Hospital as a Service, not a Building (NHS 2025): Reflections on the Future

The NHS 2025 vision reimagines hospitals as decentralised, digital services focused on prevention and remote care. It prioritises integrated care pathways, interoperable records and national platforms for communication. Virtual hospitals and AI-enabled triage are proposed, yet artificial intelligence remains underutilised. Strategic investment in AI, ethical standards and workforce training is essential to deliver sustainable, patient-centred healthcare across evolving systems.

Key Points

• Hospitals should be redefined as flexible, digital services rather than physical locations.
• Care pathways must prioritise virtual-first models for chronic and frail patients.
• Unified health records and secure clinician platforms ensure effective communication.
• Virtual hospitals and remote wards need structured funding and trained professionals.
• AI should be a core element in diagnosis, triage, monitoring and operational planning.

The document “Hospital as a service, not a building” (NHS 2025) proposes a deep reform of the British hospital system, steering it towards a more flexible, digital and patient-centred model. Here is a summary of its key recommendations, organised around strategic principles.

Principle 1: Reimagining Care Pathways

The report calls for a comprehensive clinical review of care circuits for patients with multimorbidity and frailty, led by specialists within an integrated system spanning primary, hospital and social care. A critical analysis of in-person versus flexible services is encouraged to redesign care pathways with a virtual-first approach where appropriate. These redesigned pathways should be assessed and improved through peer review programmes focused on care journeys rather than individual professionals or institutions.

To support implementation, local “SWAT teams” at ICS level should assist physicians and hospitals. Primary care “Pay by Results” (PbR) pilots are proposed, with tariffs adjusted to case complexity and administrative support provided by hospitals. The model is to be formally evaluated after three years to determine its scalability or potential replacement.

Principle 2: Prioritising Communication over Location

A national clinician-to-clinician communication platform, secure and tailored to NHS needs, is proposed. This would be complemented by a national professional directory integrated with AI-powered semantic search and supported by financial incentives to reward efficiency in clinical communication.

The report recommends the implementation of a mandatory Unified Care Record (UCR) across all health and social care providers, ensuring full interoperability. This should be supported by national standards for coding, interoperability, data quality and security. Legislation would enforce these standards, with a defined technical transition period. Local UCR pilots should precede national rollout, and electronic patient record (EPR) contracts should be limited to five years to promote competition, innovation and quality.

Principle 3: Redefining the Hospital Around Remote Care

The report advocates for “Remote General Hospital” pilots in at least three regions, with two-year evaluations covering costs, outcomes and user experience. It proposes defining a minimum set of mandatory services suitable for remote delivery, including virtual A&E and relevant specialties. Professional training should be adapted to these remote settings, in partnership with medical colleges.

Five-year guaranteed funding for virtual wards is recommended, with incentives for meeting care goals without increasing physical bed numbers. Nursing homes should be integrated into virtual wards through per-patient payments. Successful implementation requires dedicated personnel and a national repository of best practices and lessons learned. Data standards for remote monitoring should be established to ensure interoperability between devices and electronic records.

Critical Reflection on the “Hospital as a Service” Model

The report proposes transforming the hospital from a physical infrastructure into a distributed, digital and flexible service focused on prevention. This vision includes broad use of telemedicine, remote monitoring and unified health records, alongside the deployment of virtual hospitals and remote consultations. Structural reforms in funding, governance, interoperability and professional training are also central to the model.

Such a transformation is both ambitious and necessary, as the current hospital system is increasingly unfit for the needs of an ageing population, a rising burden of chronic disease and evolving public expectations. Detaching the concept of “hospital” from its physical location and redefining it as a network of integrated, digital services appears both disruptive and timely, especially following the COVID-19 pandemic.

The report clearly identifies key structural issues in the NHS, such as fragmentation, institutional rigidity and limited technological adoption. However, some aspects deserve further scrutiny, particularly the underappreciated role of artificial intelligence (AI), which is only superficially mentioned.

Critical Issues and Missed Opportunities

• Underestimation of Artificial Intelligence: While AI is briefly mentioned in connection with the clinical directory’s semantic search, its broader potential as a driving force behind the new hospital model is not explored.
• Implicit Distrust in Clinical Automation: The report omits any reference to established AI applications such as assisted diagnosis, prediction of clinical deterioration, risk analysis or prioritisation of waiting lists—even though these technologies are already proving valuable in various health systems.
• Absence of Ethical or Regulatory AI Strategy: There is no discussion of how to address key concerns such as trust, explainability and medical oversight in an increasingly algorithm-driven healthcare environment.

Highlighting the Role of AI in the Hospital of the Future

Artificial intelligence should be positioned as a structural component of healthcare as a service. In diagnosis and triage, AI can enhance early detection of chronic, oncological or cardiovascular diseases, and support automated triage in virtual A&E settings. For monitoring and prediction, algorithms can detect clinical deterioration in patients with conditions such as COPD, heart failure or diabetes, and reduce hospital readmissions through proactive alerts in virtual wards.

Clinical decision support systems can help physicians choose appropriate treatments based on historical data, scientific evidence and personalised risk-benefit assessments. Operational optimisation can also benefit from AI in managing waiting lists, bed occupancy, staff scheduling and demand forecasting based on seasonality, disease outbreaks or social determinants.

Final Recommendation

To build a truly innovative and sustainable “hospital as a service,” artificial intelligence must be considered a strategic pillar, not a secondary tool. This will require a national deployment plan for clinical AI, the establishment of clear ethical and regulatory standards, and investment in digital talent and AI literacy among healthcare professionals.

These reflections go beyond the NHS report. Health systems everywhere should strategically embrace AI as a catalyst for the future of care.