IHOs: Another NHS rebrand? Why ‘integrated care’ is doomed without a financial revolution

By Lucia De Santis

For thirty years, the NHS has chased the dream of integrated care through a dizzying series of reforms. The latest buzzword is the ‘Integrated Healthcare Organisation’ (IHO), but it is doomed to fail just like its predecessors, unless we radically reform the financial incentives that pit hospitals against community care. By Lucia De Santis, Consultant at Edge Health.

Ghosts of reforms past: A thirty-year journey of fragmentation

Before the market reforms, District Health Authorities (DHAs) ran the whole show. They planned services and managed the hospitals and community care for their local population. It was an integrated model by design, but it had a fatal flaw. Funding was based on history, not on how many patients were treated, how complex their needs were, or the quality of the care provided. This gave hospitals little reason to innovate or improve, feeding the waiting list crisis of the late 1980s – with median waiting times for inpatient treatment (the only recorded metric at the time) hitting over 22 weeks.

The 1989 Working for Patients white paper blew this model apart, introducing the “purchaser-provider split” that would define the NHS for the next thirty years. The theory was simple: separate the buyers of care (commissioners) from the sellers (providers) and let competition drive everything forward. Money was the carrot – and the stick.

What followed, however, was a dizzying series of reorganisations, as successive governments tweaked the model, moving from GP Fundholding to Primary Care Trusts and finally to Clinical Commissioning Groups (CCGs). This market-based philosophy reached its peak with the 2012 Health and Social Care Act, which put competition at the very heart of the NHS.

*Timeline of NHS policies on the provider-commissioner split that led to the creation of ICBs and the premise for IHOs (Image credit: Edge Health)*

The market’s hangover

By the mid-2010s, it was clear the market experiment had struggled to deliver, and left a legacy of fragmentation. One could argue fragmentation has its merits – less bureaucracy, can drive high activity levels (which, until recently, was the key marker of performance). However, fragmentation shows its flaws when it comes to caring for a population with increasingly complex, long-term conditions. This requires seamless coordination between GPs, hospitals, and community services.

Plus, collaboration becomes an even greater struggle when community and secondary care are made to argue over who gets the slice of the pie needed to sustain services. Under Payment by Results, a hospital admission generates income. This wouldn’t be as much of an issue if prices were truly reflective of costs. In reality, costs change with activity (economies of scale) and often prices aren’t set to the actual cost, translating in significant cross-subsidies to sustain “loss-making” services. This creates a perverse, if logical, reality: moving care into the community isn’t just a different way of working; for a hospital trust, it is a direct threat to its bottom line.

The 2022 Health and Care Act officially buried the purchaser-provider split, establishing integrated care systems (ICSs) to bring everyone back to the same table. But while the law changed, the culture (and the money) didn’t. Today’s integrated care boards (ICBs) are left trying to align the priorities of hospitals and community providers in a system still wired for competition and cost management. This has bred a deep-seated scarcity mindset. For decades, providers have been forced to focus on their own financial preservation, diverting energy from transformation to simply keeping the lights on.

And so, we are back to a single organisation – the IHO. However, this model is fundamentally different from ICBs. If the NHS chose to mimic international counterparts, it would mean giving a single provider organisation total control over the budget for a population’s entire care journey. The hope is palpable: under one leadership and budget, integration could finally become a reality.

Making IHOs work: Follow the money

In dismantling the old command-and-control model, the reforms of the past threw the baby out with the bathwater. A single organisation overseeing both hospital and community care is not inherently a bad idea. The mistake was funding them without sufficient accountability*, and the overall lack of focus on performance, need, outcomes (and data!).

If we are serious about making community and hospital services partners instead of economic rivals, giving a single provider organisation responsibility for the whole patient journey feels like the only way forward. But to break the cycle of perverse incentives we must accept that in healthcare, real change follows the money.

The solution is a tough but effective one: change the payment model to make it more financially appealing for organisations to deliver more activity in the community and less in hospitals (where appropriate, of course). This only works, however, under one non-negotiable condition: the IHO must hold the entire budget for both community and acute care for its population and be fully accountable for the level of quality that it needs to deliver. Without this, you unleash the “NHS Hunger Games” – a turf war where providers are locked in a battle for their own survival.

By giving a single IHO control over the whole budget, shifting care from a costly hospital bed to a more efficient community setting** suddenly becomes the most rational financial choice. This requires two bold moves:

Direct investment: We must supercharge community services to build their capacity. Ideally, this would be an “invest-to-save” model, paying a premium for care delivered out of hospital. A more painful but perhaps necessary alternative would be to pay less for hospital activity that could have been delivered in the community.
Tied funding: The IHO’s budget must be linked to both population need and performance. Organisations struggling to meet population needs where others in similar contexts (deprivation, demographics) have succeeded would need to be held accountable and undergo greater scrutiny to fix the drivers or be financially liable.

Betting on prevention

One obvious critique of the above is that paying community activity at a “premium” doesn’t actually save any money – at best, if funds are moved away from the acute setting, it would achieve a net neutral scenario. But here’s the key – this shift is not going to suddenly unlock billions of savings overnight. However, it feels like the necessary carrot to drive a behaviour change: invest more in prevention, rather than focus all efforts on treatment. Currently, with a healthcare infrastructure that favours acute treatment from a financial, structural and capital point of view, there’s just not enough incentives to move activity out of hospitals.

Leaders should be making a bet: that a behaviour shift favouring prevention and community care will truly deliver a healthier population. There are very good grounds to believe it true. But we can’t expect an overnight change, that’s not how physiology works. We are unlikely to see true savings for a decade at least – but it’s a worthy investment.

*Three rules to make IHOs work in the NHS where others have failed (Image credit: Edge Health)*

A call for bold leadership

The foundations for IHOs have already been laid by Provider Collaboratives. In places like Cheshire and Merseyside, hospital trusts are already working together at scale – and won an HSJ award in 2023 for working together to eliminate long waits. If these collaboratives were given control over a single, population-based budget and the freedom to reward prevention over cure, we might finally achieve the integration we have been promised for so long.

Of course, that is if we can eventually shift collaboratives towards conglomerates that function more as a unit (operationally, digitally, workforce-y…) rather than a chimera of different interests and operating models.

Navigating this transition will be complex, and leaders will need to be bold, grasp the nettle of financial reform to really build the integrated system that patients deserve, and staff have long been promised, rather than just shuffling chairs on the deck – again.

* In the pre-1990 DHA times, a hospital received its budget as a block grant at the start of the year, and any unspent surplus was often clawed back by the authority, creating an incentive to spend the entire allocation regardless of efficiency. There was no meaningful relationship between the funding a DHA received and the number of patients its hospitals were treating. This offered limited incentives for hospitals to innovate, improve productivity, or take on additional work. Additionally, there was no independent external agent with the power or incentive to challenge its performance. If a hospital was inefficient, its waiting list would grow.

** Research from NHS Confederation found that “On average, systems that invested more in community care saw 15 per cent lower non-elective admission rates and 10 per cent lower ambulance conveyance rates, both statistically significant differences, together with lower average activity for elective admissions and A&E attendances.”

About the author

Lucia De Santis is a Consultant and NHS-trained medical doctor. She is passionate about engaging workforce in healthcare improvements, evidence-based transformation and operational strategy. Her unique insights add depth and human element to data analysis, literature review and visualisation.

The NHS 10-Year Plan: Five opportunities that could transform prevention

By Professor Rob Copeland

As attention turns to delivering the NHS 10-Year Plan’s bold ambitions, Professor Rob Copeland of Sheffield Hallam University argues that its true potential lies in community-based prevention. Drawing on evidence from the Advanced Wellbeing Research Centre, he sets out five overlooked opportunities that could redefine how the NHS supports population health and tackles inequality.

While recent media coverage has focused on AI promises and workforce expansion, the NHS 10-Year Health Plan for England contains important commitments regarding community-based prevention that could prove just as transformative for health outcomes.

At Sheffield Hallam University’s Advanced Wellbeing Research Centre (AWRC), we have spent the last five years implementing and evaluating community-based prevention approaches across South Yorkshire. This experience has convinced me that the plan’s intention to shift focus from “sickness to prevention” isn’t just rhetoric, but is the necessary policy focus to re-imagine health and care and tackle inequalities. It won’t just happen, however; it needs investment.

The plan contains specific mechanisms that, if implemented effectively, could revolutionise how hospital leaders think about population health, financial incentives, and community partnerships. Here are five elements worthy of immediate consideration:

1. Health and Growth Accelerators represent an economic-health integration revolution

The plan’s commitment to establish Health and Growth Accelerators across all integrated care boards (ICBs) represents a principle we’ve been advocating for a number of years at the Advanced Wellbeing Research Centre – that health and economic outcomes are inseparable.

The commitment for all ICBs to establish “specific and measurable outcome targets on their contribution to reducing economic inactivity and unemployment” marks a significant shift in the NHS’s role from a service primarily focused on treating illness to one accountable for population-level economic outcomes. To realise this ambition, the NHS must go beyond policy and actively build the relationships and infrastructure within communities that enable prevention and wellbeing to flourish.

This approach aligns with evidence showing that for every £1 invested in community-led health initiatives, up to £8.56 in social and economic value is generated. It also reflects a growing recognition that “the biggest barriers to better health often lie in systems that make healthy choices difficult for those living in the poorest communities” – a reality we’ve long highlighted, where your postcode still largely determines your health outcomes.

Through our virtual clinic for long-COVID, we’ve demonstrated how community-based approaches can reach underserved populations who might otherwise struggle to access traditional healthcare services. By addressing the social determinants of health – employment, housing, access to green space – we can create measurable improvements in both population health and economic activity.

2. Co-location mandates could revolutionise infrastructure beyond sharing buildings

The plan’s mandate for Neighbourhood Health Centres to “co-locate NHS, local authority and voluntary sector services”, including rehabilitation services, represents the infrastructure revolution we’ve been pioneering at the National Centre for Sport and Exercise Medicine in Sheffield over the past decade.

Our model has facilitated over 120,000 annual clinical appointments in community settings, with nearly half of referrals coming from the most deprived communities. We’ve also seen examples where co-location achieves substantial reductions in secondary care referrals. Ensuring that the majority of the population has access to co-located services within 20 minutes of their home would be transformative in terms of health equity – but we’ve learned that co-location must go beyond physical proximity with success dependent on genuine community ownership and design.

This requires productive partnerships that leverage diverse skills, reduce duplication and drive innovation, prioritising investment in community-led decision making.

3. Value-based payments finally reward prevention over treatment

The plan’s commitment to ‘pay for impact on health outcomes’ represents the most significant opportunity to embed prevention at scale. Our Active Together cancer prehabilitation programme demonstrates exactly what this looks like in practice – we’ve observed a 95 per cent one-year survival rate compared to 85 per cent for non-participants, with estimated net savings of £366.36 per patient.

The introduction of Year of Care Payments that incentivise keeping patients healthy rather than treating illness represents a fundamental shift we’ve been arguing for. These payments consolidate all primary care, community health, mental health, specialist outpatient care, and emergency services into single capitated budgets, creating sharp incentives to invest in prevention rather than just treat illness, and providing a powerful drive to develop the aforementioned relationships and infrastructure with community organisations that will be essential for keeping people well.

4. Prevention workforce development remains critically underdeveloped

Despite the plan’s prevention rhetoric, it overlooks the importance of equipping existing staff with prevention skills. This reflects a missed opportunity to make rapid, yet meaningful progress. We know from our work that healthcare professionals need practical skills to have meaningful conversations about physical activity, movement, and lifestyle. The Physical Activity Clinical Champions (PACC) programme has upskilled over 58,000 healthcare workers across England, creating the capability, capacity and scalability for a prevention-focused workforce.

The plan’s commitment to overhauling education and training curricula over the next three years creates the perfect opportunity to embed physical activity promotion as a core competency. Our integrated curriculum approach at Sheffield Hallam University shows how this can work – but it requires systematic commitment, not just good intentions. Without workforce development, the prevention shift risks remaining aspirational rather than operational.

5. Prehabilitation represents untapped potential beyond cancer care

The plan’s limited detail on prehabilitation programmes represents a significant gap, particularly given the evidence of their impacts across multiple conditions and surgical outcomes. While we’ve demonstrated clinical and economic benefits in cancer care through initiatives like our Active Together programme, the potential extends far beyond oncology to orthopaedics, cardiac surgery, and other planned procedures.

Community-based prehabilitation programmes that address barriers such as geographic location and socioeconomic status create more resilient populations while reducing system pressure. Our research demonstrates that addressing common barriers to access promotes inclusivity and achieves better health outcomes for all populations.

We call for a comprehensive rehabilitation (including prehabilitation) guarantee across all ICBs by the end of this Parliament – not just for cancer care, but as a systematic approach to building population resilience across all planned procedures and long-term conditions. The evidence base exists; what’s missing is systematic implementation across the NHS.

Local innovation must bridge the implementation gaps

The plan’s success depends on local innovation to bridge the aforementioned implementation gaps in terms of capability and capacity. Therefore, hospital leaders should be supported and encouraged to focus on immediate actions such as developing prevention capabilities within existing teams via PACC training, establishing meaningful partnerships with community assets through embedded and co-funded roles, and designing prehabilitation into the pathways of planned procedures, including those that extend beyond traditional clinical boundaries.

We invite hospital leaders to visit the AWRC at the Sheffield Olympic Legacy Park to see these approaches in action. The evidence is compelling, the methods are established, and the time for action is now. As the NHS implements its 10-Year Plan, we have a unique opportunity to create a healthcare system that doesn’t just treat illness but purposefully promotes health for all communities.

Featured, News, Systems, Thought Leadership August 6, 2025

From plan to practice: Reacting to the 10-Year Plan in Greater Manchester

By David Duffy

At a recent dinner hosted by Public Policy Projects and HealthPathways, senior NHS and public health leaders from across Greater Manchester came together to reflect on the challenge that now sits at the heart of health reform in England: how to translate the ambitions of the NHS 10-Year Plan into real, measurable improvements in the lives of citizens.

The meeting, held against the backdrop of a period of seismic reform for the NHS and wider care system, revealed both the promise and pain points of system integration. Stakeholders present emphasised leadership, system-wide data use, behaviour change, and trust as critical enablers of transformation. Participants included NHS trust CEOs, ICS leaders, clinicians, and senior public health officials from across Greater Manchester, considered to be one of the most integrated health systems in England.

The dinner also featured a presentation from HealthPathways Advisor, David Meates, who previously led the integrated Canterbury Health System in New Zealand. HealthPathways supports clinicians across New Zealand, Australia, and the UK by providing access to evidence-based best practices at the point of care. Its system-wide approach to care pathway redesign has demonstrated significant benefits for patients, staff, and health systems. Notably, its work with New Zealand’s Canterbury District Health Board resulted in marked improvements in productivity and patient outcomes across the system, highlighting the importance of prioritising cultural change, intelligent incentivisation, and ongoing community and patient engagement.

Despite widespread agreement about the direction set out in the 10-Year Plan, there was a clear sense from the meeting that national policy has so far failed to address the deeper behavioural, cultural and financial architecture that will determine whether the plan succeeds or fails.

A region built for integration, still struggling with fragmentation

Greater Manchester, with its devolved governance model and longstanding commitment to integration, is arguably the most fertile ground in England for delivering on the ambitions of the 10-Year Plan. With nine provider trusts and deep collaboration with the Greater Manchester Combined Authority, the region has made major advances in data sharing, population health management, and broader public service alignment.

However, challenges for the region remain stark. There remain significant post-Covid performance pressures, and Greater Manchester has some of the longest waiting lists in the country, in addition to large-scale financial deficits. “We’ve built some of the most sophisticated integrated data infrastructure in the UK,” said one attendee, “but we still face fundamental problems of access and inequality.”

As one trust leader put it, “We’ve made progress, but we haven’t yet cracked the problem of how to enable the system to truly work as one.”

Vagueness as virtue or risk?

The 10-Year Plan has been welcomed in Greater Manchester for its broad framing and long-term outlook. However, delegates argued that the plan’s perceived vagueness is a liability to tangible service improvement. “The plan leaves the hard questions, such as trade-offs, funding and prioritisation, on the table,” one participant said. “NHS England makes a virtue of this in order to give local leaders space to develop local solutions. However, we need clarity about who is empowered to answer those questions locally.”

David Meates pointed to the opportunity inherent in this ambiguity. “Don’t wait for the centre to tell you what to do,” he said. “Use that space. Make it yours.”

There was widespread agreement that success now depends on local leaders stepping into that gap, with both strategy and delivery. “This isn’t a conversation we can leave in Whitehall,” one attendee reflected. “This is about what we do locally.”

Lessons from New Zealand

Many of the issues faced by David Meates when he took over the Canterbury system have clear parallels to NHS struggles, including a fragmented system and a lack of local cohesion. As Meates articulated, exponential increases in funding from previous New Zealand governments had yielded little to no improvement in service delivery, productivity or patient outcomes.

Meates’ team sought to create a framework for “a connected system, centred around people, that aimed not to waste their time”. This was built upon three core strategic objectives:

People take greater responsibility for their own health
People stay well in their own homes and communities
People receive timely and appropriate care

Crucial to addressing these issues was the creation of the community-based HealthPathways, aimed at improving the interface between secondary and primary care. After reviewing a backlog of referrals, clinicians identified that many common issues could have been prevented through better communication between hospitals and primary care providers. GPs and hospital specialists were then brought together to agree on optimal management and referral pathways for specific conditions. The HealthPathways methodology is currently gaining traction as an approach across the Northern hemisphere, including England and Wales.

The left shift: Still a distant reality?

Participants echoed a now-familiar frustration: that the NHS continues to talk about shifting care into the community while still funnelling most funding and attention toward acute settings. “NHS England isn’t taking the left shift as seriously as the Greater Manchester system is,” one leader argued.

There was deep concern that the national focus on individual provider performance and waiting list targets was actively pulling against the system logic of integration and prevention. “If we keep paying for activity, we’ll keep getting activity,” one speaker noted. “We need to change what we value and how we fund it.”

Instead of continuing to reward throughput, participants called for an urgent shift toward outcomes-based funding. “The current incentives are not aligned with what patients actually need or what the system is trying to achieve,” said another attendee.

From data to delivery

Several leaders highlighted the power of Greater Manchester’s linked datasets, which have begun to reveal critical insights into unmet need, health inequality, and clinical variation across the region. One senior clinical lead described how analysts had used linked data to identify patients receiving suboptimal care, stratify risk, and deploy neighbourhood teams to intervene.

“We’ve used data to change how we deliver care at the local level, but the opportunity is far bigger,” they said. “This is about system-wide intelligence, not just analytics.”

However, others warned that data alone would not deliver change. “We’ve got brilliant information,” one attendee noted, “but unless it’s made usable, and unless we align it with pathways and accountability, it’s just noise.”

One participant summed up the challenge: “Change happens at the speed of trust. If the system doesn’t trust the data, or the people using it, it won’t move.”

The cultural fault lines: Professions, power, and permission

The discussion often turned to the deeper cultural and behavioural dynamics holding the system back. Professional silos, legacy power structures, and the politics of hierarchy were seen as major obstacles.

“We [system partners] have irritated each other for years,” said one participant. “The radicals and the pragmatists, the commissioners and the providers. And we’re still stuck with binary questions such as: who controls the money? Who owns the patient?”

Several attendees emphasised the need to move beyond organisational identities toward collective purpose. One leader said: “There’s no such thing as integrated neighbourhood teams if you don’t have full primary care at the table. We need inclusive leadership, and we need to stop second-guessing what communities want.”

Others argued for a more clinician-led approach to transformation. “You can’t prescribe behaviour change to doctors,” one attendee noted. “Ask them to define the problem and let them solve it. That’s where the buy-in comes from.”

Funding, incentives, and the problem of productivity

A recurring theme was the mismatch between national funding mechanisms and local ambitions. “Strategic commissioning? Wasn’t commissioning always supposed to be strategic?” one participant asked.

Several leaders warned that simply rebranding roles or structures, without real changes to financial flows, will have little to no impact. “The incentives are still fundamentally wrong,” said one. “And if we don’t fix that, the 10-Year Plan is just a dream.”

There was a strong appetite for exploring new financial models, especially those that allowed local areas to reinvest savings, take managed risks, and move money around the system to meet citizen needs. “If you’re funding institutions, you protect institutions. If you’re funding outcomes, you protect people.”

Reimagining public health as everyone’s business

Public health leaders voiced concern that prevention still sits too far outside the core machinery of the NHS. One commented: “We have to stop defining health in such a narrow way. The system still treats public health as someone else’s job.”

David Meates noted that in Canterbury, integrating public health into mainstream service delivery had been one of the toughest challenges, but the most essential. “Public health has to be seen as a system-wide priority,” he said. “It’s about changing the narrative, not just the structure.”

Others called for a broader conceptualisation of prevention beyond the medical model, one which encompasses education, employment, housing, and lifestyle. “Hairdressers are frontline,” one leader said, “and professions such as taxi drivers should be considered part of the health system.”

From rhetoric to results

The dinner concluded with a clear message: the opportunities presented by the 10-Year Health Plan are real, but only if local systems seize them and develop local solutions in collaboration with system partners.

“We have to stop waiting for permission,” said one attendee. “Use alliance agreements. Build partnerships. Change the story from ‘I’ to ‘we’.”

As one final reflection summarised: “This is about codifying change, not just for the boardroom, but for the clinic, the pharmacy, the community centre. The 10-Year Plan won’t work because it’s written down. It’ll work because people make it work together.”

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Bringing the NHS 10-Year Health Plan to life: Lessons from the frontline

By David Meates

As momentum builds around England’s 10-Year Health Plan, three weeks of national conversations reveal a common theme: clarity of purpose, but deep concern about delivery. Drawing on insights from health leaders across Newcastle, Manchester and London, David Meates, Member of the New Zealand Order of Merit, explores three critical shifts needed to turn vision into lasting change.

Over the past three weeks in the UK, one detail has explicitly stood out for me. The clarity of purpose in every room I’ve been in.

I’ve been fortunate to participate in a series of forums and conversations across Newcastle, Manchester, and London with a key focus on the 10-Year Health Plan for England. Energy and engagement has been central to each of these discussions. Each conversation boiled down to a clear focus and purpose going forward – to create a future-focused health and care system that shifts from hospital to community, from analogue to digital, and from treating sickness to preventing it occurring.

The ambition is bold and correctly placed. The challenge lies not in the vision, but in the execution. The critical question we’re all asking is – how do we turn this vision into something real?

The plan has generated cautious optimism, but also a shared awareness of the significant obstacles we currently face. Fiscal pressures, workforce shortages, long waiting lists, outdated systems, and real-time access issues all cast a long shadow over future ambitions.

The fact is, accelerating our current approach or upgrading our tools alone won’t be sufficient to reach our destination. Something deeper is required.

I believe that three fundamental shifts are required to deliver on the promises outlined in the 10-Year Plan.

1. Restoring hope and trust

At the heart of every effective health system is hope. The quiet, daily belief that things can get better. This belief is what drives the immense effort from all health professionals, despite relentless pressures.

Hope has always been a currency in health. But it’s also fragile. And right now, many in the system have noted this hope slipping away.

NHS professionals I spoke with across the country described feeling overwhelmed, disillusioned, and exhausted. They’re still committed to their patients, but trust in the system, and in its leaders, is wearing thin. Ongoing frustration due to decision making that seems disconnected or random is a common trend. Secondly, the restructuring processes that feel more about prioritising image over real impact

One comment stayed with me:

“We’re under more pressure than ever as I try to do my best for my patients and the system.”

It’s time we acknowledged that truth and acted on it.

Restoring hope starts with rebuilding trust. That means showing up consistently as leaders. It means involving people in the decisions that shape their work and listening to their insight, not just collecting feedback after the fact. Most importantly, it means creating safe environments where people feel supported to do the right thing – not blamed when something goes wrong.

The health system’s greatest asset isn’t a piece of tech or a shiny new facility. It’s the continuous effort of the people who power it. When that effort disappears, or individuals lose hope, everything slows – decision-making, responsiveness, innovation. Reigniting that belief is not a soft ambition. It’s a hard necessity.

2. Simplifying the system

Health and care are inherently complex. But over time, complexity has been layered upon complexity, creating systems so convoluted that even those within them can’t easily explain how they work.

When a system becomes too complicated to navigate or understand, trust and confidence begin to erode. Efficiency suffers. The focus shifts from patient-centred care to managing processes, and decision-making becomes paralysed by layers of governance and red tape.

We must simplify. Not by dumbing things down, but by designing for clarity and connection.

In Canterbury, New Zealand, where I helped lead a decade-long transformation of the health system, we faced a similarly fragmented landscape. One of the most effective enablers we developed was HealthPathways – a platform that helped us agree, document, and communicate how care should be delivered across the system.

HealthPathways was more than a website. It was a living, breathing model of shared clinical decision-making. It brought together hospital clinicians, GPs, nurses, social care providers, and community organisations to answer a fundamental question: How do we do it around here?

It became our shared operating model – linking hospital and community, translating policy into practice, and integrating digital tools with real-world care. Most importantly, it helped rebuild trust and alignment across the system.

Importantly it made the system legible again, something that captured local reality while still being evidence-informed. And it was something that simplified – not added to – the work of delivering great care.

3. Unleashing the workforce

One of the most striking things about the health sector is that it’s filled with incredibly bright, capable people. Clinicians, managers, administrators, volunteers, many who are natural problem solvers. They see the issues every day, and they often know how to fix them.

But far too often, we tie their hands.

When decision-making becomes too removed from the point of care, responsiveness grinds to a halt. The urgency and nuance of frontline issues are lost in the shuffle of distant approval chains. The result? A system that reacts to crises instead of preventing them. A system held together by band-aids rather than built on resilience.

Empowerment isn’t just about giving people freedom, it’s about enabling them to flourish.

The people delivering care need to know their judgement is valued and that their leaders will back them when they take the right risks for the right reasons. Blame cultures, micromanagement, and punitive accountability systems have no place in a future-focused health service.

“Let me solve the problem with my team. We know what to do, we just need the space to do it.”

This was the common cry from across the system. The good news is, we don’t need to invent new capabilities. We simply need to remove the obstacles that are blocking the ones we already have.

A final thought

The 10-Year Plan is an important and necessary roadmap. But roadmaps are only useful if we’re willing to start walking. What’s needed now is not another layer of strategy, but a renewed commitment to the people who will make the change real.

That means restoring hope. Not with slogans, but with visible, supportive leadership. It means simplifying a system that has become too complicated for its own good. And it means unlocking the talent that’s already here, waiting for the signal that it’s both safe and encouraged to lead.

If we can do that, the future of health and care in England isn’t just possible. It’s already within reach.

About David Meates

David is an accomplished health system innovator most noted for his time as CEO of the Canterbury District Health Board leading the Canterbury Initiative. David is a frequent commentator and presenter on health system transformation and the role that HealthPathways can play within it.

Delivering on the NHS 10-Year Plan: Financial flows, workforce, and integrating care

By Gabriel Blaazer

As the government sets out its 10-Year Health Plan, health leaders gathered to discuss the critical enablers of long-term transformation – from fixing fragmented funding flows and investing in digital capability, to equipping the workforce and tackling the wider determinants of health. Can collaboration and local adaptation turn strategy into sustainable change?

On 10 July 2025, Salma Yasmeen (Chief Executive, Sheffield Health and Social Care NHS Foundation Trust), Dr Toli Onon (Joint Chief Medical Officer and Responsible Officer at Manchester University NHS Foundation Trust and incoming Chief Inspector of Hospitals, CQC) and Siobhan Melia (Chief Executive, Sussex Community NHS Foundation Trust and National Adviser for Community Health Services, NHS England), joined PPP and PwC for a specially convened breakfast meeting, exploring next steps following the publication of the 10-Year Health Plan.

Chaired by PPP Chair, the Rt Hon. Stephen Dorrell, and held under the Chatham House Rule, the meeting addressed some of the key implications for health and care services now that the 10-Year Plan has been made public.

Fixing fragmented funding flows

Multiple speakers and attendees highlighted the need to reform NHS financial flows, and in particular, block contracts, which hinder system responsiveness and effective resource allocation. Transitioning to activity and outcome-based funding models, such as year-of-care tariffs, was cited as complex but the direction of travel the NHS should aim for. As the Darzi Report highlighted, acute sector spending has increased from 47 per cent in 2006 to 58 per cent today – a ‘right drift’ rather than the left shift that has been pursued by successive governments, both in the UK and abroad.

As such, current funding models run contrary to the ambitions expressed in the 10-Year Plan, particularly shifting more care away from hospital settings. Since patient journeys span sector siloes, a genuinely integrated and aligned funding model would see financial resources following the patient, not the institution or provider; or, as one speaker explained: “we need funding to flow across interfaces.”

“If you’re a system in deficit, nine times out of 10 that deficit sits within the acute trust; Payment by Results creates a cultural disincentive to trade your way out of financial problems.”

There was particular weight given to shifting investment into partnerships that deliver outcomes for defined cohorts, rather than individual services. “If we can work out how money can flow into partnerships of integration…and incentivise providers collectively to deliver the right outcomes for patients, that would be a gamechanger,” said one speaker.

*(L-R) Dr Toli Onon, Rt Hon. Stephen Dorrell, Salma Yasmeen, Siobhan Melia*

Health and public services: Addressing the real determinants of health

The plan’s emphasis on the wider determinants of health – such as housing, employment and social connection – was welcomed by speakers, particularly with reference to mental health. One speaker celebrated that “this is the first time in many years that we’re dealing with the root causes of mental health,” but cautioned that protecting universal access to mental healthcare must be a priority amid continuing cuts to mental health services.

There was also recognition that more locally responsive models of care are needed, with community-level co-design and diverse participation at their core. “Equity doesn’t happen by chance,” said one speaker: “we need to build it in from the start.” This is particularly relevant when considering rural and urban populations, where the needs of communities and accessibility of health and care services can vary substantially. For example, some rural areas have found success in building Integrated Neighbourhood Teams (INTs) using existing primary care network boundaries, whereas an urban area might benefit from the co-location of GP and community nurses, social workers or pharmacists in a community health hub.

Whatever foundation is used to deliver neighbourhood care, however, speakers argued for the close participation of VCSE partners in core service design and delivery, to ensure that services are reflective of local need and to avoid the creation of “mini institutions” within neighbourhoods.

However, realising the vision of community-centred care will be next to impossible if current multimorbidity trends continue; this means substantial investment into neighbourhoods, communities, employment and housing.

Equipping and supporting the workforce

Speakers noted that the Plan’s emphasis on community and neighbourhood-based care has major implications for workforce readiness; the left shift cannot happen without reshaping training and education of healthcare professionals, nor without truly supporting new models of practice.

Those expected to deliver care in new or unfamiliar environments must be trained to do so. Speakers emphasised that outside of ‘box-ticking exercises’ on undergraduate courses, for instance, healthcare professionals receive little training for delivering care within patients’ homes.

“We need proper treatment programmes in real-world settings, but our current training doesn’t prepare people for that.”

Beyond clinical skills, workforce development also requires addressing the emotional burden faced by staff, particularly in the context of public criticism of NHS staff and professional shortages. “The resident doctors’ industrial action is a symptom of a demoralised workforce,” explained one speaker. Another added that we cannot continue routinely blaming midwives and doctors for systemic failures evident across maternity care, particularly given their shortage across the NHS, and called on the CQC to take a more constructive approach to assessment and regulation of services.

Data, digital and system learning

Concerns were raised regarding the readiness of the NHS workforce to deliver the data-led, digital-first NHS that the 10-Year Plan envisages. Attendees confronted the “assumption that AI will solve all of our problems and reduce the need for analysts,” expressing instead that AI should be viewed as a tool to be used by analysts.

Speakers also noted that while the Plan features a heavy emphasis on technology as a means of alleviating pressure on the health system, there is a significant gap in both infrastructure and capability across the NHS. Digital maturity varies substantially from one system to another, with some providers conducting robotics-assisted surgeries while others still lack access to interoperable patient records.

Investment in digital capability was seen as critical, but several cautioned that funding must also focus on the people needed to interpret and apply data, rather than solely digital infrastructure.

Low data literacy among the workforce was also identified as a particular issue, as biases or gaps within datasets can easily translate into poor service design and exacerbate access and outcome inequalities. It was argued that the government’s £10 billion investment in upgrading NHS technology and delivering a single patient record will be undermined if there is not a similar effort to upskill staff, ensuring they can handle and interpret patient data safely, accurately and with due consideration of potential biases within datasets.

Achieving a meaningful left shift depends heavily on digital maturity across both systems and the workforce. For instance, moving outpatient care out of hospital relies on seamless digital interfaces between primary, secondary and community providers. Similarly, a more connected system would allow GPs to access specialist advice more efficiently, and enable patients to view and manage their own health information.

System-wide digital maturity is essential to demonstrating the value of integrated care. With the right data infrastructure in place, it becomes possible to show how targeted investment – such as in joint models between primary, community and mental health providers – can lead to better patient outcomes, more efficient use of public funds, and a stronger return on investment for taxpayers. This kind of evidence is key to guiding where resources should be deployed in future.

Looking ahead to implementation

Though the plan marks a significant inflection point for the NHS, attendees were mindful of the implementation challenges ahead, and the mixed record of past strategies. One audience member cautioned that: “we’ve had the Five Year Forward View, the Refresh, the Long-Term Plan, the Recovery Plan… maybe a third gets implemented, maybe a third of that has any impact.”

Speakers also noted the absence of strategy for actually delivering the 10-Year Plan, as well as the challenges inherent for integrated care boards in delivering proposed changes alongside 50 per cent running cost reductions. There is also the question of social care, a plan for which is currently being shaped by Baroness Louise Casey’s independent review, and is expected to be released in 2028 at the soonest.

Nonetheless, participants expressed a shared optimism and commitment to shaping the next phase of delivery. For some, the priority is neighbourhood-based support for mental health. For others, it’s recalibrating funding to better serve integrated care.

As one speaker concluded, no single organisation can solve these challenges in isolation; humility, collaboration and local adaptation will be essential to delivering on the 10-Year Plan, and building what comes next.

Next steps

PPP will continue exploring the future of health and care transformation and the implications of the 10-Year Health Plan at our next breakfast event, Implementing the 10-Year Health Plan, on 3 September 2025. We will be joined by the Rt Hon. Alan Milburn, Lead Non-Executive Director for the Department of Health and Social Care, to examine what the 10-Year Plan means for services and local system.

To find out more and secure your place*, please visit the event page.

*Please note that places are limited.

Integrating care records is good. Using intelligence to make them active is better

By Dr Paul Deffley

What is needed for the single patient record to deliver intended benefits? Dr Paul Deffley, Chief Medical Officer for Alcidion and former NHS commissioning professional, considers how emerging policy could help patient record systems to become more active and intelligent, enhancing the delivery of care.

A single patient record already exists in the NHS. Or at least, that’s a perception shared by many. A survey of a thousand members of the public, conducted by NHS Confederation-hosted organisation Understanding Patient Data, found that more than six in 10 UK citizens believed information on their NHS history was already collated in a single repository.

A somewhat different reality is known to most people working in the health service. Anyone who has worked in healthcare policy long enough will know that overcoming the challenge of fragmented records has long been a priority for successive NHS and Department of Health leaders.

Following the publication of the NHS 10-Year Health Plan, it is timely to reflect on how the pervasive matter of fragmented records will be overcome. It appears that money will be available after Chancellor Rachel Reeves committed £10bn for NHS digitisation in June’s spending review, which specifies that a single patient NHS record will mean “every part of the health service has a full picture of a patient’s care”.

Integrating care records is good. But unless we make them active – capable of surfacing insights, prompting actions, and working seamlessly within clinical workflows – we risk building a vast digital filing cabinet that gathers dust.

Providers, systems, suppliers, and the thousands of data controllers that exist in healthcare, will all have a role to play in making such a plan reality and undoubtedly, with historic attempts having been abandoned in the past, issues such as the safeguarding of data will be key.

Many other questions must also be asked as the ambition advances to finally overcome data silos. Here’s what four of those questions might be:

Liberating data: What’s the opportunity?

There is already an enormous amount of data captured throughout the patient’s journey. Much of this data sits within the fragmented landscape of applications that form the backbone of health IT systems. Pulling all this data into a single patient record represents enormous complexity and cost, and much of the data will not be of value to future care needs.

The key to a valuable single digital patient record is accessing the pertinent information when it is needed. Liberating the valuable information pertinent to the situation.

Before we go into how an active integrated patient record might be achieved, asking why such a record needs to be created is essential. Some answers have been very well documented over the years – with integrated data opening opportunities for patients not having to repeat themselves, for better informed care, informed patients, and informed research, as well as enhancing decisions that lead to safer care provision.

Whatever transcends into policy or even legislation, designing and delivering record systems that are both useful and used poses two questions: What do clinicians really need from an integrated record? And what will benefit patients?

Patient empowerment will be key against a policy backdrop of prevention – and records will undoubtedly need to prompt and present individuals with the right information to make informed choices about their care. However, the way patients continue to both consume and contribute to that data will change – and strategic approaches must respond accordingly.

Wearables, for example, have become a rich source of data that often remains excluded from patient records. We need to think about how that data and other datasets that haven’t even been conceived yet can be better contribute to the comprehensive picture of a patient’s health. And we need to consider how data in a new single record can be integrated into the digital systems that clinicians actually use in their workflows, rather than creating a standalone silo that sits in the corner of a ward or on an app that never gets accessed.

How can emerging intelligence enable record solutions to be more active?

So, how could a single patient record be put into practice? Simply building a bigger record risks creating a very large database of patient data – something many NHS providers and professionals I speak to are eager to avoid. Particularly those already benefitting from solutions that alleviate the clinical cognitive burden and that are proactive in clinical decision support.

We need to build a solution that can work as an ally to patients and clinicians alike, and that is futureproofed to leverage emerging technologies. Every health and care worker might soon have their own generative AI assistant that can interrogate an integrated record, provide them with support or guidance, and advise on the likelihood of certain actions being a success.

The AI assistant is likely to have the capability to go out and interrogate a wide range of data sources to enrich the integrated record, making a large ‘single’ database unnecessary. Busy clinicians will no longer need to spend their time and effort searching for insight. As we develop record solutions that will take advantage of these capabilities, it is vital that the integrated care record becomes available for every health and care workflow.

The evidence that this works can already be seen in existing technology deployments – I’ve witnessed first-hand the recent benefits of integrating the Great North Care Record in one trust’s EPR, a valuable data source that has exploded in use by making it easy for clinical teams to access. It’s about more than creating a view of such data – this is about integrating data into the forms, pathways, and processes that clinicians use.

Does the NHS need a single record? Or a platform? Or both?

A single patient record is a fantastically clear way to articulate what is trying to be achieved. However, a single patient record does not mean a very large database, poorly designed into care workflows. Access to an integrated record that is populated with contextually rich and relevant data from multiple sources is a much more realistic and powerful way of delivering this capability to our clinicians. In making this happen, we need to be equally articulate about how we will get there from the earliest of stages.

That in part means learning from what has come before so that the programme can be differentiated. Large digital health programmes around the world have sometimes encountered failed adoption and escalating cost, when they have built first, and thought later, about how to integrate the data and insights into clinical workflows.

There is a need to think actively about the application of data in a clinical context, then design the data and intelligence layer that sits behind an integrated record in order to make the system a success, and to ensure we deliver active systems of engagement, rather than simply passive records.

Integrated care systems have a crucial role here – not just in adoption, but in defining what success looks like for local populations. The single patient record must be flexible enough to accommodate these differing priorities, without becoming fragmented all over again. We must be cautious not to conflate ‘single’ with ‘centralised’. A national strategy must enable local adaptability – so that records can support different services, care models, and patient needs across systems.

Who are we building this for?

Population health, research possibilities, changing our understanding of illness – all critical use cases for liberating and consolidating patient data. However, we need to start by meeting the needs of frontline clinicians and patients.

Clinicians need to be able to make good decisions first time to avoid duplication and waste that a stretched system can no longer withstand.

The record has to be an integral point of a patient encounter for it to be an effective partner and one that can then share insights across the integrated system. Imagine if were possible to prevent unnecessary readmissions by flagging patients at risk based on their complete care history, or eliminate duplicate diagnostic tests by providing real-time visibility into recent procedures across different departments and facilities.

Consider the efficiency gains when emergency department clinicians can instantly access a patient’s complete medication history, allergies, and recent specialist consultations rather than starting from scratch or waiting for paper records to be located. This reduces diagnostic time, prevents adverse drug interactions, and enables more targeted treatment protocols.

In surgical settings, integrated records can streamline pre-operative assessments by automatically surfacing relevant imaging, lab results, and specialist recommendations, reducing the need for repeat consultations and accelerating time to surgery. Post-operatively, the same system can trigger appropriate follow-up care protocols and coordinate discharge planning across multiple disciplines.

The efficiency multiplier effect becomes clear when considering how many hours clinicians currently spend searching for information, making phone calls to other departments, or repeating assessments that have already been completed elsewhere in the system. An integrated record that serves as a true clinical partner transforms these time-intensive activities into seamless, data-driven workflows that keep clinicians focused on direct patient care rather than administrative tasks.

From blame to learning: how digital incident reporting can transform patient safety culture

By Vatix

Patient safety is a cornerstone of healthcare, directly affecting the well-being of individuals, the confidence of their families, and the overall trust in the healthcare system.

This content was kindly supported by Vatix.

Keeping safety at the forefront helps reduce serious incidents and prioritise the delivery of quality care.

A key way of ensuring patient safety within any healthcare organisation is to instil the right culture.

Traditionally, the approach to reporting patient safety events has tended to be blame-focused rather than learning-oriented. In recent years, however, a shift has been taking place. The introduction of the Patient Safety Incident Report Framework (PSIRF) and new innovations in digital incident reporting systems have encouraged a culture change.

But before discussing how things are set to change, let’s examine the underlying problem.

The problem: a blame culture in healthcare

A blame culture is when individuals are punished or blamed for mistakes, rather than looking at the bigger picture of why something went wrong. It’s particularly prominent in healthcare as mistakes are often very serious and can be life-threatening.

For example, this could look like blaming a nurse for a medication error without looking into the broader context to see if there could be an issue with unclear labelling or a lack of resources.

This also has a knock-on effect on reporting figures, as people may be wary of reporting events for fear of punishment. And often, the true root cause of the issue is not discovered, meaning that there’s a higher chance of incidents being repeated.

The Serious Incident Framework (SIF) was the old process for reporting patient safety issues in healthcare. It tended to zero in on how the actions of individuals, rather than systems or processes, resulted in mistakes. This emphasis on individual responsibility for a mistake bred a culture of punitive action within some organisations and shifted the focus away from learning and prevention.

Why a learning culture matters for patient safety

A learning culture is built around the value of shared and continuous improvement. Instead of blaming an individual when a mistake is made, organisations should look at the wider context and root cause of the incident.

Incidents should be viewed as a learning experience and encourage open and honest communication about why the event occurred.

The Patient Safety Incident Response Framework (PSIRF) was brought in to replace SIF, which was recognised across the healthcare sector as problematic. PSIRF moves away from blame and towards learning and improvement.

Some of the core benefits of implementing a culture of learning within healthcare organisations include:

Encouraging honest reporting of incidents.
Identifying patterns and trends rather than isolated mistakes.
Promoting proactive safety measures rather than reactive discipline.

However, cultivating a learning mindset doesn’t just happen overnight; effort needs to be put in to ensure it’s fully embedded into an organisation’s culture.

Best practices for creating a sustainable learning culture

Creating a learning culture that is truly embedded in an organisation’s values and operations must begin with a clear commitment from leadership. Leaders must encourage reporting, model transparency, and create an environment where everyone feels safe to speak up without judgment or repercussions.

Regular training and reflection sessions for staff also help keep learning front of mind. The key takeaways from any major incident should be circulated to avoid reoccurrence and assign any relevant corrective actions. During this process, there should be a focus on system-wide issues or the greater context that led to an event rather than individual fault.

Another very important element of creating a lasting safety culture is ensuring that there is an effective and user-friendly digital system in place for reporting and managing incidents.

The role of digital incident reporting in creating a learning culture

Typically, filing a report was paper based, meaning that information could be scattered over several different systems and that it was hard to keep track of learnings and outcomes.

Modern digital reporting tools make reporting incidents easier for staff, patients, and family members. People are more likely to report an incident if it’s simple and they know it will be followed up on.

Digital tools help organisations shift away from a blame culture in a number of ways:

Anonymity and psychological safety: Ensures staff feel safe to report without fear.
Real-time data analysis: Helps identify trends and root causes.
Standardised reporting: Reduces human bias and ensures incidents are reviewed fairly.
Automated feedback and learning: Digital tools can provide instant feedback, resources, or training suggestions based on reported incidents.

The future of patient safety through digital learning

Creating a learning culture in healthcare is vital for improving safety, transparency, and quality of care. Moving away from a culture of blame and towards one focused on shared learning allows staff to feel confident speaking up and participating in meaningful change.

Digital incident reporting systems like Vatix’s are key enablers of this transformation. Vatix makes it easy for staff, patients, and families to report incidents through a secure, user-friendly platform – removing barriers to reporting and encouraging early intervention. Its system supports real-time data analysis and customisable workflows that help organisations spot patterns, address risks proactively, and track actions taken.

With features such as reporting via QR code, mobile access, and seamless integration with other compliance tools, Vatix empowers healthcare organisations to meet safety standards and continually learn, improve, and deliver safer outcomes for everyone.

If you’d like to find out more about how Vatix can help embed a safety culture within your organisation, get in touch today.

The 10-Year Health Plan: A win for community pharmacy?

By Samantha Semmeling

The government’s 10-Year Health Plan outlines a major shift in NHS priorities, aiming to move care closer to communities, emphasise prevention, and harness digital tools. Central to this vision is an expanded role for community pharmacy, raising questions about how the sector will adapt and whether it is equipped to meet these ambitions.

The government’s 10-Year Health Plan sets out an ambitious transformation for the NHS underpinned by three major shifts: hospital to community, analogue to digital, and sickness to prevention. At the heart of this transformation is the proposed development of a ‘Neighbourhood Health Service’, where pharmacy is set to play a vital role.

The plan outlines a clear transition for community pharmacy, from a predominantly dispensing to a more clinical, preventative and digitally-enabled role. Over the next five years, the government proposes that community pharmacies will:

Manage long-term conditions such as obesity, high blood pressure and high cholesterol
Deliver more preventative services, including vaccinations and screening for cardiovascular disease and diabetes
Support complex medication regimes and offer independent prescribing
Be linked into the Single Patient Record, enabling more seamless service delivery

These proposals build on the success of existing services like Pharmacy First and hypertension case-finding, both of which demonstrate the value of pharmacy in improving access and early intervention. However, this success hinged on public awareness, strong pharmacy leadership, and swift IT integration – which must be central strategies if ambitions for the sector are to be realised.

Pharmacies are critical for prevention as they are well-embedded in local communities, but particularly so in underserved areas that often face the highest burden of chronic disease. However, pharmacies must be equipped with the right tools and training. Innovative diagnostic technologies, such as point-of-care testing, can support early detection and intervention. Although there have been some promising pilots, they are not yet used at scale. Deploying such tools in tandem with workforce training will be essential to delivering preventative services in community pharmacies.

Public Policy Projects (PPP) has previously advocated for a more integrated role for community pharmacy, parity across primary care and a broader understanding of the sector’s role beyond clinical services and medicines optimisation.

Community pharmacies are hyper-local, highly trusted and universally accessible, offering huge potential to deliver social value. From providing culturally sensitive health advice, supporting marginalised populations, or acting as an informal hub for wellbeing, community pharmacies are ideal settings to form part of the emerging Neighbourhood Health Service.

However, unlike general practice, community pharmacies do not hold registered patient lists and often serve individuals who move across geographical boundaries. As such, new services must be designed around the needs of patients, not tied to artificial catchment areas. Primary care contracts which are complementary and integrated by nature, allowing providers to collaborate, not compete, will be essential to seamless service delivery.

The 10-Year Health Plan marks a pivotal moment for community pharmacy. It recognises many of the sector’s often overlooked strengths and proposes a more strategic role for pharmacies in health and care delivery. However, these opportunities must be matched with sustainable funding, contractual reform, and meaningful collaboration across all system partners.

Next steps

To further explore the implications of the 10-Year Health Plan and engage with PPP’s Pharmacy and Medicines work, please contact: Samantha Semmeling, Policy and Programmes Manager, Public Policy Projects (samantha.semmeling@publicpolicyprojects.com)

New report launched to improve productivity measurement in healthcare

By Integrated Care Journal

The report calls on the NHS to adopt multi-faceted measures that better reflect long-term investment, patient outcomes and workforce resilience, alongside greater evaluative and technical integration to bridge the gap between local insights and national decision-making.

A new technical report on Measuring Productivity in Health Care has been published by NHS Arden & GEM Commissioning Support Unit (CSU). Commissioned by the Health Foundation, the report provides an in-depth examination of how productivity in the NHS is currently assessed and how it should evolve to meet the growing challenges facing the health system.

Set against a backdrop of increasing demand, constrained resources and post-pandemic recovery, the report looks at how we measure, and how we should measure productivity in such a complex system as the NHS.

Katie Fozzard, Senior Economist at the Health Foundation, said: “The government has placed significant emphasis on increasing NHS productivity – setting a stretching target for the health service to deliver 2 per cent annual productivity growth. The way productivity is measured, and whether it captures what matters most, is therefore of crucial importance. This report is a vital resource to help us understand the different ways that productivity is measured and areas for improvement.”

Drawing on a wide body of literature and engagement with stakeholders across government, academia, NHS England and local health systems, the report explores the current strengths and limitations of existing productivity metrics, also looking forward to recent developments in productivity measurement, as set out in the ONS recent Public Services Productivity Review. It highlights persistent challenges such as fragmented data, inconsistent coverage across settings, and a lack of tools to evaluate long-term investment, preventative care and workforce resilience.

Rose Taylor, Executive Director Health and Care Transformation at Arden & GEM said: “Understanding and improving NHS productivity is essential to delivering high-quality care with finite resources. This report provides a fresh lens on how we measure productivity in such a complex system, highlighting where current metrics fall short and where new approaches can drive meaningful change.”

The report highlights the breadth of reasons for measuring health care productivity and corresponding approaches. It proposes a new classification framework to better align metrics with their intended use, whether for system-level planning, local service improvement, evaluating resource allocation or national financial accountability.

Among its key areas for development, the report calls for:

The adoption of multi-faceted measures that better reflect long-term investment, patient outcomes and workforce resilience, to strengthen how measures align with future service needs
Greater integration of micro-level evaluative and macro-level technical approaches to bridge the gap between local insights and national decision-making
Investment in metrics that account for the value of preventative care beyond short-term costs
Improved tools to measure productivity across evolving care pathways and system partners, including social care and the independent sector

The Health Foundation will build on these findings in future work to support better long-term decision making across health and social care.

The full Measuring Productivity in Health Care report is available here.

Holding our nerve: Making the ‘left shift’ a reality in health and care

By David Duffy

At a recent dinner hosted by Public Policy Projects and HealthPathways, senior NHS executives and leaders gathered to reflect on one of the most urgent challenges in health and care today: how to deliver a meaningful ‘left shift’ – moving care out of hospitals and into community settings, as outlined in the forthcoming 10-Year Health Plan. The conversation offered a candid look at the structural barriers that continue to impede progress, while also spotlighting the leadership, collaboration, and bold action required to overcome them.

The discussion was chaired by Len Richards, who stepped down as CEO of NHS Mid Yorkshire Teaching Trust in April 2025. With executive leadership experience in healthcare systems across both the UK and Australia, Richards has been a consistent advocate for integrated system working and for modernising health services through partnership-driven reform.

As Richards noted at the outset, much has changed in recent months. Financial pressures have deepened across the board, with providers and systems increasingly asked to deliver more with fewer resources. Meanwhile, major structural reform looms, including the anticipated merger of NHS England with the Department of Health and Social Care, and a sweeping review of the core functions of integrated care boards.

Despite these developments, many long-standing challenges remain unresolved. Hospital congestion and ever-growing waiting lists continue to plague the NHS, despite multiple central reorganisations. These pressures have fuelled a crisis in public confidence and severely undermined staff morale.

Drawing on his leadership experience in Australia, Wales, and the UK, Richards emphasised that real progress depends on genuine system-wide change. He highlighted his longstanding use of HealthPathways as a practical tool to support integration – a model that draws on clinical expertise, community knowledge, and patient experience. For Richards, HealthPathways’ system-wide approach to care pathway redesign has consistently delivered clarity, confidence, and hope during times of change.

This sentiment feels more poignant than ever, as the system now requires a whole-of-system approach to left shift – one that builds additional capacity, boosts productivity, and firmly places patients at the centre of care.

The reality of the left shift

Despite years of policy promises and widespread rhetorical backing, there was a shared acknowledgement that the shift towards community-based care has yet to take meaningful form. System leaders expressed frustration that, while the vision is widely accepted, progress on the ground remains slow. With funding still disproportionately directed toward hospitals, acute care continues to be treated as the default care setting, despite decades of political commitments to reallocate resources toward prevention and community services.

The message was unmistakable: the current approach is falling short – and in some cases, actively worsening outcomes for patients. Long waiting times, increasing health-related anxiety, and ongoing challenges in mental health services are eroding public trust. Transitioning to a community-based, preventive, and integrated model of care is no longer just an aspiration – it is fundamental to the sustainability of the NHS.

Yet, under the weight of existing system pressures, achieving this transformation feels increasingly out of reach. There was a strong call in the room for political rhetoric to be matched by bold, system-wide action, and for local leaders to be genuinely empowered to make decisions that reflect the needs of their communities.

A system that still thinks in silos

Leadership, risk, and public trust

Some leaders did highlight that large sections of the public still maintain that the hospital is the safest and most effective place within the sector to receive care. It is up to leaders, political and otherwise, to have a frank conversation with the public to address this trend and clearly articulate how health and care services can be accessed.

Leaders must be clear of purpose, instil confidence, and perhaps most importantly, hold their nerve in the face of political and institutional pressure. But bravery cannot stop at the hospital board room.

Several attendees emphasised the need for political courage at the national level. Without it, the system will remain risk-averse and locked into a cycle of short-term performance management at the expense of longer-term transformation.
There was strong consensus that DHSC needs to be brave in redistributing resources away from acute settings, even when these efforts run counter to entrenched assumptions or public sentiment.

Rebuilding public trust is paramount, and confidence in the NHS is closely tied to waiting times and access. When people don’t know how long they’ll have to wait or to whom to turn, anxiety grows among the public. Leaders present at the dinner stressed the importance of clear, honest communication with the public – explaining not only what is changing, but why. People want simplicity, not bureaucracy; certainty, not confusion.

Reimagining metrics and accountability

A fundamental rethink of how success is measured was also discussed. Many of today’s key performance indicators are designed for performance monitoring, not for meaningful change. Attendees called for metrics rooted in health economics, place-based outcomes, and patient experience, rather than just ‘activity focused’ hospital throughput or financial balance.

The discussion also explored wider issues of financial governance. Some questioned whether systems should be permitted to run short-term deficits in order to unlock longer-term savings and improved outcomes. Others highlighted the pressing need for greater clarity and transparency in place-based spending—an area where the NHS still falls short. What became clear is that NHS financial structures remain rigid and poorly suited to support innovation or invest in preventative approaches that may not yield immediate performance gains, demand reduction, or visible returns. There is still discomfort within the system when benefits are not directly or immediately felt by the organisation itself.

Stop talking. Start doing

The dinner closed with a sense of urgency. The opportunity presented by the 10-Year Plan is real, but so too are the risks of continued inaction. Siloed thinking, limited risk appetite, and cultural inertia are holding the system back. Leaders agreed that it’s time to stop talking about integration, co-production, and shifting left, and time to start doing them.

This means creating space for genuine community engagement, sharing risk across sectors, and aligning incentives to patient outcomes rather than institutional survival. It means trusting others in the system to deliver value, even when they sit outside the NHS’s traditional structures. Above all, it means holding our collective nerve.