A new delivery model: What Labour’s NHS plans mean for improvement and transformation in frontline care

The NHS landscape is poised for significant change, with the Labour Party’s proposals to establish a delivery unit within the Department of Health and Social Care (DHSC), alongside the abolition of NHS England and headcount reductions at ICBs and the DHSC itself, promising a radical shift in how improvement and transformation are managed. But what does this really mean for those of us working on the ground? 

The creation of a dedicated delivery unit signals a deliberate return to the principles of “deliverology,” a methodology championed by Michael Barber during the Blair era [1]. This isn’t just about setting targets; it’s a comprehensive approach that emphasises rigorous data analysis, meticulous performance management, and a relentless focus on achieving specific, measurable outcomes. It implies a shift towards a more centralised, performance-driven culture within the NHS, where progress is tracked relentlessly and interventions are targeted at areas lagging behind. This could bring much-needed focus, but the success of this model hinges on the nature of those metrics. Are we simply tracking operational efficiency, or are we truly measuring the impact on patient lives? 

The abolition of NHS England and the proposed cuts to ICBs and the DHSC itself suggest a streamlining of the organisational structure. While reducing bureaucracy is a laudable aim, it’s crucial that this doesn’t lead to a loss of essential expertise or hinder local innovation. ICBs, despite their challenges, have played a vital role in integrating services and tailoring them to local needs. The risk is that this centralized approach could stifle this local flexibility. 

The new delivery unit is set to wield significant influence, holding NHS organisations to account and driving progress on national priorities. This raises questions about the balance between national direction and local autonomy. Will local leaders have the freedom to innovate and adapt to their unique circumstances, or will they be constrained by centrally imposed targets? Finding this balance will be critical to the success of the new model. 

As a clinician my primary concern is always the quality of care and the outcomes for patients. While reducing waiting times and improving emergency care performance are essential, they are merely stepping stones. We must shift our focus to metrics that reflect the true value of healthcare: improved health, enhanced quality of life, and positive patient experiences. This is where the new delivery unit has a unique opportunity. It must go beyond traditional productivity measures and embrace a broader set of metrics that capture the essence of high-value care.  

Ultimately, the success of this new model will depend on several factors: 

• Appropriate choice of metrics: The metrics chosen must reflect patient outcomes and quality of care, not just operational efficiency. 

• Data-driven decision-making: The delivery unit must be equipped with the tools and expertise to gather and analyse data effectively.  

• Collaboration and communication: Open communication and collaboration between the delivery unit, local services, and other stakeholders will be essential.  

• Balancing national and local priorities: Finding the right balance between national direction and local autonomy will be crucial.  

• Sufficient resources: The DHSC and the delivery unit must be adequately resourced to fulfil their roles.  

As professionals working with the NHS, it’s important that we engage with these changes and contribute to shaping the future of our healthcare system. We must move away from a system that prioritises activity over outcomes and embrace a culture of local innovation and continuous improvement that places patient wellbeing at its core.