by Erika Bannerman, Managing Director, NHS Shared Business Services
The 10 Year Health Plan sets an ambitious direction for the NHS: care closer to home, a focus on prevention, and services built on modern digital foundations. Delivering that ambition depends on finance, procurement, payroll, and workforce systems that work reliably across the whole NHS, not only within individual organisations but also across them.
That is the focus of our new analysis, Futureproofing the NHS: The case for transforming corporate services for innovation and productivity, published today. It draws from insights and conversations with NHS leaders and other experts, combining that with a review of the existing evidence base.
The importance of the operational layer
The productivity gap in the NHS is real and is not just a clinical problem. Corporate costs have risen by 40% since 2018/19, excluding pay and pensions, and poor IT costs doctors an estimated 13.5 million working hours every year.
The evidence in the report suggests that these issues can be addressed when shared operational foundations are well designed and implemented.
What works and why it matters
A consistent conclusion from recent research is that shared services work best not as a means of imposing uniformity, but as a way of creating freedom for leaders to bring their judgement and expertise to bear in the areas that matter most. Clinical decisions, community relationships and local service priorities rightly stay local. What works better when shared are the operational functions that look essentially the same across every NHS organisation – payroll, invoice processing, procurement, workforce administration and the like.
The practical examples in the paper tell a compelling story. At Central and North West London NHS Foundation Trust, automating a single consent process returned 56 clinical hours a day to patient care. In another NHS organisation, workforce analytics predicted staff attrition with 95% accuracy months before it would have appeared in waiting times.
These outcomes came about from organisations that were willing to redesign their processes, involve staff, and sustain the effort afterwards. As the Health Foundation’s analysis of 467 technology studies found, outcomes depend far less on the technology being introduced than on workflow redesign, staff engagement, and ongoing support for it.
Why investment alone will not close the gap
With £10 billion committed to NHS digital and technology transformation by 2028/29, and significant structural reform now underway, the conditions are in place for real progress. However, our report suggests that investment in disjointed operational structures will yield diminishing returns. Each pound invested in a system where data cannot cross organisational boundaries, or where the same problem is being solved independently in dozens of trusts, delivers less than it should.
Operational data has a particular role here because workforce, finance and procurement information can reveal system pressures months before they show up in clinical metrics – functioning, when it flows properly, as an effective early warning system.
Seven priorities
The paper sets out seven practical recommendations for health service and government leaders, including:
- Treating operational infrastructure as a system asset with sustained, multi-year investment.
- Investing in understanding problems before procuring technology.
- Deliberately extending proven shared platforms, rather than solving common problems separately.
- Designing governance that makes collaboration a rational choice rather than an additional burden.
None of these requires starting from scratch, and proof that shared services work already exists in parts of the NHS. The challenge is to extend the approach consistently, deliberately, and with the collective commitment that individual organisations, working alone, cannot sustain.
At NHS SBS, we are part of the operational fabric this paper describes. We have learned from what has worked and from what has not. We offer these recommendations in that spirit: as a framework built from evidence and experience, to support the NHS in making the most of the window for change that now exists.
Download the white paper at: https://www.sbs.nhs.uk/futureproofing-the-nhs/
