What our research reveals about cloud maturity in UK healthcare

Earlier this year, we partnered with Coleman Parkes Research to survey 75 NHS IT and digital leaders across the UK, examining how cloud is being used across healthcare and where it is delivering consistent value.

The data shows clear progress. Cloud is established across the NHS, supported by formal strategies, growing governance maturity and sustained investment.

It also highlights a more specific challenge. Organisations are operating within complex, distributed environments, where outcomes depend less on access to cloud and more on how effectively those environments are integrated, managed and aligned to operational priorities.

Cloud strategy adoption is increasing while maturity and alignment vary

Cloud adoption is advancing across the NHS, though strategy and governance maturity vary between organisations. Forty percent report having a formal cloud strategy, and 20% say cloud operations are well managed within their IT strategy. At the same time, none describe cloud as fully integrated into business strategy.

Where that alignment is still developing, the impact is practical. Teams are managing fragmented environments, balancing cost visibility across multiple platforms and working around integration constraints between cloud services and existing clinical systems. Decisions about workload placement, performance optimisation and security controls are often made within those constraints rather than through a fully aligned strategy.

From what we see, organisations that have progressed further in aligning cloud with operational priorities tend to have clearer governance, more predictable cost management and greater control over how systems and data interact across environments.

Workload placement continues to shift

Our research shows a high level of movement in where workloads are placed. Thirty-seven percent of organisations have moved workloads between cloud providers, and 29% have moved workloads from public cloud back to on-premises environments.

These decisions sit at the intersection of several pressures. Data security and regulatory requirements define where sensitive workloads can run. Existing clinical systems influence how easily new platforms can integrate. Operational teams need visibility and control across environments that have evolved over time rather than being designed as a whole.

In that context, workload placement becomes an ongoing process rather than a one-time decision. Organisations are adjusting environments to meet current requirements while trying to maintain flexibility for the future.

Legacy architectures continue to shape cloud outcomes

Legacy architecture and technical debt continue to influence how cloud capabilities are deployed and integrated.

Fifty-two percent of organisations say legacy systems significantly limit their ability to modernise, and 70% report moderate to high levels of technical debt. These constraints are most visible in cybersecurity, compliance and data integration.

Electronic patient record (EPR) systems provide a clear example. Adoption is widespread, with 85% of organisations using EPR platforms. However, confidence in interoperability remains limited, with only 20% reporting strong confidence in how those systems connect with others.

This creates a structural challenge. Cloud introduces new capabilities, but the value of those capabilities depends on how well systems exchange data and operate together. Where integration is complex, progress depends on incremental change rather than large-scale transformation.

Outcomes correlate with the quality of integration and control

Across our findings, a consistent pattern emerges. Organisations that have integrated cloud into their operating model report stronger control over cost, clearer governance and more predictable performance. Where integration is weaker, teams spend more time managing complexity across systems and environments.

The challenge now is to operate cloud environments as part of a coherent, well-governed model that supports clinical and operational priorities, with integration, cost management and control addressed as part of the design rather than through ongoing adjustment.

Strengthening the foundation already in place

Cloud adoption continues to advance across the NHS, with organisations building capability at different stages of maturity. The next stage of progress depends on how effectively those environments function together in practice.

That involves reducing technical debt where it limits integration, designing architectures that support consistent data flow across systems and ensuring that security and compliance requirements are addressed within the design of those environments rather than after the fact. It also requires closer alignment between cloud strategy and the priorities that drive day-to-day operations across clinical and administrative teams.

These factors determine whether cloud delivers isolated improvements or sustained, system-wide value.

The opportunity now is to ensure cloud environments operate with the consistency, integration and control required to support the next phase of digital care.

For a deeper view of the UK findings, including AI adoption and cyber resilience, explore the full NHS-focused Rackspace Healthcare survey report.