When there is no more money, true innovation happens

The sixth instalment of the Strasys Thinking Differently webinar series, titled “There is no money, now what?”, brought together some of the UK’s most respected voices in health policy, clinical practice and innovation. With the imminent arrival of the NHS 10-Year Plan, the session tackled an urgent question: how do we release trapped value and deliver better care when there is no new money?

Below are the key insights from the expert panel, offering a blueprint for a more agile, efficient and patient-focused NHS.

A system without a silver bullet

Sally Gainsbury, Senior Policy Analyst at the Nuffield Trust, a former investigative journalist and NHS commentator, opened the session by dismantling the idea that money alone can fix the NHS. She pointed to a £37bn funding gap when compared with historic trends and explained how inflation and rising demand are swallowing resources.

Technology doesn’t save money in healthcare. It often increases cost.

The same goes for shifting care from hospitals to the community. Outputs in these sectors are harder to measure, making it difficult to direct funding effectively.

She warned that targets like the Mental Health Investment Standard have had unintended consequences, notably an increased reliance on temporary staffing. Importantly, she urged the system to think in terms of need and equity.

When looking at how resources are allocated to former CCG areas, there are no CCGs that are both in the most deprived and oldest decile due to lower life expectancy. That should tell us everything.

A surgeon’s view: 40 years of clinical practice, still too many inefficiencies

Professor Nizam Mamode, a Transplant and Humanitarian Surgeon, shared a powerful perspective drawn from four decades in the NHS. He acknowledged improvements: shorter stays, better training and hygiene, evidence-based treatments. But he emphasised persistent inefficiencies.

He cited examples from a single week: a patient admitted to hospital an extra day due to a faulty cannula; another waited a week for an angiogram at another hospital; a woman couldn’t be discharged due to lack of social care support at home; 20 theatre staff called in sick, forcing a 2-hour pause with no contingency plan in place.

If you ask a surgeon whether they’d like to operate more, they’ll always say yes. But we’re blocked by inefficiencies.

He critiqued the workforce plan, noting it doesn’t factor in data on how many doctors are likely to retire over the next 10 years or what the demand for a particular specialty is. He stressed the need for proper data, particularly around theatre utilisation, and empowering clinical leaders with budgets and decision-making authority.

Leadership in crisis: Alder Hey’s compassionate model

Dame Jo Williams, Chair of Alder Hey Children’s NHS Foundation Trust, made a compelling case for visionary leadership grounded in compassion and courage. She described how Alder Hey created its 2030 Vision by listening to the voices of children and families, rather than defaulting to top-down strategies.

Children and young people are absolutely at the heart of everything we do. Their voice really matters.

Four patient personas emerged from this consultation: “Get me well quickly” (children seeking fast return to normal life), “Complex needs” (requiring personalised, connected care), “Health inequity” (those in deprived communities needing systemic support), and “Optimistic visionaries” (pushing for big scientific breakthroughs).

This data-led, values-driven approach has already delivered success. A respiratory programme training mothers to support other mums has reduced emergency department attendances.

I think when things are tough, as the environment is now, there’s a temptation to focus on the money and structural change. But for us, the priority is transformation.

What makes this work? Dame Jo pointed to empowerment at all levels, distributed leadership, a courageous risk appetite, and workforce care.

Unlocking trapped value in the NHS

Mark Jennings, Chief Solutions and Services Officer at Strasys, made a data-led case for redefining value in healthcare.

If I ran the NHS, I’d ask two questions: Where is the money going? And what are we getting for it?

He described how Strasys has mapped all English acute trusts by expenditure and activity, with a stark finding: the largest trusts with the most resource are amongst the least efficient.

The more you spend, the less you get.

A focus on getting the largest 13 trusts to the productivity of the 104 smaller trusts could save the NHS £8bn a year in FY24 figures.

This inefficiency is even more striking when adjusting for disease prevalence. The proprietary Health Alpha metric shows that larger trusts often underperform when delivering outcomes relative to the health challenges in their local populations.

He shared a striking stat: improving the outcome performance of the 11 largest trusts could result in 1,800 lives saved annually.

To track progress, he has created the Strasys Value Index, measuring productivity and quality per £1,000 spent. The takeaway? Variation is opportunity. And the NHS is rich with variation.

In every region of England, the lowest performing trust is the largest or second-largest. Conversely, Barnsley, rated “Good” by the CQC, ranks first on the Strasys Value Index.

Care models built around buildings are obsolete

Mark called for a radical re-think of how care is structured. He criticised systems built around hospitals and specialties, rather than the actual needs of patients. The Strasys approach reverses this, starting with patient segments and building models of care tailored to them, not institutions.

Three steps summarise this logic: start with patient need, organise care around that need, measure value relative to cost.

The current model isn’t delivering the best care. In fact, the organisations receiving the most money are often furthest from where they need to be.

He warned that medical advances and technology will continue to drive up cost, so the only way to make room for progress is to become ruthlessly efficient today.

Innovation needs permission and courage

A recurring theme across the webinar was the call for bold, risk-tolerant leadership. Nizam described the hostile environment for innovation, where it takes more than a year to approve even minor changes. Mark and Dame Jo both argued that transformation cannot wait for structural reform or funding windfalls.

We’ve been told repeatedly now that there is no more money. And that’s not necessarily a bad thing. Because it forces us to confront a broken model.

The group agreed that to drive innovation, leaders must:

• Accept risk as part of doing business
• Decentralise decision-making
• Focus on outcomes rather than just inputs or activity
• Listen deeply to both staff and patients

Innovation through constraints

In the absence of new money, true innovation becomes possible. By aligning around clear vision, listening to patients, measuring what matters, and addressing inefficiency with urgency, the NHS can thrive. Not despite constraints, but because of them.

We all know the issues. The question is what are we going to do now? It’s time to move from talk to action.

And the action, as every speaker agreed, starts with thinking differently.

Watch the full webinar

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Strasys, the Decision Intelligence engine for healthcare, launched their “Thinking Differently” webinar series in March 2024 and couldn’t have predicted how popular it was going to be. Covering the pertinent topics being discussed in boardrooms from workforce, inequalities to productivity, a clear demonstration of the appetite for new ideas and thought leadership in this space.

The key questions