Davos Dreams, NHS Reality.

While tech CEOs promise AI domination, Britain’s health service loses the leader who actually knew how to deliver it.

This morning many of us woke to headlines announcing a proposed merger between SpaceX and xAI, a deal spoken about in trillion-pound terms and framed as the creation of a new industrial titan. Rockets, satellites, supercomputers and foundation models bundled into one vertically integrated machine for the future. Across the Pacific, China continues to accelerate with deliberate intent, pairing state coordination with technology, healthcare and data to create a formidable edge and even exporting that capability through a growing wave of medical tourism. The message from both sides of the world is blunt: scale wins, speed wins, compute wins.

Meanwhile Britain, once the world’s superpower, looks uncomfortably fragile in its largest and most human sector. Healthcare, the institution millions depend on every day, is quietly losing hard-earned experience and leadership depth at precisely the moment technology is meant to transform it. The optics could not be more different. Silicon Valley talks about domination. The NHS talks about survival. One side unveils moonshots. The other juggles winter pressures, ageing estates and overflowing waiting lists before breakfast. It is an odd juxtaposition, almost surreal. On one screen you see rockets lifting off. On another, a hospital control room trying to find three beds and a physiotherapist before lunchtime. Both claim to be building the future. Only one has to keep the lights on while doing it.

Photo: Elon Musk, on announcement of SpaceX and xAI Merger (2026)

At global gatherings the language is imperial. Artificial intelligence will reshape civilisation. Data will become the new oil. Compute will be sovereign power. One chief executive after another steps onto the stage promising that their companies will not merely adopt AI but dominate it. Slides glow with maps of hyperscale datacentres and token factories the size of small towns. The tone is confident, almost inevitable, as though progress were guaranteed by capital alone. Yet for all the talk of world transformation, something essential is missing. Execution. Not the kind measured in press releases or chip supply, but the harder, quieter kind that determines whether real institutions with real people actually make technology work. Because building a model in a lab is one thing. Embedding it safely into a national health system is quite another. Algorithms do not automatically fix fragmented workflows. Dashboards do not magically create trust. Grand visions rarely survive first contact with procurement rules, privacy law, clinical scepticism and legacy software older than most trainees. In healthcare especially, progress is less like a rocket launch and more like plumbing repair. Slow, methodical and occasionally involving a metaphorical wrench. It is not glamorous, but it is what delivery looks like.

Photo: President Xi Jinping, ahead of Chinese New Year celebrations in Beijing (2026)

Back in Britain, far from the applause and chalet receptions, that reality plays out daily inside NHS England. Here the challenge is not how to invent the next breakthrough model, but how to stitch together thousands of existing systems so that information flows reliably at all. The NHS Federated Data Platform aims to connect decades of fragmented infrastructure into something approaching real time insight across trusts and regions. It is not a shiny pilot, but a foundational rebuild of the plumbing that makes everything else possible. The service has been driven forward by leaders determined to turn strategy into delivery and to focus on outcomes rather than theatre. Among them, Sir Jim Mackey has been widely recognised as one of the most impactful and connected figures since the NHS began, pushing change at a pace few thought possible and insisting that transformation be practical, measurable and grounded in patient benefit. Change at this scale inevitably carries unintended consequences. However, one of the more recent losses across the wider data and digital leadership community feels less inevitable and more unfortunate. At the very moment the NHS needs deep operational memory, experienced hands are stepping away. These are the people who know where the wires run, which integrations already failed, which suppliers overpromised and which clinicians will champion a new approach. When that knowledge leaves, the loss is not symbolic. It is operational.

The irony borders on absurd. At Davos, executives speak of AI as if it were an inevitability, a tide that will simply roll in and lift all boats. In the NHS nothing rolls in easily. Every inch of progress is argued for, budgeted for and tested against the question of patient safety. The service is not a sleek technology company able to rebuild its stack overnight. It is a seventy-five-year-old public institution layered with local autonomy, regulatory scrutiny and political oversight, modernising while still treating millions every week. Leaders are expected to deliver transformation at venture speed inside governance frameworks that would make most founders hesitate. Responsibility is enormous, control is partial and scrutiny is relentless. Winter pressures never really end. Targets stack up. Success is assumed, failure is personalised. Over time even the most mission-driven people feel the strain. Burnout becomes commonplace. Diaries fill with risk reviews and funding gaps rather than innovation. It is hardly surprising that some look across at the private sector, see calmer roles and higher salaries and decide they have done their bit. Yet the consequences in healthcare are far greater than in commerce. When a technology firm loses a chief data officer, shareholders grumble. When the NHS loses the people who understand its architecture, patients wait longer, systems stall and investments underperform.

This is the uncomfortable truth obscured by the spectacle. AI is not magic. It is plumbing. It is governance. It is people who know how to make vast, messy systems behave. The CEOs on stage can promise domination because their organisations are built for speed. They can scrap products, pivot strategies and hire armies of engineers at will. The NHS has no such luxury. It must modernise while still delivering care to millions, protect public trust, satisfy regulators and keep the lights on all at once. That requires continuity of leadership more than anything else. It requires individuals who remember why the last integration failed, which trust needs extra support and how to turn strategy into something that actually works on a Tuesday morning. Strip too much of that memory away and the service does not collapse dramatically. It simply slows, becomes cautious and loses its edge. AI projects become pilots. Pilots become reports. Reports become footnotes. Meanwhile the rhetoric grows louder elsewhere. So while trillion-dollar mergers and moonshot announcements dominate headlines, the real future of healthcare will be decided in hospital control rooms and server racks at dawn, where teams quietly clean data, free capacity and make care flow. It is not glamorous, but it is what delivery looks like. And in the end, delivery beats theatre every time.