How Do We Stop The Latest NHS Reform Plan from Failing?

How do we stop yet another NHS plan from failing? The plan is not the solution. What matters most is HOW it is delivered.

A New NHS Plan For Change?

It says a lot that your local health organisations are more likely to have changed their names in recent years than reduced their waiting lists.

When I read the latest plan from the NHS for improving waiting lists, it was hard to not feel deja-vu.

The new Plan for Elective Care Reform was launched this week promising radical reform.

However, many of the new initiatives had been projects i had previously worked on myself in the NHS about 3 or 4 years ago.

So much of these reforms were introduced as either as as of the 2019 NHS Long Term Plan, such as personalised care, increase choice for patients and digital first strategies or part of the 2022 Elective Recovery Plan to reduce waiting lists.

Sadly the Other NHS Plans Failed to Make an Impact

Unfortunately, when the 2022 plan was launched with a very similar set of proposals as this weeks plan, the waiting lists was 6.1 million whereas they have since reached 7.5 million. 

Whilst strikes didn’t help, it can hardly be said that the last plan was a great success to be repeated.

Reading the Darzi Report which provided the evidence that NHS was said to be broken, there did not seem to be an issue that HADN’T been a specific target of previous plans. Lord Darzi himself bemoaned the fact that the recommendations of his previous report had not been implemented.

There had been NHS plans to transform areas such as mental health, GP waits, health inequalities, A&E, Ambulances, Cancer Care use of technology and diversity (I’ve written about why that failed here). In fact i could go on and on, mentioning things like recruitment and cancer care.

I’m not questioning that the plans did not have some good ideas. What is obvious looking back is so few of the changes in plans over the last 13 years have NOT been implemented. (I’ve written here about previous plans and avoiding the mistakes of the past.)

NHS Planning Implementation Problems

The lack of progress on delivering on implementation of plans was not for a lack of trying: passing blame onto leaders and organisations, budgets have been cut as punishment, removing boards, special measures, action plans, countless targets and assurance processes and turn around plans have all consistently failed.

The cycle of failure is so consistent i wrote about it 2.5 years ago and it stll being repeated. I called it the beaureucrate planning stress cycle and it seems just as valid today with the launch of the new plan and the steps to implement it.

NHS England is very keen on having an evidence based approach. How much more evidence that it does not matter how good the plan, the NHS really is unable to implement meaningful change.

How Can the NHS and Healthcare Implement Change Better?

The structures of organisations have changed far more than the ability of the NHS to improve outcomes or things that matter to patients.

At the same time when there are initiatives that have impacted patient care they usually pilots or initiatives, where local people have collaborated and given resources directly to create their own solutions.

The evidence is clear, if we want to improve the NHS and outcomes of people, what matters is not coming up with the right plan, setting targets, what actually matters is HOW we implement the changes.

I believe the actual changes proposed in the plans are good ones. But instead of enforcing compliance we need to encourage and support staff to choose what changes will have most effect for their staff and patients enable them to make it happen. In a previous post i’ve described how healthcare needs to replace stress and fear with love.

After all it is clear and the evidence is overwhelming that the old fashioned NHS planning and control approaches fail.

It’s time the NHS moves from planning, compliance blame and punishment, to empowering people to create an effective momentum for change to the people in their area.

What Works in Implementing Change in NHS and Healthcare

The evidence is clear plans only work when they inspire collaboration, foster psychological safety, and allow for flexibility in adapting to real-world conditions. By prioritising relationships, building trust, and nurturing the inherent strengths of staff and communities, the NHS can move from surviving to thriving. It’s time to replace bureaucracy with humanity and control with empowerment to create lasting, impactful change​​​.

Conclusion

The success of the NHS does not hinge on yet another carefully crafted plan but on how that plan is implemented. The repeated failures of previous plans highlight a persistent issue: a focus on compliance and targets over meaningful, adaptable action. To break the cycle, we must shift the paradigm from rigid top-down directives to empowering local teams to co-create solutions that resonate with their unique challenges.