Technology decisions shape how care is delivered. When those decisions are designed around platforms rather than people, they can quickly introduce friction into workflows, fragmented communication and increase risk for patients and staff alike.
Over time, incremental investment, organisational silos and platform led decisions have created complex technology estates that no longer reflect how care is delivered in practice.
As services have expanded beyond acute settings into community, virtual and preventative care, digital infrastructure has struggled to evolve at the same pace — increasing cognitive load for staff, fragmenting communication, and introducing avoidable risk.
The issue is not always technology itself, but how infrastructure decisions are made. When design is driven by platforms and architectures rather than workflows and behaviours, systems optimise for stability and scale — often at the expense of usability, continuity and trust.
As pressure on healthcare systems continues to rise, organisations can no longer afford digital infrastructure that simply functions. Infrastructure must actively support how people work, communicate and make decisions — across wards, communities and preventative services.
Organisations that have made progress take a consistent approach: they start with people, design for real-world complexity, and use technology — including AI — to reduce friction rather than introduce it.
The following principles outline how healthcare and public sector organisations can design digital infrastructure that delivers measurable benefit for both people and systems.
Start with real workflows, not idealised ones
Understand what is actually happening. One of the most common failures in digital design is starting with what should happen rather than what actually happens.
On a ward, systems must support rapid switching between tasks. In community settings, they must tolerate variable connectivity. In preventative services, they must enable continuity over time rather than speed alone. Infrastructure needs to absorb this complexity without passing it on to users.
People-centred infrastructure should:
- Identify where legacy architecture forces workarounds, duplication, or delays.
- Design resilient, simplified infrastructure layers that remove steps for users, rather than compensating for complexity with additional applications.
Treat communication as core infrastructure
Communication underpins almost every critical interaction in healthcare — from triage and safeguarding to coordination across services. As such, voice and digital communication should be treated as core infrastructure, not peripheral tools.
In many organisations, communications sit across multiple systems with limited visibility, resilience or governance. This increases operational risk and makes it harder to assure quality.
People-centred infrastructure should:
- Provide reliable, secure communication services across sites and remote settings
- Ensure conversations can be captured and retained appropriately, in line with policy and regulation
- Enable analysis that supports quality, assurance and service improvement
Explore communications solutions
Use AI to reduce complexity, not introduce it
AI is most effective when applied at the infrastructure layer to simplify operations and surface insight, rather than to disrupt clinical decision making.
High value use cases focus on:
- Reducing manual oversight and administrative effort
- Identifying patterns across large volumes of operational or communication data
- Supporting assurance and decision making at scale
Build trust through security and governance
Infrastructure decisions directly influence trust, for staff, patients and partners.
People centred infrastructure embeds security, compliance and governance by design, ensuring that:
- Data is protected without restricting required use
- Access to systems and information is appropriately controlled, monitored and auditable
Design for today’s demand and future models of care
Infrastructure needs to support current operational pressure while enabling a shift towards more proactive and preventative models of care.
This means making technology decisions that can:
- Capture insight from everyday service interactions across clinical, operational and administrative services and use this data to support decision making
- Scale securely as services expand beyond acute settings into community and remote care
- Enable collaboration and information flow across organisational and system boundaries
- Provide visibility and observability so issues can be identified and addressed before they impact care
- Adapt to new models of delivery without requiring repeated largescale redesign
Infrastructure is a people decision
The most effective digital transformations programmes recognise that technology choices shape behaviour, risk and experience.
When infrastructure is designed around how people work, across teams and organisations, it becomes a stable foundation for safer care, better outcomes and a more sustainable system.
That is when digital infrastructure delivers lasting value.
Find out more about the digital foundations, services and insight supporting the NHS 10 Year Health Plan.
Connecting the Future of Health and Care
