Delivering the ambitions of the NHS 10 Year Health Plan requires more than new digital systems: it also requires a clear view of the legacy technology that still consumes budget and supports essential services. NHS organisations have made significant progress in digital transformation, but leaders now face a dual challenge: improving operational efficiency while building technology estates capable of supporting future models of care.
However, digital transformation does not end with electronic patient records. While NHS organisations have modernised many clinical and administrative systems, operational technologies and estate-based services often remain reliant on ageing infrastructure including legacy PSTN and ISDN lines that sit outside traditional transformation budgets. From lift emergency phones and access control systems to legacy communications platforms and environmental monitoring devices, many critical services continue to run quietly in the background, consuming ongoing maintenance budget with limited operational visibility until a failure occurs.
Our work across the NHS has highlighted a recurring issue: hidden legacy costs and operational dependencies need to be understood together, not treated as separate financial and technical problems. Supporting large-scale communications and technology change, including migrating three acute hospitals onto a single cloud communications platform, has shown Trig Point Consulting how both can remain undiscovered despite major investment in digital initiatives.
The Hidden Legacy Technology Challenge
NHS estates are large, complex, and often spread across multiple hospitals, community sites, and administrative facilities. While significant investment flows into frontline digital systems, legacy technologies remain embedded within operational environments, running up continuous support costs and contract fees for systems that are rarely audited until they fail.
The challenge is not simply finding old equipment. As organisations modernise frontline services, they also need to establish who owns each operational system, which services depend on it and whether its contract still delivers value. Many systems continue to perform essential functions, while legacy line services and overlapping contracts can sit outside traditional IT governance processes. Without that joined-up view, neither the operational risk nor the opportunity to reduce expenditure is clear.
Examples of critical, cost-heavy services operating on ageing infrastructure, analogue connectivity, or legacy PSTN/ISDN lines include:
- Department Telephone Lines.
- Legacy PBX and telephony platforms
- Red Phones
- Lift emergency phones
- Access control and door-entry systems
- Medical gas monitoring devices
- Telecare and remote monitoring systems
- Fire alarm signalling lines
Before cancelling or migrating a service, leaders need answers to five questions: What does it support? Who is accountable for it? What depends on it? What does it cost? How will continuity be demonstrated after the change? Bringing estates, digital, operational and finance colleagues into that assessment helps make budget release a controlled decision rather than a disconnected cost-cutting exercise.
Uncovering where these systems exist and what they cost is the vital first step toward eliminating wasted expenditure, reducing operational risk, and establishing estate resilience.
Modernisation Starts With Visibility (and Unlocks Immediate Savings)
Before organisations can modernise legacy infrastructure or fund emerging digital priorities, they must first understand what exists across their estate.
A primary hurdle is that operational technologies often sit outside central asset and contract registers. As a result, both financial waste and infrastructure risks remain hidden until an emergency occurs. Establishing full visibility delivers measurable financial value before any new technology is even deployed.
During a major NHS communications transformation programme, Trig Point established a comprehensive inventory of legacy line services. This enabled the rationalisation and cancellation of over 5,000 redundant telephone numbers and lines. The financial benefit came from removing unnecessary chargeable services, eliminating associated line rental charges and freeing revenue budget, while the rationalisation also simplified contract management.
Comprehensive visibility gives healthcare leaders the financial data and operational clarity needed to:
- Make targeted, evidence-based investment decisions.
- Identify immediate quick-win cost eliminations.
- Direct released funds straight into high-priority digital and AI initiatives.
Why Modernisation Cannot Wait: Reinvesting Legacy Spend into AI
NHS organisations face double-sided pressure: maintaining absolute operational resilience while finding the financial headroom to innovate.
As legacy infrastructure ages, support and maintenance costs steadily climb, contract renewals become more expensive, and integration with modern digital platforms becomes nearly impossible.
Openreach’s PSTN closure date of 31 January 2027 creates an immediate reason to review legacy connectivity, including PSTN and ISDN dependencies, and confirm migration requirements with service providers. For NHS organisations, that review can do more than replace lines: it can expose duplicate services and redundant contracts. Where these can be retired safely, modernisation can release recurrent budget as well as reduce operational risk.
Unlocking the Budget for Next-Generation Care
Retiring obsolete infrastructure can create financial headroom, but a credible investment case needs to distinguish gross savings from the budget available after migration costs and continuing service requirements. Subject to those costs and agreed reinvestment decisions, money no longer tied up in outdated copper lines and legacy support contracts could support priorities such as:
- AI-driven diagnostic and clinical workflow tools
- Automated administrative and operational intelligence
- Advanced digital care pathways supporting the NHS 10 Year Health Plan
Trig Point’s experience highlights the value of early assessment: it gives organisations time to identify waste, plan its removal and reduce the risk of expensive emergency contract extensions. Capturing those efficiencies and reinvesting them in future-ready technology then requires a clear benefits case and explicit decisions about how released budget will be used.
The Financial & Operational Risks of Delaying Action
Failing to audit and modernise legacy estate technology creates compounding risks:
- Drain on operational budgets: Continuing to pay line rentals, maintenance, and support fees for unneeded or obsolete services.
- Elevated project costs: Emergency, reactive replacement programmes forced by sudden system failure cost significantly more than planned migrations.
- Innovation bottlenecks: Legacy architecture blocks integration with high-value AI platforms and modern cloud tools.
- Service disruption & security vulnerabilities: Ageing hardware creates unseen security loopholes and single points of operational failure.
Delaying action can leave NHS organisations paying for legacy circuits and contracts that deliver diminishing value, while increasing their exposure to reactive change. The executive decision is therefore broader than replacing ageing technology: it is how to protect essential services, reduce avoidable expenditure and create financial headroom for agreed priorities, including AI and automation where there is a clear case for investment.
How Trig Point Can Help
At Trig Point Consulting, we help NHS organisations turn hidden technology risks into strategic funding opportunities.
For Trig Point Consulting, the starting point is your organisational and financial outcomes, not a supplier’s preferred solution. As an independent, vendor-neutral consultancy, we provide an objective evidence base for deciding where to eliminate wasted spend, where modernisation is needed to strengthen estate resilience, and how released budget can support digital growth.
Our track record includes:
- Legacy Technology Modernisation & Rationalisation
- Communications Transformation & Cloud Migration
- Estate Discovery, Line Auditing & Asset Assessment
- Programme & Project Delivery
- Targeted Switch-Off Response Planning
Having led complex initiatives including migrating three acute hospital sites to a unified cloud communications system, rationalising 5,000+ line numbers, and executing one of the UK’s first NHS 111 platform migrations within a 20-minute cutover window we bring proven playbooks for extracting efficiency from complex NHS environments.
The SORT Approach (Switch-Off Response Team)
For trusts navigating the upcoming PSTN and ISDN sunset, our SORT (Switch-Off Response Team) approach provides a structured assessment of dependencies, operational risk and contract spend. Its four stages turn discovery into evidence-based recommendations and a practical migration roadmap, helping leaders identify where savings may be released without losing sight of service continuity.
- Respond: Rapidly review current services, inventory, and supplier contracts to identify all PSTN/ISDN dependencies.
- Examine: Deep-dive into technical dependencies, operational impacts, and ongoing contract spend.
- Diagnose: Deliver a clear risk and financial assessment, surfacing quick-win line cancellations and immediate savings opportunities.
- Prescribe: Provide vendor-neutral recommendations and a practical migration roadmap designed to release cash for digital and AI transformation.
A credible roadmap also needs to explain how change will be controlled: accountable service owners, agreed supplier responsibilities, dependency testing, cutover criteria, contingency arrangements and operational acceptance. The aim is not merely to replace a connection, but to demonstrate that the service it supports will continue to work. That is the bridge between identifying a risk and managing a migration.
More Than Compliance: Funding the Future of Care
The PSTN and ISDN switch-off is far more than a mandatory compliance deadline it is a financial opportunity.
A proactive approach to legacy modernisation connects three decisions: what must remain resilient, what can be simplified or retired, and where any released budget will create the most value. For NHS organisations, eliminating redundant contract costs and streamlining complex technology estates can strengthen the foundation for modern healthcare. The opportunity is to use that financial headroom deliberately, supporting AI, automation and improvements in care where the investment case justifies them.
Start with an independent view: what must you protect, and where could you save?
Book a consultation with Trig Point Consulting to discuss your legacy technology dependencies, operational risks and opportunities to reduce avoidable expenditure. Start with an independent view of the evidence needed to prioritise migration and assess where savings could support your organisation’s digital ambitions.