The FAIR Case for A Coherent Interoperability to support NHS 10 Year Health Plan.

There is an urgent need to improve the data infrastructure supporting access to patient information within the National Health Service (NHS), England's publicly funded healthcare system. Delivering effective, patient-centred care depends on timely access to accurate and sufficient patient information. However, achieving this remains challenging in a fragmented health and care environment, where a longitudinal patient record depends on interoperable information sharing across organisational and geographical boundaries. The health and care landscape in England is characterised by considerable organisational, technical, and governance complexity, resulting in substantial variation in digital maturity and information sharing capability across health and care settings. Within this heterogeneous environment, effective interoperability depends not only on the ability to exchange data but also on the alignment of standards, governance, and organisational capability. These interdependencies suggest that achieving coherent interoperability requires more than isolated technical solutions. Rather, they highlight the need for a unifying framework for interoperability that integrates standards, governance, and implementation, informed by internationally recognised standards and approaches. Such a framework could help shift the focus from recurring debates and isolated initiatives towards more consistent, scalable, and sustainable interoperability. Notably, current research provides limited guidance on how data governance and standards stewardship can be coordinated to achieve coherent interoperability across direct care systems. Existing approaches have largely focused on technical integration and standards implementation, with comparatively less attention has been given to the governance, semantic, and lifecycle processes required to sustain interoperability at system scale. This paper explores the role of data and standards management as foundational components of interoperability and considers the potential of the FAIR (Findable, Accessible, Interoperable, Reusable) Principles as a framework for advancing interoperability in direct care. Drawing on FAIR-aligned health research initiatives, we suggest that extending FAIR-informed approaches from health research to direct care within the NHS could provide a unifying framework for more coherent interoperability, while informing future standards governance, policy, procurement, and legislation in support of the NHS 10-Year Health Plan (2025-2035).