Reform, transformation or recovery – what does the NHS really need?

Isabel Lawicka profile picture

26 April 2022

Isabel Lawicka
Head of Policy and Analysis


Language matters. But what really counts for patients and staff is how we put those words into practice. The NHS has become fluent in the language of reform, recovery and transformation in recent years. These terms are interconnected but each has slightly different connotations: 'reform' might indicate something's wrong and needs to change; 'recovery' suggests getting back to where you started; and 'transform' could be interpreted as 'evolving into something better'.

It's also easier to see why 'transformation' is the more commonly used terminology across the NHS.

Isabel Lawicka    Head of Policy and Analysis

It's easy to see why politicians generally favour the language of reform. It's more dramatic, it can help to set out a vision of change for people to sign up to and it might be a more attractive banner for your business case to the treasury, manifesto writers or party leaders. It's also easier to see why 'transformation' is the more commonly used terminology across the NHS. It implies a recognition that good work is already happening and there's a need to build on this. Whereas 'recovery', which is used lots in the context of discussion around care backlogs post-pandemic, implies a return to the status quo.

But are any of these terms helpful in getting to the crux of what the NHS needs now, as it treads a careful balancing act between continuing to deal with the immediate consequences of the pandemic and seeks to integrate services and, critically, tackle health inequalities? In fact, a term like 'continuous improvement' would be more helpful in recognising the dynamism and vision needed to reflect, adapt and achieve, making things better for the people using NHS services.

Sajid Javid, the health and social care secretary, has started to set out his vision for reform. In a recent key speech, he talked about prevention, personalisation, performance and people. He endorsed the founding principles of the NHS, to provide high quality care for all, free at the point of use. He also signaled a need to go further than the vision set out in the NHS Long Term Plan of 2019 to meet the public's expectations, referencing a suite of white papers and plans, encompassing social care, elective recovery, primary care and the Health and Care Bill.

NHS leadership teams, and teams within trusts, are recognising areas for improvement and acting on these on a daily, monthly and annual basis.

Isabel Lawicka    Head of Policy and Analysis

Importantly, Javid recognised that people within the system are the greatest drivers of change. This ties in well with the concept of 'continuous improvement'. NHS leadership teams, and teams within trusts, are recognising areas for improvement and acting on these on a daily, monthly and annual basis. We know that the largest and most sustained benefits come when a whole organisation approach to improvement is taken, something NHS Providers advocates through our trust-wide improvement programme, supported by the Health Foundation.

But how far does improvement at a trust-level take us? And what additional support might be needed from government and national bodies?

It's important at this point to consider the scale of improvement needed and the power trust leaders have to make changes. Javid's point still stands that it's people within the system who are the greatest drivers of change. But there's a threshold at which improvements may need to be enacted or supported at scale. Some improvements can't be unlocked without organisations working together. Some simply can't make traction without central support from government or national NHS bodies.

There are some common themes that arise when considering these at-scale changes – workforce, digital, health inequalities and environmental sustainability are key examples. These are areas that need local leadership but where it's not fully within trusts' power to go as far as they would like or need to without the right cross governmental or national NHS policy framework, resourcing and support.

Even the best leaders and teams will sometimes meet a barrier where support and consistency nationally or at scale is required.

Isabel Lawicka    Head of Policy and Analysis

Improvement works best when it's ground up, not top down, when it identifies the issues that genuinely need addressing and the solutions that will work. Yes, this relies on leaders within the NHS doing all they can to build in mechanisms for identifying areas for improvement and empowering teams to change as needed. That requires dynamism and vision and the ability to critique, ask the right questions and bring people with you. These are some of the necessary qualities of high-performing leaders.

But even the best leaders and teams will sometimes meet a barrier where support and consistency nationally or at scale is required. These are the areas where the government should focus its attention. Regardless of the choice of terminology for its programme of change, the government needs to focus on listening, supporting and empowering the NHS on its path of continuous improvement.

Top of the list of things that do require government support at the moment is improving national workforce planning and tackling NHS workforce shortages. A recent survey of our members found that staff shortages across the NHS are having a "serious and detrimental impact" on services and will hinder efforts to tackle major care backlogs and improve access to services. That's why NHS Providers, along with over 100 other health and care organisations, supported an amendment to the Health and Care Bill which would require the government to publish regular, independent assessments of how many health and social care staff are needed to keep pace with projected demand over the next five, 10 and 20 years.

What the NHS really needs right now is for workforce shortages to be addressed. Otherwise reform, transformation and continuous improvement – or whatever we choose to call it – will not have the people-power it needs to succeed.

This blog was first published by Public Sector Focus.

About the author

Isabel Lawicka profile picture

Isabel Lawicka
Head of Policy and Analysis

Isabel is head of policy and analysis, overseeing NHS Providers' finance, operational performance and workforce policy portfolios as well as its survey and analysis programme. Prior to joining the team, Isabel worked for a leading health policy communications consultancy and held a number of patient advocacy and policy roles in London and Edinburgh. Read more

We use cookies to ensure you have the best possible experience on our website. By continuing we’ll assume that you are happy to receive them. Read our updated privacy and cookie policy. Close