Richard Armstrong: Value-based care comes into focus when data connects
The NHS collects vast amounts of data, but too often the links between them get lost. Without a joined-up view across systems and teams, insight stays partial and decisions pull in different directions. Close the gaps and the same data informs decisions that people can stand behind.
The need for ‘connected data’ is stronger than ever. The NHS must improve outcomes, reduce unwarranted variation and make better use of limited resources. At the same time, value-based procurement is shifting attention from unit price to impact across the whole patient pathway. Value-based healthcare depends on understanding how outcomes and spending relate. Outcomes alone do not show value, and spending alone cannot guide clinical decisions. The insight sits in the connection between them.
Orthopaedics is a clear example. Procurement focuses on implant prices; finance on spend and activity; clinicians on practice and patients. Each dataset is useful on its own, but value sits in the link. Without it, what happens in theatre cannot be tied reliably to outcomes or overall cost, so people see fragments, not the full picture.
In my role at NEC, I’ve seen first‑hand how registries turn dispersed information into long‑term insight that clinical teams can use. Health registries hold long‑term outcomes and clinical detail. On their own they are partial but combined with spending and operational data, they surface what matters, where like‑for‑like devices deliver different results; where costs run higher than necessary; and where paying more is justified by better outcomes for specific patients.
For over twenty years, NEC has worked with the National Joint Registry, and in 2017 we began linking procedure-level outcomes to the actual implant prices used, at trust and surgeon level, so clinical and commercial discussions drew on the same facts. The approach gave teams a single view of usage, outcomes and total implant cost per case against the national picture. It proved that connecting outcomes, practice and price is doable in the NHS and produces fair, usable comparisons that clinicians, procurement and finance can analyse together.
Building on that foundation, today we are working with the NJR and NEC AdviseInc’s spend analytics platform to connect orthopaedic implant pricing with registry outcomes and clinical context, including ODEP ratings, demographics and surgeon data, so teams can view cost and quality side by side.
A great example of this is work done to assess the appropriate use of higher cost implants in primary hip procedures. In joint replacement surgery, outcome is generally measured by rate of revision, with patients able to reasonably expect that primary hip implants will not need revising for 15-20 years. Where different implant types have a significant difference in cost, such as using ceramic bearing surfaces, we are now able to assess the extent to which the increase in implant cost is justifiable through improved outcomes for patients (reduction in revision rates). The results are fascinating and vary significantly dependent upon the age of the patient. Suffice to say, in some cases the data provides strong evidence for using higher cost implants, and in other cases the data offers no justification.
At provider level, we have plotted average revision rate against average implant cost. The results are again fascinating and certainly challenge any assumption that higher price always buys better outcomes.
Because NEC AdviseInc classifies devices at model and component level, we can track shifts in product brand mix and costs over time, and link this back to local clinical practice, making variation visible and actionable. Ultimately, we strive to provide clinicians and local teams evidence-based insights to inform local clinical practice, highlighting cases where lower cost choices offer better value without comprising patient outcomes, giving clinicians, procurement and finance a single set of facts to work from.
The challenge we face is that connected data is still not routine across the NHS. Many trusts and integrated care systems are working with incomplete information: they know variation exists and opportunities are there but lack a practical way to link the data they already hold. The move to value-based procurement strengthens this need, and the work we are doing makes it possible. For anyone working through similar challenges, I will be sharing some of this work at Digital Health Rewired 2026.
Richard Armstrong is Director of Registries and Real‑World Evidence at NEC Software Solutions, which is sponsoring the Data and Digital Stage at Digital Health Rewired 2026. His session, “The art of the possible: data at the heart of research and innovation,” takes place on the Data and Digital Stage on day one from 9:00 to 9:45.
