This report asks: how best to design national policy on the NHS to accelerate improvements to health care?

Download Constructive comfort: accelerating change in the NHS.

We argue that national bodies’ efforts to effect change follow three broad types of approach:

  • Type 1: ‘Prod organisations.’ This approach aims to direct, prod or nudge providers of care from the outside. 
  • Type 2: ‘Proactive support.’ This approach focuses on enabling organisations more directly to make the changes needed.
  • Type 3: ‘People-focused.’ This approach includes both prods and proactive support, targeting NHS staff rather than organisations, as well as actions to inspire, engage and involve staff.

We have identified the following seven success factors for change at any level of the health system, but particularly locally in organisations:

  • Committed and respected leadership that engages staff
  • A culture hospitable to, and supportive of, change
  • Management practices that ensure execution and implementation
  • Capabilities and skills to identify and solve problems
  • Data and analytics that measure and communicate impact
  • Resources and support for change
  • An enabling environment which supports and drives change.

These seven factors are not consistently present in the NHS – meaning efforts to improve services and make changes are more difficult than they need to be. Our analysis identifies particular barriers to change in four areas: recognition of the need to change, having the motivation to change, headspace to make change happen, and the capability to execute change.

We conclude that national bodies now need to take the following action:

  • Immediately develop a shared view of how change happens in the NHS and what national bodies should do to catalyse it.
  • Develop the current blend of organisational levers (‘prod organisations’) to best support change.
  • Invest far more in support for change (‘proactive support’), starting with a coherent improvement strategy for the NHS in England.
  • Focus action on people who work in the NHS (‘people-focused’).

Supplementary report

Transformational change in NHS providers is a specific analysis of provider transformation, based on interviews with senior leaders from a range of acute providers.

Further reading


Robert Namushi

Interesting read. The NHS is a very conservative organisation with capital C. To move from type 1 to type 2 change is difficult given the way the services are funded. However, there is a way forward through the Five Year Forward Plan. We has to integrate social service and health service strategies and funding streams. It will be interesting to see how when the board and senior management teams have responsibility for the integrated service. I call it the "health social service". The proposed Greater Manchester Model is a step forward.

I agree with fellow bloggers that the current structures within the NHS are not attractive enough for practicing clinician (doctors, nurses and professions allied to medicine) to sacrifice their time for leadership responsibilities. However, I am encouraged to see many taking up leadership since 2006. Doctors are not resistant to change, they love change but want to have evidence that change is likely to help the patients. Change champions should have data at hand if they want to carry doctors with them.

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