Future Research Agenda: Five Priority Gap Areas

Introduction

This article identifies five areas where the current Digital Change knowledge base has limited or no coverage, and surveys quality research material to support further study. AI and machine learning in care is excluded from this analysis as it is covered in a separate knowledge base.

1. Integrated Care Systems and NHS Restructuring — High Priority

The Health and Care Act 2022 established Integrated Care Systems as the statutory commissioning architecture for the NHS in England, replacing Clinical Commissioning Groups. ICSs bring together NHS trusts, primary care, local authorities and the voluntary sector under a single Integrated Care Board and Integrated Care Partnership. This structural change is directly relevant to the platform hypothesis and the four Complexity Challenges: ICSs represent precisely the kind of cross-silo, population-level governance that the platform approach requires — yet early evidence suggests they are reproducing many of the same fragmentation and sustainability problems.

A further structural disruption is now underway. In 2025 the government announced the abolition of NHS England, with functions reverting to DHSC. 42 ICBs are being merged into 26, taking effect April 2026 and 2027. ICBs have been required to cut operational costs by 50%, with significant consequences for digital, data and innovation team capacity. The King's Fund's July 2024 report concludes that ICSs are making progress but require greater local flexibility to realise their potential.

Key sources: The King's Fund (2024), Realising the Potential of Integrated Care Systems; NHS Confederation (2025), The State of Integrated Care Systems 2024/25; Cresswell & Williams (2026), npj Digital Medicine — a synthesis drawing on 15 years of evaluation data across three NHS national programmes collectively valued at £13bn, including 1,079 interviews and 819 clinical observations.

2. Post-COVID Evidence on Remote and Virtual Care — High Priority

The COVID-19 pandemic forced the rapid deployment of remote care at a scale and pace that had not occurred in the preceding two decades of investment. By 2021, GP video consultations had risen from negligible levels to over 25% of appointments in some practices; virtual wards were operating across multiple trusts; and remote monitoring programmes had been stood up within weeks rather than years. The knowledge base's pre-2019 evidence base — though strong for its time — predates this period.

The virtual ward programme is the most significant development. NHS England set a target of 40-50 virtual ward beds per 100,000 population by December 2023; by early 2024 there were over 12,000 virtual beds operating nationally. A South East England evaluation published May 2024 reported that 9,000 hospital admissions were avoided in 2023–24. However, the published evidence base for virtual wards remains contested. The 10-Year NHS Plan (2025) designates virtual wards, wearables and remote monitoring as core to its "hospital to community" shift.

Key sources: NICE (2022), Evidence Standards Framework for Digital Health Technologies (updated to include AI); NHS England (2025), Virtual Wards Operational Framework; York Health Economics Consortium (2025), Virtual Wards: Challenges, Opportunities and Evaluations in the NHS.

3. Digital Inclusion and Health Inequality — Medium Priority

The knowledge base makes a strong positive case for digital care but does not address the risk that digital transformation may exacerbate health inequalities by creating a two-tier system. Approximately 10 million adults in England lack foundation-level digital skills; 8.5 million lack the most basic digital skills; and 7% of households have no home internet access. The groups most at risk — older adults, those with disabilities, those with low incomes — overlap substantially with the heaviest users of health and social care.

Three significant policy developments provide context. NHS England published "Inclusive Digital Healthcare: A Framework for NHS Action on Digital Inclusion" in September 2023. The Government's Digital Inclusion Action Plan (2025) sets a coordinated national approach. The Digital Poverty Alliance published an Inquiry into Digital Inclusion and Health in April 2025. Good Things Foundation statistics document that 33% of those who are offline find it difficult to interact with NHS services.

This gap has particular salience for the platform hypothesis: if digitally excluded populations cannot access digital care channels, the platform risks concentrating benefits in populations already better served by the system.

4. Interoperability Standards — Medium Priority

The platform hypothesis rests on a technical foundation — reusable, standards-based, non-proprietary infrastructure — that the knowledge base describes only in the abstract. The practical realisation of that foundation depends on a specific and contested landscape of health data standards, none of which are addressed in the current wiki.

The dominant standards in the NHS context are: HL7 FHIR (Fast Healthcare Interoperability Resources) for real-time data sharing via APIs; openEHR for semantic interoperability and long-term data persistence; SNOMED CT for clinical terminology; and OMOP for longitudinal research analytics. The Data (Use and Access) Act 2025 introduces mandatory information standards for NHS IT suppliers for the first time — materially altering the interoperability landscape by enabling EPR vendors to be compelled to meet standards, addressing one of the structural lock-in problems identified in the knowledge base.

5. Information Governance and Health Data Law — Medium Priority

Information governance is identified throughout the knowledge base as the dominant structural barrier to digital change — more consistently obstructive than technical limitations. Yet there is no article dedicated to the legal and regulatory framework that creates that barrier, nor to recent legislative changes that may substantially alter it.

The Data (Use and Access) Act 2025 received Royal Assent on 19 June 2025. Its principal effects for health data are: new mandatory information standards binding on NHS IT suppliers with enforcement powers; expanded legitimate interests provisions making it easier to use patient data for research without specific consent; enabling real-time data access across NHS systems; and provisions supporting digital identity infrastructure. The Act is described by legal commentators as the most significant change to NHS data governance since the Health and Social Care Act 2012.

The NHS 10-Year Plan (2025) proposes a Single Patient Record — a unified digital record accessible to clinicians and patients through the NHS App — as the cornerstone of its digital strategy. The DUAA 2025 provides some of the necessary legal underpinning. For the knowledge base, a dedicated IG article would explain the legal framework, map the specific IG barriers that have appeared in the case studies, and analyse how the DUAA 2025 changes the landscape.

Priority Summary

Priority 1 — ICS architecture and NHS restructuring: structural change already embedded; no current KB coverage. Priority 2 — Post-COVID remote care evidence: evidence base stops at 2019; virtual wards and NHS@Home not covered. Priority 3 — Digital inclusion and health inequality: mentioned but not analysed; no framework article. Priority 4 — Interoperability standards: platform hypothesis assumed but technical substrate not described. Priority 5 — IG and health data law: GDPR mentioned in passing; DUAA 2025 not covered.