good news is that from our work we have seen practical examples of where teams are designing inclusive digital health care services, and demonstrating how meaningful patient engagement can be done. The NHS can build the capacity to do this as well.

Going back to your first question, investing in the change not just the tech also means investing in genuine partnerships with staff, patients and public, towards a shared ambition of what better care looks like.

July 2025