Foreword by Matt Hancock, former Minister of Health of UK
A leader should always walk the boards. So within weeks of being appointed Health Secretary by Theresa May in 2018, I volunteered for a nightshift as a porter at the Chelsea and Westminster hospital in London. The Chelsea and Westminster is a terrific hospital, well supported, with excellent leadership. I enjoyed the shift and learned a huge amount. On moment stuck with me more than any other, though, and lit a fire of passion I still feel vividly today.
As I walked into the busy Emergency Department, I approached the nurse in charge. Standing in a small booth in the middle of the intersection between minors, majors, resus and paeds, the nurse was directing traffic and making urgent initial assessments as patients were brought in from the ambulance bay. Impressed at his two screens that looked like a City trading desk, I made a passing comment about his technology. “Not good news” he said. “I don’t have two screens to manage workflow. I have two screens because I have to type details from this system into that one.”
I’d experienced poor patient data flows before, as a citizen, representative, and Minister. But this was extraordinary: At the most acute point in the logistics of a major London hospital, where life and death decisions were taken many times a day, the failure of systems to talk to each other left the clinician in charge typing furiously to transfer information from one screen to another. Introducing errors, wasting time, making the ability to analyse impossible, this wasn’t just a failure to co-ordinate between distant institutions: this was the inability to communicate within the hospital itself.
In the programme of improvements I was privileged to lead over the next three years, this moment always stuck with me.
Since then, major improvements have taken place, in the UK and across the world.
System integration is much improved. As the charts in the book demonstrate, not only has interest in patient data increased, so has provision. In England, the NHS app is now ubiquitous, being built on by each administration, and strengthening all the time. Wes Streeting, the current Health Secretary, speaks the right language on technology and makes the case, rightly, that the future of the NHS depends on it.
Meanwhile the naysayers are on the retreat. Paper based records are increasingly rare. The rapid advances necessitated by the pandemic have largely continued – with a few unfortunate steps back like the re-bureaucratisation of data protection rules, and the abolition of NHSX to deprive those driving progress a voice at the core of the machine. While irritating, these concerns are small compared to the progress.
Most importantly, it seems to me from talking to people across the world, people in health systems can now see that citizens – patients – demand and expect the best use of technology, and their data. Strong society-wide data protection rules like GDPR have removed the need for health-specific privacy solutions. And training in digital systems has come on leaps and bounds.
There is another change in the offing, which while technical gives the opportunity for more rapid progress still. Until very recently, getting data systems to talk to each other meant defining data standards that everyone would stick to. Most people agreed with this principle, so long as the standard everyone stuck to was theirs. Asking – requiring – the majority to move their architecture to fit someone else’s standard is always hard, and gives a veto to those who, for ideological, practical, or commercial reasons don’t want to move. I tried to drive this agenda, but progress was halting. It’s always easier to say no than make the change.
One of the panoply of opportunities generated by AI is the promise that systems can talk to each other without common standards. That way, data from a multitude of sources can be pulled together to improve services, analyse, research and improve outcomes for patients. This capability, deep in the tech stack, has enormous potential to unlock so much more. It will help allow us to unlock the insights in the data like never before. And it is happening right now in the UK and beyond.
So this is a time of opportunity, and an exciting time to deliver change for the better, and no better time for this book. By carefully and eloquently setting out how many different health systems operate their digital systems, it is a must-read for a policy-maker or technologist alike. Who knew that Hungary was such a leader? How can we translate an insight from the NHS to France? What can we learn from the pioneering Estonians?
I wish I’d had this book to hand when I was appointed Secretary of State. It wasn’t written yet, just like the smooth, effective and life-saving health systems of tomorrow are waiting to be written right now. I’m grateful to the distinguished authors for their effort and insight, and I’m glad you have the chance to read it now.
The Rt Hon Matt Hancock
London December 2025
