Emma Lugrin, PFI and Dr Michael Watts, Blum Health, 8th August 2025
This blog comes out of conversations I’ve been having across health and care, topics including the use of data, digital tools, and the pressure to move fast.
There’s plenty of ambition, but also a lot of uncertainty. Teams are being asked to trust new systems, make decisions faster, and keep things safe, all at once. And often, they’re doing it without clear information about where data’s going, who’s responsible, or how decisions are being made behind the scenes.
I’ve partnered and co-wrote this with Dr Michael Watts from Blum Health Ltd.- Together, we want to name some of the tensions we’re seeing and offer a joined-up, grounded view of what safer, more trustworthy digital care might actually look like.
Navigating the Tensions in Governance
Across the system, we’re all feeling the same pressures: rising demand, stretched teams, very little breathing space. And into that, digital solutions are being pushed hard as part of the fix. In many ways, rightly so. There’s real potential for better, safer care. The direction is clear: the NHS Long Term Plan and A Plan for Digital Health and Social Care both make digital transformation non-negotiable.
Globally, too, health systems are reaching for digital tools to support triage, manage populations, streamline admin. But while innovation is racing ahead, our governance systems aren’t always keeping pace.
We’re used to clinical governance it’s baked into our working lives, through audits, safety huddles, escalation routes. But data governance? That still feels abstract. Often, no one’s quite sure how data is being used, who can see it, or what’s behind the outputs we’re being asked to trust. And that creates pressure especially for those trying to deliver safe, complex care on the frontline.
Three tensions keep cropping up in our work:
- Speed vs. Safety
- Innovation vs. Integrity
- Clarity vs. Complexity
Many clinicians are now making rapid decisions based on digital summaries but don’t always know what’s been left out, or how the system got to its conclusions. That can be uncomfortable.
As the Goldacre Review 2022, put it, we need to use health data “better, broader, safer.” But that only happens when governance gives people confidence not confusion. It has to be something visible and practical, not just hidden in policies or back-end processes.
Document Management and Auto-Reviewing: The Friction on the Frontline
Ask most frontline teams what’s slowing them down, and document management comes up fast. Letters don’t arrive. Results get missed. Notes are repeated, but key information still slips through the cracks. The workload is constant, and it’s not always safe.
So, it’s no surprise that people are turning to digital solutions especially ones that promise to cut through the mess. Tools that summarise notes or flag concerns feel like a lifeline. But we’ve got to ask the awkward questions early.
In one outpatient pilot, a summarisation tool helped clinicians work through notes more quickly. But some of the nuance, the kind that matters was lost. Things like safeguarding context, home life details, or why a medication was changed. The output wasn’t harmful but was it good enough?
This isn’t about pushing back against digital innovation. It’s about making sure we know what we’re building into the system. How does it work? What does it miss? And crucially, who’s accountable if something goes wrong?
We can’t afford to have clinicians sidelined or left guessing. If oversight is patchy or no one can trace how a summary was generated, then risks creep in unnoticed. Digital systems need to be built with clinical reality in mind not just operational logic.
Overseas Servers and Data Sovereignty: The Quiet Risk
One issue that doesn’t get talked about enough is where patient data actually lives. Lots of tools use global cloud infrastructure, which often means data is processed or stored overseas.
It might sound like a back-end technicality, but it matters. When data crosses borders, questions of jurisdiction, consent, and legal access come into play. Take the US CLOUD Act (2018) it’s triggered genuine concerns about potential access to UK data, even if that access is only theoretical.
There are workarounds. Keeping data in UK or EU-based centres, for example. Processing it locally. But those routes often bring extra cost, complexity, or delays. So, they’re not always the default.
This is why governance isn’t optional. Teams need to know where their data is, who can see it, and what that means in practice for patient trust, and for legal safety. It’s not just about compliance boxes. It’s about real confidence in the systems we’re using.
From the Tech Lead’s Side: What Good Looks Like
As a manufacturer of digital health solutions, we recognise that if we invent something as important as a ship, we also invent the shipwreck. Our goal, therefore, is to ensure we protect data and patients, whilst still providing enough value to warrant its adoption – and this is a really intricate and often unclear line to tread. The regulations in place are there for a reason, but they can be complex, ever-changing, and expensive, which leaves small businesses at an instant disadvantage.
Regulation also creates critical safety netting, health market competition, and the ability to stop unsafe businesses from entering the market, It filters out unsafe products, raises the standard for all of us, and rewards those who take governance seriously. It’s what lets those of us who care about doing this well continue to build and build better
The easiest way to appreciate whether an innovation is truly innovative is by asking – does this solution reduce resources (and that could be materials, people, time, costs) without compromising safety. If the answer is yes, then that supplier has solved a real-world problem, whilst not making unsafe decisions. If the answer is no, then either the innovation is a solution looking for a problem, or the gut instinct that it could present clinical risk, is probably right.
Ultimately, data can transform the way that we care for patients globally The UK innovation landscape, in our view, strikes a fair balance between risk and opportunity, the main challenge is regulation keeping up with the new technologies that are continuously coming round the corner, and subsequently the researchers and innovators keeping up with them.
We won’t always get it right the first time. But with shared responsibility, open dialogue, and clear governance, we stand a much better chance.
Conclusion: Care and Code, Working Together
This isn’t about picking sides between innovation and safety. It’s about keeping them in step. For digital tools to work in real clinical settings, they need to be designed with care, governed with purpose, and trusted by the people using them day in, day out.
Good governance isn’t just about policies. It lives in the conversations we have, the trade-offs we make, and the standards we hold often quietly.
And as with any quality improvement work, two simple questions are a good place to start:
- What problem are we actually trying to solve with this technology?
- And how will we know if the change is helping?
We know this isn’t easy work. Time is short. Priorities are stacked. But small, thoughtful steps toward better governance do matter. They reduce risk, build trust, and help systems grow in the right direction.
If we can stay curious, stay collaborative, and stay focused on the people these systems serve, then digital care has a better chance of being not just efficient but genuinely human.
We won’t get it perfect. But we can get better together.
What This Means for You
Clinical Leaders
Don’t get pushed to the edges of digital change. Ask questions. Make safety and clarity part of the ask not just efficiency or speed.
Tech Builders
Design with care in mind. Build systems that are transparent, testable, and shaped by clinical need not just technical feasibility.
Policymakers & Funders
Back the culture and infrastructure that make safe digital care possible. Governance deserves investment too.
If you would like to explore how Partnership for Improvement and Blum Health can support you and your systems please reach out to either Emma or Micheal.