To explore the implications, Healthcare Management convened a roundtable of sector leaders: former health minister and co-host of the Prevention is the New Cure podcast, Steve Brine; Shane DeGaris, group chief executive of Barts Health NHS Trust; Richard Kirby, chief executive of Birmingham Community Healthcare NHS Foundation Trust; and Sally Gainsbury, chief policy analyst at the Nuffield Trust.

Digital funding

One of the centrepieces of the Autumn Budget was the £300m earmarked for NHS technology. DeGaris welcomed the investment, noting the potential it unlocks for remote monitoring, virtual wards and more intuitive outpatient pathways. ‘This is about helping patients become better partners in their own care,' he said. ‘Making it easier to book and manage appointments, access records through the app – these are the kinds of shifts we need to support a left-shift in care delivery.'

Kirby said the opportunity of more funding lay in knitting together disparate systems: ‘The interface between community health, GP systems and social care is critical', he observed. ‘Shared care records only work if they span the whole spectrum.'

Gainsbury was quick to caution against assuming any short-term productivity boost, however. ‘Technology adoption is not linear,' she said. ‘There's a time lag between implementation, process redesign and any resulting efficiency. And staff need time to learn, adapt and absorb change. That's often overlooked.'

Brine warned transformation depends less on the size of the cheque and more on the system's capacity to deliver. ‘You only get productivity gains when tech is wrapped in genuine service redesign,' he argued. ‘What worries me is whether NHS England has the internal capability left to do this after the exodus of staff from the former NHS Digital. Without the workforce and integration, I struggle to see rapid rollout.'

He recounted NHS England chief executive Sir Jim Mackey's recent assertion that if the NHS continues with traditional clinical–admin pathways – ‘patient sees doctor, doctor writes letter, patient attends building' – the system is ‘done'. Digital transformation is not optional, Brine emphasised, but the risk lies in slow, fragmented execution that fails to meet the moment.

Neighbourhood health centres

If technology investment drew cautious optimism, the Budget's commitment to build 120 neighbourhood health centres by 2030 prompted more scepticism. Gainsbury was blunt. ‘I am sceptical,' she said. She assessed that NHS funding growth of around 2.6% in real terms over the Spending Review period left ‘no headroom' for the double-running costs inherent in shifting substantial activity from hospitals to community settings. ‘You can't close a ward on Tuesday and reopen the same capacity in the community on Wednesday,' she warned. ‘Patients need to trust new pathways first.'

Kirby said he saw the value of the neighbourhood model but not the ease of the transition. He said his already hosted prototype neighbourhood hubs and emphasised the transformative potential when services genuinely integrate around local need. But he cautioned the NHS was still wrestling with a fundamental question: ‘Is this just outpatient redesign in a new building, or is it genuinely a more preventative, community-anchored model that includes social care, employment support and wider regeneration?' he asked. Without clarity, he said, the opportunity could be squandered.

DeGaris, who said is well-versed in the challenges of major capital schemes, described the 2030 target as ‘tough going'. Beyond the buildings themselves, he stressed the importance of managing patient behaviour and expectations. ‘People don't think in terms of infrastructure or pathway redesign,' he said. ‘They think about where they can get care. We need to bring them with us.'

Brine added a political dimension, highlighting the tense relationship between government and general practice. With GP leaders insisting that neighbourhood health must be built around them, he predicted variable progress across the country. ‘There'll be pockets of excellence,' he said, naming the North East and Frimley as likely frontrunners. ‘But will the services inside these centres actually answer the access problem they're meant to solve? That's still a huge unknown.'

US trade deal

The roundtable ended with what may prove the most consequential announcement from the Government that came shortly after the Autumn Budget: the implications of the UK–US trade deal on medicines pricing.

Gainsbury expressed deep concern. While ministers have suggested an additional £1bn in medicines costs by 2028/29, she noted this figure is shrouded in ambiguity. ‘We don't know which elements it reflects,' she said. Gainsbury said the deal's two major components – a higher NICE cost-effectiveness threshold and changes to the branded medicines rebate system – could together drive significant increases.

She said raising NICE's threshold represents poor value for money. ‘You end up paying far more for the same health benefit,' she explained. ‘Every pound spent on high-cost branded drugs is a pound not spent on general practice, community health or preventative services – areas with far higher cost-effectiveness.'

DeGaris acknowledged the risks but also noted the potential upside for the life sciences sector, particularly in London, where major hubs were emerging. ‘This could be positive for UK Plc and we want to capitalise on that,' he said.

Kirby pointed to the unavoidable trade-off: ‘More money at the sophisticated end means less for preventative interventions, especially for children and young people.'

Brine was unequivocal. ‘This is absolutely a Trump shake-up of the NHS,' he said. ‘The life sciences sector is happier than it was last week, but the question of who pays remains unanswered. And debts kicked down the line only get heavier.'

No clear answers

Brine concluded: ‘The exam questions are clear. The answers aren't. Until we have them, the NHS will muddle through dealing with winter, disputes, day-to-day pressures – while transformation remains something always planned for tomorrow.'