NHS England initiated a ‘financial reset’ for 2025/26, expecting Trusts to improve productivity by 4%, operate within reduced budgets, and provide evidence of control. Gareth Jenkins from Changeology Group Ltd outlines how the company can help achieve these goals
National productivity and efficiency packs now give every organisation a clear map of opportunities – but diagnosis is only the first step. The real test is converting insight into sustained, recurrent savings.
Changeology’s work with NHS Trusts and systems shows that success comes from fewer, better-defined initiatives, disciplined governance, and delivery capability that stays with the organisation. From Waste Reduction Programmes (WRP) to predictive analytics and corporate redesign, our focus is on embedding improvements into the cost base so they deliver year after year. The priority is simple: turn today’s gains into tomorrow’s baseline, and make operational excellence the default, not the exception.
The NHS reset – turning insight into impact
The 2025/26 planning guidance sets a clear expectation: deliver measurable productivity gains, live within budget, and prove it.
Productivity packs highlight where efficiency gaps exist – variation in length of stay, high bank and agency use, and untapped capacity in outpatients and theatres. But while the data shows where to improve, it doesn’t show how to make change stick.
We repeatedly see four pitfalls:
- Too many initiatives dilute leadership focus.
- Placeholder schemes linger without traction.
- In-year gains fail to convert into recurrent savings.
- Weak governance cadence allows slippage to go unaddressed.
The difference between a list of opportunities and actual delivery lies in prioritisation, operational grip, and transparency.
Changeology’s delivery framework
Our Management Operating System (MOS) hardwires delivery discipline into daily operations. It is built on four essentials:
- Governance cadence – Weekly divisional reviews, monthly executive oversight, and milestone-driven Board reporting.
- Gateway controls – Rigorous validation to focus resources on the 10–15% of schemes delivering most value.
- Real-time tracking – Live dashboards integrating finance, operational, and delivery data.
- Capability transfer – Tools, skills, and routines embedded in Trust teams for sustained improvement.
Flagship case studies – right initiatives, real results
By implementing a robust MOS, we have helped numerous NHS Trusts deliver sustainable improvement when, historically, there has been a great amount of theory and not much by way of successful outcomes.
WRP Reset – refocusing savings programme for delivery
Challenge: 306 initiatives diluted leadership focus.
Action: Gateway validation reduced this to 44 high-value schemes delivering 92% of the potential benefit.
Result: £15.2m savings in-year, 48% recurrent.
WRP Reset – £16m transformation portfolio
Challenge: Inconsistent portfolio governance.
Action: Built a validated 114-scheme portfolio with gateway controls and aligned governance cadence.
Result: £16m portfolio under live management; Board recognition of improved maturity.
Corporate TOM – aligning support functions to demand
Challenge: Corporate services misaligned to operational needs.
Action: Standardised roles, removed duplication, aligned staffing to NHSI spans of control.
Result: £1.2m efficiencies; improved accountability and role clarity.
Predictive analytics – demand-led capacity in HODU
Challenge: Unpredictable oncology day unit demand causing overtime and patient delays.
Action: Built a predictive capacity model to optimise scheduling and deployment.
Result: 65% overtime reduction, 30% throughput increase, 30% wait time reduction; HSJ Award winner.
Medical rosters – cutting bank & agency spend
Challenge: High agency usage inflating costs.
Action: Real-time roster monitoring, aligned job plans, and stricter agency controls.
Result: £2.4m in-year savings, 17% fewer agency hours, 12% better fill rates.
Income recovery – clinical coding
Challenge: Incomplete coding was leading to lost income and inaccurate reporting.
Action: Coding audit, clinician engagement, and targeted coder training.
Result: £1.1m recovered in the year, £850k recurrent; coding completeness improved by 14%.
Service remodelling – waste reduction in diagnostics
Challenge: Inefficient scanning and reporting processes created delays and avoidable costs.
Action: Introduced a ‘control room’ model, optimised reporting allocation, and embedded performance metrics.
Result: £929k savings from 396 additional scans and 161 extra reports.
Scaling to system level
The 2025/26 guidance calls for ICB–provider compacts and integrated performance management. In the North of England, we deployed a single MOS and dashboard suite across four Trusts and a Cancer Alliance. This standardised KPIs, enabled system-wide visibility, and supported a 21% activity uplift, £4.9m cost avoidance, and 78% breach reduction.
System-level visibility doesn’t just improve efficiency, it reduces unwarranted variation, ensures equity of access across geographies, and allows resources to be directed where they make the greatest impact. This is exactly the type of model NHS England is signalling for multi-provider transformation in the reset year.
Making 2025/26 gains endure
The NHS has a clear starting point in the productivity packs. The challenge now is to embed the right initiatives into governance and cost structures so that this year’s gains become next year’s baseline.
Our work shows that:
- Fewer, better-validated initiatives deliver more value.
- Governance cadence is non-negotiable for grip.
- Transparency builds trust and autonomy.
- Capability transfer ensures sustainability.
The reset year is an opportunity to make operational excellence routine. With disciplined focus and the right systems, NHS organisations can convert insight into impact — and impact into lasting value.
This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.
