But this isn’t about nostalgia. The real question is whether lessons from the past can help the NHS navigate the complex challenges ahead: an ageing population, workforce pressures, system inefficiencies, and constrained public finances.
There are early signs of a new direction. The next phase will likely require a careful balance—combining ambition for reform with a stronger focus on community-based care and digital innovation, all within a funding environment that remains hotly debated.
There’s reason for optimism. Many of the NHS’s most impactful changes have come not just from increased investment, but from bold rethinking of how care is delivered. As NHS Confederation Chair Victor Adebowale put it, the challenge is whether we can “rebuild the plane while flying it.”
Choose Your Own Adventure – But Don’t Forget the Basics
One of the standout moments came from Jim Mackey, who said, “we want people [on the front line] to be so far ahead of us that we at the centre can’t keep up.” It’s a striking statement of a new direction from the Chief Executive of NHS England, an organisation historically seen as centralised in its approach.
Yet this isn’t without precedent. In the early 2000s, trusts that demonstrated strong leadership and performance were granted greater autonomy as Foundation Trusts. That same year, NHS Shared Business Services was established, ensuring that as organisations moved forward, they had the operational support to do so effectively.
Innovation and autonomy are powerful—but they rely on strong foundations. If basic systems like payroll, procurement and finance aren’t functioning smoothly, it’s difficult for staff to focus on delivering change.
Even today, many NHS organisations face challenges in these areas. Manual processes, outdated systems, and inconsistent data management can create unnecessary friction. These aren’t criticisms – they’re realities that need addressing if transformation is to be meaningful.
Here are a few practical suggestions:
- Automate routine processes like onboarding and offboarding, or patient referrals to reduce delays and errors.
- Implement shared procurement platforms and catalogues to streamline purchasing and leverage economies of scale.
- Modernise payroll systems to allow for real-time updates and quicker resolution of discrepancies.
Reform or Rerun?
The path forward for the NHS lies in empowering its people, not just through funding or central directives, but by creating the conditions for innovation to thrive. Reform must be grounded in practical improvements, clear priorities, and a willingness to confront uncomfortable truths.
The future may not come with a DeLorean—but with the right tools and mindset, it can still be a journey worth taking.
