Making change possible

A Transformation Fund for the NHS
Comments: 6
Richard Murray, Laura Bennett, Ben Collins, Phoebe Dunn, Helen Gilburt, Matthew Honeyman, Lillie Wenzel, Anita Charlesworth, Natalie Daley, Edward Davies, Ben Gershlick, Adam Roberts, Richard Taunt, Toby Watt
The King’s Fund and the Health Foundation both support the concept of a Transformation Fund for the NHS in England. The two organisations came together to undertake a programme to establish how such a fund would be managed and resourced.

The report draws on analysis conducted by the two organisations, in particular six case studies of funding transformation, in the health sector and beyond, along with examples of local NHS initiatives. It also captures the experience of NHS leaders and some of those organisations across the NHS that have been at the forefront of efforts to implement changes in the delivery of care.

Key recommendations

  • The NHS needs a single body (whether within an existing organisation or newly created) to oversee the investment for transformative change in the NHS. It should have strong, expert leadership that is credible to clinicians and managers.
  • Existing disparate strands of transformative funding should be pooled into one Transformation Fund.
  • The Transformation Fund requires £1.5–2.1 billion a year in dedicated funding between now and 2020/21. While bringing together the existing strands will go some way towards this, more resources will be needed above the £8 billion increase in NHS funding already announced by the government.
  • The introduction of the Fund would involve two phases:
    • the first phase (2016/17–2020/21) would be split into two strands: an efficiency strand, which would look to achieve higher rates of efficiency growth across all services, and a development strand to invest in new models of care
    • the second phase (2021/22 and beyond) would focus on widespread roll-out of the successful new models of care; this would include double-running’ costs associated with these new models.
  • The Fund must be properly resourced to support investment in four key areas, which are essential for successful transformation: staff time, programme infrastructure, physical infrastructure and double-running costs.
  • The Fund should ensure proper accountability for public money, ensuring its investments are properly linked to, and measured against, core objectives. 
  • Ongoing evaluation should be a core activity of the Fund, and should include both summative (what works) and formative (how it works) components.
  • Further consideration should be given to generating funding through the development of the NHS estate into a long-term sustainable source of new income.
Making change possible: A Transformation Fund for the NHS - front cover

No. of pages: 52

Case studies

The report draws on six case studies of funding other transformations, in the health sector and beyond. Read about the case studies in more detail:


Appendices to the report give more details of the work underpinning it.

  • Appendix 1 provides full information about the case studies
  • Appendix 2 explains the methodology used to calculate the size of the Fund and gives details of the local NHS examples of change that we examined
  • Appendix 3 looks at the potential for realising value from surplus NHS estate.

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#544343 Dr Alan Cleary
Head of Audit
Accorde/London College

No! Strong contract expertise is all that is require.
Dr Alan Cleary,
Practical adequacy in contracts' specification, negotiation, drafting and enforcement comes only from years of unremitting slog and guided self improvement. It always proves a good investment. It has little to do with academic legal qualifications, degrees or memberships. That alone means that appointments of relevant staff generally are by people with very little clue. The billions of pounds in public money wasted and frittered away each year at every level in this country reflect an expanding shortage of contracts expertise and lack of machinery for creating it. Centralised and standard purchasing both prove counterproductive. The Germans are good at contracts. Their law permits painful penalties to be agreed and imposed for any breaches of a contract. Ours doesn't. We could begin by putting that right first.

#544345 Terry

Getting more and more money is one thing (and the amounts will be embarrassing if management ability does not increase bringing about greater improvement).
Make as many recommendations as you like but without the ability to put them into practice, nothing will be gained.
There are so many areas of repeated weaknesses (even on the most basics)and I really feel for those trying so hard but prevented by many die hards and under achievers with seniors not choosing, being unable or unwilling to get rid of them.

#544348 Anita
Respiratory SPR

Very interesting....I sent a proposal to health education England end of last year outlining how a very small amount of money in each Trust could be used to help frontline clinicians (nurses/doctors/pharmacists) drive transformational change, and the support that would help encourage bottom up innovation and help encourage a shift in still waiting a response! I don't the proposals in this report will necessarily help's just the way it's always been done, a large sum of money and it doesn't necessarily reach/help those key to driving transformation.

#544365 Catherine Cross
The 4OC

Funding is one thing having the skills and experience to make change happen, at what ever level, is another - and they are sorely lacking across the public and private sectors. Change is not easy and there is no magic bullet. It takes structure and rigour. To make it happen everyone must have their accountabilities and responsibilities clearly articulated and understood and aligned - the organisation must have the right systems and processes in place to help staff execute their responsibilities. Senior managers much have a clear set of priorities that are directly linked to these and must not flip flop. You need visibility, good and relevant performance measures and we must, must, must engage front line staff (and patients) in designing new ways of working. They have the best ideas! If, after all that people don't do their job, at what ever level, there must be a consequence.

#544553 David
Management Consultant

Funding can help, however one of the main issues is the short term nature of all the programmes of change. Real deep seated change takes time to achieve and requires strong leadership and management at all levels of the organisation. Most NHS organisations are forced to look at in-year change based on their need to deliver an in-year CIP target. This more often than not drives the wrong behaviours and leads to 'change fatigue'. Perhaps starting with a clear understanding of demand and future demand and then building national/regional models of care around these would help deliver an efficient and effective service.

#545617 Fazeela Patel

If change to improve staff experiences which consequently improves patient experiences and creates a positive cultivating culture, then that change needs to be made by FRONT-LINE Practitioners who know exactly how to achieve it. But neither are they heard and neither do they have the power, regardless of their skills or expertise in bringing it about. Is funding then used in the right place...?

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