Opinion: The Spending Review Is Only Step One

At Confed last week, I felt a cautious sense of optimism. There was energy in the air and an expectation that this year’s Spending Review might finally bring the clarity we’ve all been calling for.

Now that it’s landed, we can begin to digest what it really means for the future of health and care. 

The numbers are headline-grabbing: 

• A 3% annual uplift in NHS revenue spend 

• Nearly £10 billion committed to digital transformation 

• An ambition to achieve 2% productivity growth per year 

• A single NHS patient record promised, backed by major AI investment 

These are welcome moves. But let’s be clear,  money alone does not create transformation. It simply creates the conditions for it. What we do with those conditions is what matters most. 

If we’re honest, the barriers to innovation in health and care are not primarily financial. They are structural, cultural and systemic. They exist in the silos between services, in the inertia of old delivery models, and in the lack of time and capacity for teams to think and work differently. 

We’ve seen these patterns repeat in every project, every system, every sector we’ve worked with. Good ideas stall. Proven innovations fail to scale. And too often, the people who would benefit most are the ones who wait the longest for change. 

So, while I welcome the Spending Review’s commitments – especially the increased focus on R&D, digital, and life sciences – I also believe it’s time for the system to go further. 

We need a shift from digital-first to innovation-first 

Yes, digital tools are critical. But they are only one part of the puzzle. We need to think broader: 

• How do we create the right environment for innovation to thrive? 

• How do we enable local teams to take bold steps, backed by evaluation and learning? 

• How do we build the capacity to improve, while delivering under pressure? 

A truly innovation-first NHS requires investment in more than just tech. It requires investment in relationships, in system leadership, and in aligning people behind a shared purpose. 

We need incentives that reward improvement 

Parts of the system are structured to preserve the status quo. Not because people aren’t trying, but because the conditions (indeed incentives) to try something different aren’t there.

Look at delayed discharge. We all know it’s a critical pressure point. But how often is meaningful resource or support directed to local teams who could actually change the picture? How often is a direct and frank conversation had with someone who has “always done it this way” and doesn’t want to change?  

If the Spending Review is serious about unlocking productivity and impact, we must ask: what incentives are in place to help teams tackle root causes, not just meet surface-level targets? 

We need the courage to scale what works 

There is no shortage of brilliant ideas and innovations. But what’s missing is the infrastructure to scale them. Proven innovation sits in silos, quietly improving outcomes in one trust, one community, one service. Imagine what could happen if that learning was actively spread, supported by the right partnerships, funding and policy enablers. 

We need to keep the human at the centre 

In the rush to digitise, automate, and optimise, we must not lose sight of what this system is for – people. Patients. Staff. Families. Communities. If we’re not improving their experience, we’re not succeeding. 

This is why Future Care Capital exists. We support innovation that’s impact-led, rooted in user need, and ready to move from concept to reality. We provide trusted support to teams across the system through innovation management, rigorous evaluation, and strategic insight. 

Now more than ever, the sector needs partners who can help bridge the gap between ambition and implementation. That’s what we’re here to do. 

Let’s use this moment. Let’s move beyond conversation and into action. Let’s break down the barriers – team by team, project by project – and unlock the innovation (and the scale) our health and care system so urgently needs.