Key insights from our discussion with Layla Moran
The scale and pace of change facing the health system is unprecedented, but there is a growing risk that delivery is being outpaced by the sheer volume of reform.
Next month, it is widely expected that the Government will use the King’s Speech to announce, among other measures, a major health bill – likely formalising the abolition of NHS England. This comes alongside a dizzying volume of activity from the Department of Health and Social Care (DHSC), including: significant headcount reductions, another system-wide reorganisation, the 10-year Health Plan and its three ‘big shifts’, the National Cancer Plan, and the Department’s 2024 commitment to meet the 18-week elective recovery target. We are also expecting a refreshed NHS workforce plan, though its publication – initially slated for Autumn 2025 – has so far proved elusive.
To hold DHSC to account, and to shine a light on areas that risk being overlooked, Layla Moran chairs the Commons Health and Social Care Select Committee (HSC). Tendo recently hosted Layla and a group of colleagues from across the sector to discuss the Committee’s priorities and workplan. While the conversation was held under the Chatham House Rule, several themes emerged that speak to the broader direction of travel for the system.
A shift in perspective: from treatment to determinants
Before even examining the Committee’s work, it is worth considering its composition. The current Committee includes a significant number of members with backgrounds in local government, alongside experience spanning the charity sector, education, and the civil service.
Why is this relevant? It shapes how the Committee views the system. Members are, by experience, more attuned to the wider determinants of health – social care, prevention, healthy ageing, and the need to intervene earlier to reduce pressure on acute services later on.
While the Government’s focus is largely on reform within the health system itself, the Committee is equally focused on the cost of inaction elsewhere – particularly in social care and prevention – reflecting the professional and personal experiences of its members.
Ambition vs delivery
There is no shortage of ambition in current health policy. The breadth of activity outlined above speaks for itself.
The challenge, as always, is delivery.
It remains an open question how the system can realistically implement large-scale reform while simultaneously undergoing significant structural change. With major organisational shifts underway, there is a risk that attention is divided between transforming the system and simply maintaining it.
Culture and the limits of system change
Alongside structural reform, there is a deeper cultural challenge.
There was broad agreement that innovation is not the issue. The UK is brimming with bright people and bright ideas, and the NHS is not short of pilots or promising models. The difficulty lies in scaling ideas and tech, and retaining the institutional knowledge.
Too often, innovation remains localised. Pilots demonstrate value, but struggle to move beyond initial funding cycles. Decision-making can be fragmented, and in some cases overly cautious, particularly where financial accountability sits.
Importantly, this is not a reflection on NHS staff – who are operating under significant pressure – but rather on how the system is set up. Incentives, funding flows, and governance structures do not always support the adoption of new approaches, even where they have proven benefits.
The risk of short-termism
A related theme is the prevalence of short-term decision-making.
Whether in funding cycles, policy priorities, or performance management, there is a tendency to focus on immediate pressures rather than long-term transformation. This can make it difficult to invest in preventative measures, workforce development, or system redesign – all of which require time to deliver results.
There was also a sense that the system can become overly driven by what is politically or operationally “in focus” at a given moment, rather than maintaining a consistent long-term trajectory.
Integration in practice, not just in principle
Finally, while the shift towards community care and integrated services is widely supported, making this a reality remains complex.
Barriers persist between different parts of the system, be it primary and secondary care, health and social care, or across professional boundaries. Funding flows, communication gaps, and organisational silos continue to limit progress.
Unlocking the benefits of integration will require more than structural change; it will depend on aligning incentives, improving coordination, and enabling different parts of the system to work together more effectively.
