Building the foundations for transformation in the NHS

The moment

The vision of the 10-year plan is clear – a shift from hospitals to neighbourhoods, from reactive treatment to proactive prevention, and from fragmented, analogue systems to intelligent, data-enabled care.

Now, execution of this reform agenda is essential.

At a national level, government has begun to lay the groundwork for delivery. NHS organisations have been tasked with developing five-year integrated plans, setting out priorities to recover performance and lay the foundations for long-term transformation; a national Neighbourhood Health Implementation Programme has been established, and 43 sites across England have been chosen to pioneer new ways of working to shift care closer to home; and policymakers are hard at work developing blueprints, models and contracts for new providers and commissioners of NHS services – the next generation of foundation trusts, Integrated Health Organisations, and single and multi-neighbourhood providers.

Of course, national decision-makers have a key role to play in shaping the future of the NHS. They design the system’s underlying architecture and set the ‘rules of the game’ – the parameters in which change can occur. However, attempting to manage the implementation of the 10-year plan from the centre, is destined to fail. A new approach to change management in is needed if the government is to make good on its promise to bring about once-in-a-generation reform in the NHS.

The need for a new approach

The toolkit of national policymaking is insufficient to secure lasting change in the NHS. Too often, ambitious programmes for transforming the NHS do not survive contact with the messy, day-to-day realities of organising and delivering care.

The blunt truth is, the successful implementation of the 10-year plan depends less on decisions made in Whitehall and more on the work of frontline leaders running hospital services and GP practices, managing urgent care, coordinating discharge and social care flow, and leading digital transformation.

They remain under immense pressure. Care backlogs are persistent, workforce fatigue and burnout are growing, and funding, while increasing, will remain constrained for the foreseeable future. Too often, centrally directed transformation initiatives feel like another layer on an already full plate for frontline managers and clinical staff.

The government worked hard to involve frontline staff and leaders in the development of the 10-year plan, facilitating the largest public and staff consultation in the NHS’s history through the Change NHSinitiative. It must now draw on their insights, expertise and experience if it is to seize the opportunity to drive transformation from the bottom up.

IPPR’s programme

Restoring the NHS’s performance in the short term and laying the groundwork for long-term transformation will require paying much closer attention to the day-to-day processes that underpin the delivery of care and a relentless focus on getting the basics right. 

Having been closely involved in the development of the 10-year plan, IPPR will now work with local NHS teams and leaders to communicate what is required to translate vision into delivery. We will co-design a series of briefings focused on the real-world enablers of the plan, written with and for the individuals who will be implementing it.

Each briefing will include a clear articulation of the problem, based on the views of those facing it every day, a grounded vision for what better looks like, practical actions, tools, and policy levers to enable reform within current constraints, and examples from real teams already making change happen.

We will publish briefings on the following topics.

• Getting the basics right: rebuilding operational management to drive NHS reform.

• Enabling financial stability: smarter procurement for a stronger NHS.
• People first: supporting, motivating and retaining NHS staff.
• Tech that works: AI and innovation built for staff and patients.

• Patients in control:strengthening patient choice and voice.

Alongside these briefings, we will convene workshops to bring together NHS leaders and policymakers, not to rehash strategy, but to begin to communicate the short-term steps that can be taken to make way for its delivery.

The government has a once-in-a-generation opportunity to reshape the NHS. But seizing this moment will depend less on new strategies from the centre and more on equipping the leaders and staff who organise, manage and deliver care every day with the skills, tools, and insight to drive change from the bottom up. IPPR will serve as a bridge between national ambition and local reality – translating policy into practical steps and amplifying the voices of frontline leaders.

By focusing on the real-world enablers of change, convening those who will drive it, and shining a light on best practice, IPPR will play a critical role in ensuring that the government’s vision moves beyond aspiration and into lasting transformation.