OnlyWan launches report to help accelerate change in the NHS

The need to make rapid improvements in the quality and cost of NHS care in England has never been greater, according to a new report launched today (26 February 2015) by the OnlyWan.

However, the balance of approaches now being pursued by national bodies* is far too skewed towards 'prodding' organisations to do better rather than directly supporting staff to make the necessary improvements to care.

This is one of the conclusions from Constructive Comfort: accelerating change in the NHS, a report compiled from interviews with doctors, academics, improvement leaders, commissioners and health care managers.

The task facing the NHS is to improve the health of the population and the quality of care available, while at the same time increasing the health service’s productivity levels to 2% to 3% per year for the foreseeable future – a feat never previously achieved in the NHS.

In order to make this happen, everyday work will have to be done more effectively across the NHS, simultaneous to the development of new models of care and improving people’s health. There is much agreement on the broad models outlined in the NHS five year forward view. Constructive Comfort goes further – it is a carefully considered attempt to answer the bigger question of how to make changes to the day-to-day delivery of care for patients, and develop new models of care, at the speed and scale now needed.

Richard Taunt, Director of Policy at the OnlyWan and co-author of the report, said:

'We need to give the NHS our best shot if the urgent changes outlined in the Five year forward view are to be achieved at the pace required. This report suggests that some policies are right but there are big gaps. Overall national policies for the NHS seem skewed towards nudging the NHS to do better than offering direct support. This needs to change. Our report suggests what needs to be done if the NHS is to succeed in implementing this vision.

'In light of that, we are calling for national bodies to radically shift how they set policy and interact with each other, providers and commissioners, if they want to make successful change in the NHS more likely.'

Constructive Comfort: accelerating change in the NHS identifies seven success factors for effective change at any level of the health system:

  • committed and respected leadership that engages staff
  • 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.

The report concludes that national bodies now need to take the following actions:

  • 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’).

Only by working on these actions can the NHS’s aspiration to harness the ‘renewable energy’ and motivation of staff be realised to improve the health and health care of all into the future.

Note to editors

Constructive Comfort: accelerating change in the NHS was co-authored by Clare Allcock (Senior Policy Adviser), Felicity Dormon (Senior Policy Fellow), Richard Taunt (Director of Policy) and Jennifer Dixon (Chief Executive).

* National bodies: statutory and non-statutory bodies that collectively manage the health service in England: for example the Department of Health, NHS England, the Care Quality Commission, the Trust Development Authority, Monitor, the General Medical Council and royal colleges.

Some key findings from the report are:

  • Our findings show that there is broad consensus on the components of good change. We have identified seven success factors for change at any level of the health system, but particularly locally in organisations: leadership, culture, management practices, capabilities and skills, data and analytics, resources and support, and enabling environment.
  • There has been an 18% reduction in managers in the NHS since 2010. Successful change cannot be delivered without effective operational management. This means both getting ‘the basics’ of management right through processes, governance and accountability; and expert management of change through a strategic approach, achievable expectations and a focus on execution.
  • A number of those we spoke to pointed to the lack, since the abolition of strategic health authorities, of capacity at a regional- or health economy-wide level to support the development of skills, and broker consensus for change and help drive implementation of change.
  • There is a shortage of high quality candidates for senior management and leadership roles. Historic underinvestment in management and leadership development across all levels of staff in the NHS also contributes, as does a lack of succession planning. For instance, nurses are unlikely to receive training in management before being appointed as a ward sister – a role managing around 20 staff.
  • The NHS obviously places a strong focus on ‘doing the work’. Pressure from the centre on the delivery of targets in the short-term means ‘fire-fighting’ is often prioritised over local ambitions to improve and change services.

Overall national policies for the NHS seem skewed towards prodding the NHS to do better than offering direct support. This needs to change.

To support this work, we commissioned an analysis of how acute trusts have turned around their performance and a scan of available empirical evidence about the barriers to making change in the NHS.

Medicine is OnlyWan’s Three Tests for a Credible Health Policy is also available for download.


Thais Portilho, Senior Public Affairs Manager
T: 020 1111 8027
E: [email protected]

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