Revolution, not evolution, required to fix ailing NHS

14 March 2025, 11:31

As a former employee of NHS England, I am sparing a thought for former colleagues in the organisation who are facing yet more disruption.

But looking beyond what will obviously be difficult for NHSE staff, there are undoubtedly some opportunities here for the NHS.

Here’s an interesting test. Can you find anyone out there online or in the news defending the status quo?

I haven’t, and it’s clear why. The disconnect, duplication and chaos that has been generated by the current structure is having a palpable impact on the ability of the NHS to get a grip on its many problems. In addition, there has over the years been a huge concentration of staff at the national level, leaving the wider NHS system that operates on a more local level with insufficient capacity to help make change happen on the ground.

Something had to give, so although seismic, I can see the logic in this decision.

To get it right though, the changes must be delivered with care.

Previous NHSE restructures (and I have been through them myself) have taken a salami-slicing approach – trimming a lump off all teams, so you are still left with a complete mess, albeit a slightly more meagre one. A fundamental reshaping of the organisation needs to take place that leaves the government with a workforce fit to deliver the strategy.

Through this change, the department of health must hold on to their digital skills at all costs. A shift from analogue to digital is not only a key plank of Streeting’s strategy but it also wholly underpins the two other shifts he wants to see - from sickness to prevention and from hospital to home. The digital agenda that NHSE is grappling with, and the criticality of digital to NHS reform, means NHSE can ill afford to lose further digital specialists.

This isn’t just about the use of technology but a different mindset and culture. The NHS is a highly devolved service that needs to be led rather than commanded, as previous efforts, successes and failures illustrate. That’s precisely why taking these opportunities will give the government the best chance of delivering not just evolution but the revolution that will be required to modernise an ailing NHS.

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Chris Fleming is Partner and Health Sector Lead at digital transformation consultancy Public Digital.

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