From the frontline: Empowering staff to drive the NHS reform agenda

The return on public investment has weakened since the pandemic; more money is not leading to many more patients being treated overall. At the same time, people in the service are calling it quits, loudly and quietly. The challenge is huge, but decisive solutions are yet to been found.

This report attempts to break free from the cyclical history of NHS 'reform'. It puts forward a new approach that is based on ideas of democracy and decentralisation as the way to achieve better decision-making throughout the NHS. It argues the twin crises in the NHS – low productivity and poor staff retention – are interlinked and reinforce one another.

We propose ideas to embed more staff voice into decision-making in the NHS, from the level of clinical service design through to national policymaking. We call for three sets of reforms:

1. Empowering frontline staff to transform clinical services and drive innovation.
2. Organisations that listen and respond to staff on key decisions, and share what works.
3. Staff voice in setting national workforce policy.