The NHS is in what the financial markets would call a ‘doom loop’ – that is, a cycle where workforce attrition drives system strain, triggering further departures and capacity decline.
The economist John Maynard Keynes observed: ‘The difficulty lies not so much in developing new ideas as in escaping old ones.’ This captures the NHS’s fundamental challenge: transforming a cherished institution while preserving its core mission of universal healthcare access.
Two of the fundamental problems are burnout among staff, which is resulting in departures of qualified healthcare professionals – often overseas, in the case of junior doctors – which increases pressure on the remaining staff; and the technology infrastructure, which lags global standards and contributes to the challenges of innovating in healthcare delivery.
The NHS could be transformed by adopting some of the best practice from around the world
The demographic context adds urgency. By 2050, the number of people in the UK aged 65 or older is projected to be around 19 million: one in four of the population. The number of people aged 80 and over is set to more than double from three to six million in the next 40 years, according to the Centre for Ageing Better. The NHS staff vacancy rate in 2023 was 8.4%, or 121,000 full-time roles, according to a report by the King’s Fund. All this puts the onus on solutions that focus on prevention rather than the current reactive treatment of disease.
Time to transform
Innovative tech solutions and financial structures applied by other countries have helped create fiscal sustainability and personal responsibility while maintaining universal access. The NHS could be transformed by adopting some of the best practice from around the world.
Germany, for example, has instituted regional health councils. By replacing NHS Trusts with this system of governance, and establishing regional councils under central government control, strategies and initiatives can be conceived and rolled out locally, enabling regions to experiment with different delivery models.
When people have a stake in their healthcare spending, they make more informed choices
Singapore, meanwhile, has a hybrid funding model, combining progressive taxation, mandatory health savings accounts and optional private insurance. When people have a stake in their healthcare spending through health savings accounts, they make more informed choices about using healthcare services while still having access to essential care.
The workforce structure needs to be redesigned so that staffing becomes more integrated across the healthcare system. While responsibility for recruitment and day-to-day management should lie with regional bodies, a nationwide framework for staff mobility and career development pathways needs to be implemented.
Technology should also be used to reduce administrative burdens, freeing up professionals to spend more time with patients. In Denmark, integrated care networks achieved a 55% reduction in hospital readmissions by making their procedures to discharge patients more efficient and effective. And Estonia’s digital transformation in e-health services has generated savings estimated at 2% of GDP.
From reactive to proactive
The NHS should focus on disease prevention, moving from a reactive to a proactive approach to treatment and ‘health optimisation’. This requires restructuring payment models to reward regional councils that focus on prevention, building digital infrastructure for early intervention, and launching specialised programmes for employees in the workplace that support healthy working lives.
Denmark has implemented community-based preventative care models
In Japan, early intervention strategies such as comprehensive screening programmes and health promotion initiatives have significantly reduced chronic diseases, while Denmark has implemented community-based preventative care models, where local engagement has helped drive better health outcomes.
Culture change
The current crisis exemplifies what healthcare strategists term a ‘triple-aim’ challenge: enhancing patient experience, improving population health and reducing per capita costs.
To implement these changes, three phases will be needed: foundation (establishing digital infrastructure and piloting new funding mechanisms); scaling (rolling out successful pilots and strengthening preventative care); and optimisation (fine-tuning systems and establishing robust metrics).
As management guru Peter Drucker observed, ‘Culture eats strategy for breakfast’; for this transformation to be successful, NHS leaders will need to ensure they have a programme for cultural as well as structural change.
Modern professionals should be part architect, part engineer and part orchestra conductor
This will require ‘adaptive leadership’ – leaders who can help support the process of changing priorities, beliefs and practices. They will need to balance preserving valuable institutional ‘memory’ while enabling innovation and adaptation to new circumstances.
Professional skills
Finance professionals play a pivotal role in ensuring financial rigour, accountability and sustainability in NHS transformation. Their expertise in structuring payment models, managing capital investments and driving cost efficiencies is essential for moving towards a prevention-focused system. Strong financial governance has facilitated effective resource allocation and digital transformation in Singapore and the Netherlands. By applying similar principles, we can help align funding with outcomes.
Modern professionals must balance multiple roles: they should be part architect, part engineer and part orchestra conductor, serving as strategic partners driving direction, performance leaders optimising resources, risk stewards protecting value, and change champions fostering innovation.
Maintaining the the NHS’s founding principle – universal healthcare free at the point of use – requires reimagining the institution. Winston Churchill said ‘Never let a good crisis, go to waste’. The current situation provides an unprecedented opportunity to reimagine healthcare delivery for the 21st century.
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