From central oversight to local ambition
Annual planning has constrained strategic focus and forced local services into reactive modes. The Medium Term Planning Framework introduces a three-to-five-year horizon with clear expectations for plan triangulation, productivity and reduction of unnecessary bureaucracy, creating space to reset foundations (workforce, estates, digital) and deliver immediate improvements.
Shifting roles and responsibilities
Delegation of specialised services to integrated care boards (ICBs) expands local accountability. System leaders will need operating models that balance local autonomy with national frameworks: transparent decision rights, shared risk, and alignment to trajectories in elective care, urgent and emergency care, primary and community services.
Multi-year planning is not a spreadsheet exercise; it is how we rebuild confidence, capacity and care pathways.
Finance and planning discipline
Multi-year discipline demands credible phasing of investments and benefits. Plans should connect medium-term affordability to service change, demonstrating how savings from administrative simplification are reinvested in frontline capacity and quality.
Risks and mitigations
Fragmentation risk as responsibilities devolve: mitigate through common assurance standards, league-table style transparency and peer review. Capacity gaps in planning and governance: mitigate via shared-services across clustered ICBs, analytics uplift, and phased delegation with gateways.
Delegation without discipline invites variation; discipline without delegation stifles innovation. The art is the balance.
Practical actions for boards
Establish a Medium Term Plan Office to coordinate submissions and maintain a single source of the truth.
Publish a system accountability framework mapping national trajectory to board KPIs.
Run quarterly performance clinics to test triangulation and corrective actions.
Stand up cross-system design councils for specialised services transfer, with clinical and voluntary, community and social enterprise (VCSE) participation.
Get in touch
Interested in working together or exploring these ideas further? Get in touch with Sandra Atik to discuss commissioning with purpose: [email protected].