Why neighbourhood data, not just platforms, will define the future of NHS care

Estonia’s digital public infrastructure is globally recognised. But what makes it relevant to the NHS is not its scale. It is the principles.

1. Interoperability without centralisation

Estonia’s X-Road enables secure, real-time data exchange between thousands of systems. Each provider retains its own data, but connects through a lightweight, standard interface.

The NHS opportunity: Think laterally, not just vertically. The NHS already defines FHIR and GP Connect as its interoperability standards. But adoption is uneven: most practices offer read-only GP Connect, write-back is still rolling out, and many community systems can’t yet consume it.

Estonia takes this further. Every system must expose a lightweight interface; citizens can see every access event; no team re-keys what another already holds.

That is the shift: mandatory, real-time, bidirectional exchange – not optional, partial links.

The NHS can adopt these levers, not abandon its standards.

2. Power the last mile

Platforms like the FDP and Shared Care Records are truly transformative. But for a community nurse updating a medication record, or a physio checking discharge notes, the “last mile” is what makes care work.

The NHS opportunity: Build simple interfaces and exchange layers that bring national data to the point of care, and allow frontline updates to flow back in. No workarounds, no write-back limbo.

3. Earn trust at the local level

In Estonia, patients can see who accessed their data and why. They can revoke consent at any time. That transparency fuels a 99 percent participation rate.

The NHS opportunity: Trust will not be restored through national policy alone. It must be earned in neighbourhoods, through transparency that is visible and accessible. Think local data conversations, not just national communications.

4. Build resilient systems on open standards

Estonia’s X-Road runs on open standards and is governed as public infrastructure. That keeps costs down and adaptability high.

The NHS opportunity: Before buying another full-stack platform, ask what can be connected first. Adapters and open protocols are often more cost-effective than migration. When systems change, the data keeps flowing.

It's time to think of data as shared community infrastructure. Locally driven where appropriate, connected always. Not static, but dynamic. Not owned, but stewarded.

Imagine a "Neighbourhood Data Exchange": not a new platform, but a connective fabric. Each community powers it with the data it generates. When care changes, a patient moves from hospital to home, a GP retires, a practice merges, the grid flexes. When systems merge, the lights stay on.

Picture this: A 72-year-old with diabetes is discharged from hospital on Friday afternoon. Her district nurse gets an alert on her phone, not Monday morning, but within the hour. The medication reconciliation is already done. The social care team knows about the grab rails that need fitting. The GP practice has the discharge summary. The patient's daughter can see the care plan on her app.

No phone calls. No emails. No delays. Just seamless, connected care that works for everyone.

Your neighbourhood teams already know what they need: fast access to relevant data, simple ways to share and update it, and confidence that it's working for patients, not the system.

This isn't a vague call for federation. It means:

• Building lightweight exchange layers using standards that already exist – FHIR, GP Connect, HL7 – don't reinvent the wheel
• Prioritising the "last mile" of care – start with high-impact pathways like discharge or frailty. Test agile federated exchange and ask frontline teams what data would change their day-to-day reality
• Creating transparency at the point where care and consent meet – in GP surgeries, community centres, patients' homes
• Using what you already have to move faster – connecting before replacing, adapting before rebuilding

The government's 10-Year Plan demands three big shifts. But they won't happen if your frontline teams are still wrestling with fragmented data, fighting fires instead of preventing them, burning out because the tools don't match the task.

This is how the NHS can make data not just a system asset, but a local enabler: powering smarter care, stronger teams and healthier communities. In a world where every pound matters and every minute counts, that's not just an opportunity, it's an imperative.

Nortal is a strategic innovation and technology company with an unparalleled track-record of delivering successful transformation projects over 25 years.