Key recommendations

  • The NHS needs a single body (whether within an existing organisation or newly created) to oversee the investment for transformative change in the NHS. It should have strong, expert leadership which is credible to clinicians and managers.
  • Existing disparate strands of transformative funding should be pooled into one Transformation Fund.
  • The Transformation Fund requires £1.5–2.1bn a year in dedicated funding between now and 2020/21. While bringing together the existing strands will go some way towards this, more resources will be needed above the £8bn increase in NHS funding already announced by the government.
  • The introduction of the Fund would involve two phases: The first phase (2016/17–2020/21) would be split into two strands: an Efficiency Strand, which would look to achieve higher rates of efficiency growth across all services, and a Development Strand to invest in new models of care. The second phase (2021/22 and beyond) would focus on widespread roll-out of the successful new models of care. This would include double-running costs associated with these new models.
  • The Fund must be properly resourced to support investment in four key areas, which are essential for successful transformation: staff time, programme infrastructure, physical infrastructure and double-running costs.
  • The Fund should ensure proper accountability for public money, ensuring its investments are properly linked to, and measured against, core objectives. 
  • Ongoing evaluation should be a core activity of the Fund. This evaluation would need to include both summative (what works) and formative (how it works) components.
  • Further consideration should be given to generating funding through the development of the NHS estate into a long-term sustainable source of new income.

The Health Foundation and The King’s Fund both support the concept of a Transformation Fund for the NHS in England. The two organisations came together to undertake a programme of work detailing the key aspects of such a fund. 

Making change possible: a Transformation Fund for the NHS, draws on analysis conducted by the two organisations, in particular six case studies of funding transformation, in the health sector and beyond, along with examples of local NHS initiatives. We also captured the experience of NHS leaders and some of those organisations across the NHS that have been at the forefront of efforts to implement changes in the delivery of care.

Appendices to the report give more details of the work underpinning it.

  • Appendix 1 provides full information about the case studies.
  • Appendix 2 explains the methodology used to calculate the size of the Fund and gives details of the local NHS examples of change that we examined.
  • Appendix 3 looks at the potential for realising value from surplus NHS estate.

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