The NHS local technology spend report

What is the NHS actually spending its technology budget on - and is it buying the future the 10 Year Health Plan promises?

We believe this is the first independent, data-driven assessment of technology spend across NHS trusts in England. The picture it reveals is more sobering than the headlines suggest.

Public and political rhetoric paints a health service moving rapidly towards AI, remote care and prevention. The spend data tells a more grounded story. Drawing on supplier-level invoice data from more than half of England’s acute trusts across four financial years, we set out what is being spent, on what - and what it is costing the health service to continue as it is.

The headline is stark. At its FY24/25 peak, an estimated £1.3bn of local technology spend flowed through English trusts - but 65 pence in every pound went to simply keeping ageing systems running. Less than 10 pence reached the technologies most likely to change clinical outcomes and shift care closer to home: remote monitoring, population health, and AI-assisted triage and diagnosis. We estimate the cost of standing still at between £1.5bn and £2.9bn a year in avoidable operational costs.

What the report reveals: Seven findings that demand a response 

1. Spend has peaked - and is now contracting

   Visible supplier spend rose 28% to a £1.3bn peak in FY24/25, then turned: our sample is tracking around a quarter lower in FY25/26 as capital tightens. The question is no longer whether to spend less, but whether what remains is being spent on the right things.

2. Two-thirds of spend keeps the lights on

   65% goes to core estate - EPR licences, infrastructure, cyber and back-office tools. Essential, but not transformational. The NHS is not an innovation desert, but it is currently spending like one.

3. The ‘left shift’ is missing

   The technologies that move care from hospital to home account for under 10% of spend - and that share is not growing. Remote patient monitoring, which underpins virtual wards, totals less than £37m nationally over four years.

4. Regional inequality is hardening, not softening

   The North West directs 14.7% of its technology spend to left shift categories; the East of England just 5.1% - the same region with the longest waits and lowest virtual ward adoption. The places that most need to shift care are least equipped to do it.

5. A two-speed market

   National programmes run at pace and scale - a motorway of funding - while local adoption grinds onto single-track lanes, constrained by scarce implementation and change-management capacity.

6. AI is about to reshape the landscape - and the NHS response is unclear

   Less than £11m was spent on AI-first solutions in the last year - not an adoption wave, but a ripple. The critical gap is not technology; it is strategy, skills and governance.

7. Local programmes are duplicating national investment

   When trusts fund their own versions of nationally provided capabilities, the combined cost - in money, skills and delay - far exceeds any single programme. No one is currently mapping what exists, what is being built, and what should be rationalised.

What this means for you

Behind every percentage point in this report is a patient. The findings raise practical questions for everyone with a stake in the NHS’s digital future.

For NHS leaders, CFOs and trust executives

• Can you say what proportion of your technology budget genuinely enables transformation - and is it above 15%?
• Are you tracking ‘left shift’ spend separately, and protecting it when operational pressure spikes?
• Is EPR benefit realisation - not further procurement - now your priority?

For government and national bodies

• How do you move from investment programmes to measurable adoption, without repeating the mistakes of the past?
• What would it take to fix the CapEx/OpEx barrier and let funding reach the frontline in time to be spent well?
• How do you back British health-tech innovators without picking winners?

For suppliers and investors

• Where are the ‘flypaper’ trusts - the digitally mature adopters that absorb and sustain innovation?
• How exposed is your model to the capital cycle, and to AI displacing recurring SaaS revenue?
• What does the contraction in local spend mean for your route to repeatable scale?

How Baringa can help

Baringa works at the intersection of health system strategy and technology transformation, advising NHS England, integrated care systems and leading health technology companies on investment prioritisation, programme design and commercial strategy. We help leaders translate system-level insight into practical action - from where to invest, to how to make that investment deliver.