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By Stephen Sutcliffe, Director of finance and accounting, NHS Shared Business Services I love to speak with NHS colleagues about their experiences, so please feel free to reach out to me. I can be contacted on Stephen.sutcliffe1@nhs.net |
What do the NHS and Team GB’s cyclists have in common? (Hint: it’s not the legs.) The answer? Both are under relentless pressure to perform better, go faster and do more.
For the NHS, that pressure is now even sharper. Alongside ongoing national reforms, NHS trusts have been instructed to dramatically reduce corporate spending, pushing organisations to find new ways to deliver more for less. “No extra money without reform,” as Sir Keir Starmer famously said last year.
But whilst national reform is underway, those at the sharp end still need to keep the wheels rolling — delivering high-quality care and driving savings, all while dealing with the uncertainty of what lies ahead.
They may find inspiration in Team GB cycling, who under Sir David Brailsford’s leadership in 2003, pioneered the concept of the aggregation of marginal gains. The principle is simple: making numerous small improvements, which in Team GB’s case transformed them from winning just one gold medal in 76 years to dominating both track and road cycling on the world stage.
Under Sir Dave’s tutelage, cyclists learned how and when to wash their hands to stay healthy, understood the importance of rest (even travelling with their own mattresses and pillows for better sleep), received counselling for mental health, and refined every detail from bike technology to race suits to minimise drag. The inside of the team truck was even painted white to spot dust and maintain cleanliness standards.
The result? A team that won 16 Olympic gold medals and the Tour de France multiple times — and a philosophy now adopted across sectors from elite sport to Toyota’s manufacturing systems to Amazon’s algorithms.
So, what lessons could NHS trusts draw from this? Especially now, when the DHSC is requiring a fundamental rethink of how corporate functions operate — with clear expectations that non-clinical costs must fall without sacrificing frontline care.
Operational efficiency: small tweaks for big impact
Healthcare systems are inherently complex, with countless moving parts — from appointment scheduling to supply chain logistics. Just as Brailsford’s team targeted marginal gains in areas like bike weight and rider position, NHS trusts can drive efficiencies by addressing small but impactful operational inefficiencies — a crucial part of meeting corporate cost reduction targets.
- Optimising inventory management – Even minor improvements in tracking and ordering supplies can significantly reduce waste and unnecessary spend.
- Automation of routine processes – Inexpensive automation tools can cut time spent on tasks like invoice consolidation or purchase order dispatch by up to 90%, freeing up corporate resource for higher-value activity.
- Catalogue management – Ensuring procurement is channelled through pre-approved catalogues not only improves supplier pricing but reduces back-office processing time — helping trusts do more with smaller administrative teams.
Staff support and performance
Brailsford’s team placed huge emphasis on the mental and physical wellbeing of athletes — a principle NHS trusts can apply to boost staff engagement and retention, particularly as corporate functions undergo streamlining and resources become tighter.
- Getting pay right – A basic expectation, but critical for morale. Getting pay right is about giving staff more control (for example, by being able to choose weekly or monthly, and an online platform to view and manage their pay). It’s also about putting under and over-payments right swiftly, and processing pay changes so they’re seen in-month.
- Supporting starters – Smooth recruitment and onboarding ensures new hires can contribute quickly, even as HR and administrative teams manage increasing demands with fewer resources.
- Learning from leavers – Gathering insights through exit interviews helps reduce avoidable attrition, limiting the operational and financial impact of losing valuable staff. Yet anecdotal evidence suggests many trusts rarely, if ever, hold them.
Harnessing data for continuous improvement
One of Brailsford’s biggest innovations was the systematic use of data to identify areas for improvement — an approach NHS trusts can now adopt to drive smarter decisions.
- Real-time financial monitoring – With DHSC’s sharper focus on value for money, real-time (or near real-time) financial oversight is becoming essential to keep spending under control and corporate functions accountable.
- Benchmarking and learning from success – Trusts that embrace cross-system learning will be better placed to meet corporate efficiency targets while maintaining service quality.
- Making data accessible – Tried-and-tested, affordable AI and automation tools can provide rapid insights into trends like spending patterns, payment anomalies, or staff retention risks — helping trusts manage corporate performance proactively rather than reactively.
Why marginal gains matter
The aggregation of marginal gains is powerful because it doesn’t demand radical overhauls or huge investments. Instead, it’s about fostering a mindset of continuous improvement: seeking out small wins, consistently and persistently.
Just as Team GB cycling became a dominant force by improving hundreds of tiny details, NHS trusts can unlock new levels of efficiency, resilience, and quality of care by applying the same philosophy.
As Brailsford showed, success isn’t about finding a single silver bullet labelled “reform” — it’s about improving 100 things by 1%, rather than one thing by 100%.
A version of this blog was first published by One NHS Finance.
