The real £3.25 billion question
The NHS isn’t broken because of who’s been in charge.
It’s broken because of how it works — and how change has historically been managed.
Earlier this year, the Government announced a major shake-up: scrapping NHS England, moving control back under the Department of Health, and launching a £3.25 billion Transformation Fund alongside the NHS 10-Year Plan. The ambition? Leaner operations, digital-first care, and a more connected health system.
On paper, it’s a bold, historic move. In reality, we’ve seen this before.
If you’ve ever worked near the frontline, you’ll know the issue isn’t just policy — it’s process. Outdated systems, manual workarounds, and exhausted teams trying to deliver care through complexity. Transformation doesn’t fail because of vision. It fails when change isn’t built around people, process, and behaviour.
The NHS doesn’t need another top-down restructure. It needs a ground-up redesign — one that fixes what truly stops progress: poorly managed change, disjointed processes, and systems that make it harder — not easier — to care for patients.
The reality behind the NHS 10-Year Plan
To understand what real transformation looks like, we first need to face the facts. Without addressing the deep-rooted inefficiencies that hold the NHS back, even the most ambitious reforms risk becoming just another rebrand.
As Bev Wright, Head of UKI Public Sector at Adobe, says:
“The Transformation Fund is a welcome signal of intent to unlock the productivity and capability benefits of AI, but without organising government and citizen data, and replacing legacy systems first, there’s a risk it won’t move us forward.”
Across the NHS, fragmented systems, paper-based processes, and siloed data remain the biggest barriers to change. The State of Digital Government Report found that over half of public sector organisations dedicate more than 40% of their time and budget simply to maintaining legacy systems — and 42% still rely heavily on paper.
AI has been earmarked as a game-changer, but rolling it out before fixing foundations could make the problem worse. Without strong data governance and clarity on regulation under the AI Act, AI risks becoming another burden on already overstretched teams.
The NHS 10-Year Plan promises neighbourhood health centres and digital-by-default care pathways, but success depends on one thing: getting the operational groundwork right.
Five priorities to make the NHS 10-Year Plan deliver
To turn strategy into real, lasting change, the Government must focus on what happens day-to-day — not just what’s outlined in policy. Here are the five priorities that will make or break this transformation.
1. Follow the patient, not the process
The NHS must be designed around the patient journey, not its organisational structures. Clinicians can’t treat what they can’t see.
At Nottingham University Hospitals, mapping the full patient journey before implementing electronic prescribing revealed hidden process gaps and led to safer, faster care.
Transformation succeeds when systems interoperate — when data flows seamlessly from GP to hospital to community care — allowing staff to make better, quicker decisions.
2. Fix the way people work before you digitise it
Technology should amplify what works, not hard-code inefficiency.
Too often, digital tools are implemented before understanding how people actually work. Capability mapping exposes broken processes and identifies where technology can drive real improvement.
Transformation must be built on insight, not assumptions — and digital systems should reflect how people deliver care, not dictate it.
3. Stop draining staff to power broken systems
NHS staff don’t need resilience training. They need systems that work.
Transformation fatigue stems from constant change without meaningful improvement. The solution? Continuous feedback, frontline involvement, and co-creation — not top-down directives.
When staff shape change, transformation sticks. Because if change is exhausting, it’s probably bad change.
4. Trust the people closest to the patient
Integrated Care Boards (ICBs) know their communities better than anyone in Whitehall. The Government’s role should be to provide guardrails, not micro-management.
Effective reform empowers local teams to tailor solutions to their context — turning national ambition into local action.
5. Redefine what ‘good’ looks like
Dashboards for dashboards’ sake don’t save lives. Dashboards that help clinicians make faster decisions and reduce patient delays do.
The NHS must shift from measuring activity to measuring impact — outcomes like faster recovery, earlier diagnosis, and smoother care journeys.
Data is only valuable when it drives action. Anything else is noise.
A once-in-a-generation opportunity for intelligent transformation
This reform could be a defining moment for the NHS — but only if it tackles the operational challenges beneath the surface.
We need to move from reorganisation to redesign. From structural change to intelligent transformation — transformation that aligns strategy with behaviour, insight with action, and ambition with delivery.
Change Management isn’t about communication plans and training slides. It’s about helping people adapt with clarity, confidence, and purpose. When done right, it bridges the gap between vision and reality — and ensures transformation sticks.
Want to read more? Read Erica Hodgson’s full diagnosis of the NHS Transformation challenge in her article for Government and Public Sector Journal.
How Differentis can help
At Differentis, we partner with NHS Trusts across the UK to make transformation real.
We help leaders:
- Map how their teams actually work — surfacing inefficiencies and opportunities for improvement.
- Define the business case for change and prove value from existing transformation efforts.
- Build capability maps that guide smarter investments in technology and people.
- Deliver intelligent transformation — combining operational insight, people-first design, and change management that lasts.
If you’re ready to turn the NHS 10-Year Plan from strategy into reality, we can help. Book a meeting with our team to discuss how Differentis can support your Trust’s transformation journey.
