NHP Leadership Roundtable: Embedding transformation within capital programmes 

IMPOWER recently hosted a roundtable discussion with NHP Programme Directors and SROs to explore the role of transformation within capital programmes, sharing learnings and best practice approaches to driving clinical change through infrastructure planning and investment.  

• Significant change is assumed across all NHP schemes, with whole-scale clinical and digital transformation required across system partners.  

• If not gripped and delivered these assumptions present a significant risk to future system – likely worsening Trusts’ operational, workforce and financial positions.  

• Achieving this level of change is complex, requiring substantial time and coordinated efforts across systems to integrate and consistently deliver benefits.   

• Nationally, schemes have taken different approaches – a locally tailored approach is essential, considering Trust context and system needs. 

• Whatever approach is taken, schemes need to start by widening ambition around clinical transformation, test-and-learn from early initiatives now, scaling up successful change ahead of hospital activation and building a resilient and learning organisational culture to manage ongoing change.   

Policy context and implications for NHP schemes 

The past eight months have brought significant transition with new policy priorities that sets a clear direction for the NHS under the Labour government. Confirmation of the NHP has provided stability for Wave 1 schemes with increased political scrutiny and pressure to align with government agendas. 

The focus remains on three key shifts and neighbourhood health, forming the foundation for the 10-year plan. There’s a renewed emphasis on elective recovery, strengthening ICB’s strategic commissioning role, and promoting local government devolution and regional economic growth. Financial challenges require radical decisions as traditional operating models are unsustainable. The government’s push for transformation and digital technologies, including the NHS app, EPR systems, AI diagnostics, and FDP, highlights the urgent need for change. 

Moving quickly and showing tangible outcomes are crucial, balancing NHP assurance with programme momentum. Schemes must align with policy priorities and address finance, workforce, and demand pressures. Digital integration is essential, aligning NHP requirements with trust/system investments. The prominence of ICBs requires proactive system engagement to streamline approvals and align with system-wide priorities. 

Embedding transformation in capital programmes 

Role of transformation and opportunity for Trusts 

Discussion emphasised the importance of integrating clinical changes within capital planning, highlighting opportunities to drive system-wide transformation, social and economic value and enhance operational and financial efficiency. 

A primary concern was the risk of inaction, with fears of demand overload upon opening the facility, highlighting the inadequacy of relying solely on new infrastructure to resolve capacity challenges. Demand growth already exceeds business assumptions, necessitating immediate transformational efforts. Programme Directors emphasised the urgency of implementing new ways of working, aligned with future clinical strategies, rather than deferring change until facility completion. Construction is seen as predictable, but ensuring facilities meet long-term needs efficiently is the greater challenge. 

The discussion then focused on the complexities of delivering this transformation. It was acknowledged that a tailored, context-specific approach is essential, as rigid methodologies can hinder innovation. Participants highlighted the need to balance effective decision-making within potentially restrictive regulatory frameworks, encouraging a culture of experimentation and innovation locally.  

Learnings from elsewhere – Royal Adelaide Hospital  

Our speaker, Nicole Samuel shared insights from the Royal Adelaide Hospital, a global exemplar new build, digitally-enabled hospital that faced financial distress after moving to its new building in 2017. Despite extensive planning and substantial investment, the hospital immediately struggled with capacity, requiring opening of escalation areas, increased temporary staffing, worsening operation position and ultimately financial turnaround. Their planned EPR launch was also delayed for two years.  

Reflections from the team in Adelaide pulled out the following learnings:  

• Design of the building (e.g. single rooms) had implications on operational running, staffing models and revenue costs.  

• To enable affordability, increased costs were planned to be offset by demand management, new models of care and benefits of EPR implementation.  

• Additional capacity was planned to meet ongoing growth; it was assumed not required in the short term and its use was not factored into financial plans.  

• Significant change management and engagement was undertaken, but was focused on hospital activation not clinical change. 

• The level of change required was underestimated, including  the time needed, people involved, link to the wider system and individual behaviour change. 

• In the new building, staff faced pressure to implement numerous changes simultaneously, while managing significant operational pressures. 

• This impacted staff morale, engagement and the EPR roll-out was paused in order to phase change management. 

• The implementation of clinical model change occurred two years later, resulting in a more challenging and prolonged process.  

The key takeaway is that these schemes should be approached as change programmes, emphasising system transformation and behaviour change, and initiating this process as early as possible. 

Digital transformation – the specific opportunities and challenges this presents  

Digital must be integrated into all aspects of planning for the new hospital particularly in understanding how staff will interact with new digital tools and workflows. Small early changes can demonstrate possibilities and generate excitement. 

Digital tools should not be seen as a silver bullet. Tools should be carefully chosen, with processes designed around user needs. True benefits come from productivity improvements, streamlined processes, and freeing up capacity. Digitising existing workflows without re-evaluating pathways won’t yield significant benefits. 

Approaches and opportunities being taken forward by schemes 

Across NHP programmes, a shift towards leveraging the ‘anchor institution’ model is evident, considering opportunities beyond traditional builds including neighbourhood rejuvenation and wider economic development.  

In the East of England, NHSE teams are looking at the opportunity of significant multi-Trust investment to drive change across the region through collaborative discussions, co-design of innovative care models and digital enablers. These investments are driving  broader system-wide thinking on care delivery even for sites without direct funding. Digital collaboration is a priority, with forums established to share best practices.  

Schemes tackle integrating digital with infrastructure, often managed separately. Practical innovations are emphasised, understanding advanced technologies aren’t always necessary. Small initiatives, like mobile x-ray services, can reduce admissions and deliver early transformation. Sites test technologies for immediate benefits and long-term strategies, with initiatives like ‘Silent Hospitals’ and continuous patient monitoring focusing on patient care and workforce efficiency. 

Programmes shared examples of system-wide transformation plans, including virtual care models and integrated data platforms. Collaborative efforts like joint EPR programmes expand provider conversations across regions. Governance structures focus on change management and clinical service lines engage in pathway redesign to enable a ‘left shift’ in care. 

IMPOWER’s approach to transformation 

IMPOWER is a leading change consultancy, helping health and public service leaders create lasting, positive change in complex systems. Our theory of change sets out one way capital programmes can think about driving transformation across their programmes.  

1. Widen ambition: Establish a shared understanding of the desired change and opportunities for early pathway transformation, align the system and assess joint readiness for change.  
2. Test and build confidence: Demonstrate local impacts to build trust, align clinical priorities with identified need, test-and-learn interventions and benefits tracking to plan for scaling successful initiatives.  
3. Scale and learn to manage change: Scaling improvements, establishing trajectory to opening that demonstrates delivery against benefits, and securing system support for changes, such as funding models. 
4. Build resilience: Prepare for asset activation, create a resilient system, and develop financially and operationally deliverable plans. 

This transformation will be enabled by people – engaging staff to build commitment to success alongside skills development. Whole system ownership is essential, integrating TOM development with partner organisations. This needs to be supported by robust process and management practices, with codified and validated clinical and operational changes. Finally, adopting a behavioural science approach, rather than simply mandating change, is key to supporting staff in adapting to new ways of working.