As NHS England transitions into the Department of Health and Social Care, healthcare leaders must look beyond the typical narratives surrounding bureaucratic streamlining. While structural reforms are often presented as pathways to greater efficiency, they can unintentionally disrupt the very frontline services they aim to enhance. The critical question they should be asking is how do we reshape healthcare systems to meet the needs of those who rely on them daily?
This moment presents an opportunity for more than just reducing red tape. It’s a chance to rethink how healthcare services are designed and delivered. Instead of focusing solely on shifting responsibilities or reducing layers of management, we must focus on improving how services function in practice. This begins with understanding the lived experiences of patients, healthcare professionals, and other stakeholders who interact with the system.
The importance of service design in healthcare reform
So, what can be done differently? The answer lies in service design, a concept that’s long been used in other industries but is still underutilised in healthcare. At its core, service design is about understanding the experience of everyone involved in a service, from the end users to those delivering the service. By focusing on this human-centred approach, service design aims to streamline processes, improve accessibility, and enhance overall service delivery.
In healthcare, applying service design principles means deeply understanding the challenges faced by patients, healthcare providers, and even administrative staff. It’s about creating services that are efficient, intuitive, responsive, and built around the actual needs of the people who use them. When digital tools, data, and new technologies are integrated into this process, the potential for creating a truly patient-centred healthcare system becomes limitless.
Learning from past mistakes
In previous NHS reorganisations, there was a narrow focus on structural changes. These changes were often framed as a means of improving operational efficiency, but in reality, they didn’t take into account how these changes would affect the experience of those on the ground. The result was disruption rather than progress, leaving healthcare professionals to deal with new administrative burdens without seeing any meaningful improvement in patient care.
For example, the 2012 reforms introduced a new layer of complexity. While they aimed to remove political interference, they inadvertently created confusion and slowed decision-making. The focus was too much on the internal workings of the system and not enough on the practical realities faced by those using and delivering care.
This time, reform must be different. The NHS needs to move away from focusing on internal structures and begin focusing on the user experience – on how patients access services, how healthcare providers collaborate, and how processes can be streamlined to minimise barriers.
The role of service design in real reform
A successful reorganisation must start by asking the right questions: How do patients experience care? What challenges do healthcare workers face in delivering services? How can we remove unnecessary hurdles that slow down care delivery or frustrate patients and staff?
By engaging with healthcare professionals and service users from the start, we can create reforms that truly address the core issues. Whether it’s reducing waiting times, making healthcare more accessible, or ensuring staff are supported with the right resources, the focus should always be on improving outcomes. Changes should be designed to make services easier to navigate, more responsive to patient needs, and more efficient for everyone involved.
Anticipating risks and unintended consequences
While there are clear benefits to centralising certain elements of NHS management under the Department of Health and Social Care, there are also risks. The most obvious concern is that centralisation could slow down decision-making and create bottlenecks that delay the delivery of critical services. For example, NHS England has been a leader in digital innovation, implementing solutions like the NHS App and AI healthcare tools. Without a dedicated body to focus on digital transformation, this progress could stall, putting the NHS at risk of falling behind in the global healthcare innovation race.
Another potential risk is that the reorganisation could inadvertently complicate procurement processes, making it harder for smaller businesses and innovators to partner with the NHS. This is particularly concerning given the role that SMEs have played in bringing new, more efficient solutions to the table. If procurement becomes too rigid or centralised, smaller providers could struggle to compete, reducing the diversity of solutions available to the NHS.
Impact on Integrated Care Boards (ICBs) and local flexibility
In the face of this uncertainty, Integrated Care Boards (ICBs) are now under immense pressure. Originally designed to promote more localised, patient-centred care, ICBs are seeing their budgets cut and their resources stretched thin. If the centralisation of NHS functions leads to reduced autonomy at the local level, ICBs could become mere implementers of top-down decisions rather than the transformative engines they were designed to be.
In order to maintain their role as catalysts for innovation, ICBs must retain the flexibility to design and deliver services that meet the unique needs of their local populations. Without this local adaptability, there’s a risk that ICBs will simply carry out directives from the centre without the power or resources to effect real change.
Challenges and opportunities for SMEs in healthcare
On the one hand, a more centralised procurement system could create more streamlined processes and offer new opportunities for collaboration for SMEs working with the NHS. On the other hand, the complexities involved could make it harder for smaller businesses to navigate, potentially hindering their ability to work with the healthcare service.
To ensure that the NHS continues to benefit from the innovation and flexibility that SMEs bring, procurement processes need to be transparent, fair, and accessible. Small businesses must be empowered to contribute their solutions to the NHS ecosystem without facing undue barriers.
More than just cost savings
For this transformation to be effective, it must be grounded in measurable, patient-centred outcomes rather than just cost-cutting or administrative restructuring. A reorganisation that puts service design at the forefront can ensure that the NHS is better positioned to meet the challenges of the future.
To ensure that this restructuring delivers lasting improvements, success must be defined by the tangible benefits they bring. Success means better outcomes for patients, such as shorter waiting times, improved satisfaction, and better access to services. It also means a more efficient system, where resources are allocated effectively, and staff are supported in delivering the best care possible.
An NHS that delivers
Rather than viewing the reorganisation of NHS England as just another bureaucratic shuffle, it should be seen as an opportunity to rethink healthcare delivery from the ground up. By embracing a service design approach, we can build a system that works not just for administrators but for the people who need healthcare the most. This reform, if done right, can lead to a more efficient, accessible, and innovative healthcare system that delivers better outcomes for everyone involved.
