“Building resilient healthcare for the future”—the sixth roundtable in Prospect’s series exploring the UK’s most urgent challenges—brought together practitioners, policymakers, economists and other interested experts in early June. The objective? To seek potential remedies for a service confronting numerous obstacles. These include workforce burnout and retention, social care bottlenecks, post-pandemic backlogs, an ageing population and hospital bed occupancy that routinely approaches capacity.
The discussion first focused on the public, their health and wellbeing, and how to ensure they don’t become an unnecessary strain on an already overburdened system. If prevention is the aim, then even the smallest interventions, such as reducing falls among the elderly in their own homes, really matter. “Think about health and wellbeing in the communities where we spend our time,” urged one attendee, pointing to activities at work and in third spaces such as community centres and libraries. Examples included providing flu vaccines and other support at work, social prescribing within local leisure centres, and NHS health checks in the community (“People really trust the NHS brand”).
Potentially more effective still is advice shared by the people we know and trust. A new mothers’ WhatsApp group can “set norms from day one of pregnancy”, while those behind a project aimed at improving breastfeeding practices soon discovered that leaflets were no competition for “familial dynamics… God help anyone trying to get past the mother-in-law.” Embracing and influencing those networks is a route worth exploring.
Yet not all issues of prevention are created equal. Compare, for example, the challenge of applying behavioural change to combat obesity with vaccination uptake. Where the latter remains “a single point of decision” (hype around hesitancy aside), the former involves a far more complex series of decisions, incentives and nudges. Consider that according to data from the National Child Measurement Programme, children in the lowest wealth decile are twice as likely to be obese, and analysis by the Health Foundation that suggests those on GLP-1 weight loss drugs are a third more likely to be from the wealthiest areas with the lowest risk of obesity. Consider, too, that 2.8 million adults in the UK are economically inactive because of health problems profoundly influenced by obesity. Change requires more than individual willpower—it requires system changes, too. More on that later.
From the public to the workforce, and here conventional wisdom suggests that the NHS is overmanaged. But might the opposite be true? “Emphatically yes,” offered one voice. “There are more managers per head in any business of comparable size.” Fewer leaders means less training and poorer quality interaction, she argued, highlighting recent research that suggests that the health service spends more on external consultants than on staff training. “Good workplace health comes back to line management nine times out of ten.”
An antidote to poor management is the ABC framework which outlines three needs midwives and nurses require to thrive. These are autonomy (control over one’s work life), belonging (feeling connected and cared for), and contribution (the need to experience effectiveness in work).
Electronic rostering offers an example of a quick, effective and scalable way to introduce service-wide efficiencies. Yet resistance prevails
How might this approach take effect? One example is to give nurses control over rosters. Acknowledging that it’s an approach not without challenge (“a heap of admin and friction”), there remains overwhelming evidence that team-managed rosters result in reduced burnout and lower staff turnover.
The second example is based on a study of 911 dispatchers in the United States. Working on the basis that most are motivated less by money and more by a sense of helping people in moments of crisis, a bank of positive stories—written by the dispatchers—were shared weekly. “We saw staff wellbeing increase exponentially.”
Notwithstanding these examples, the workplace remains challenging. According to the 2025 NHS Staff Survey, 42 per cent of NHS staff report feeling physically unwell because of workplace stress. Many point to an inability to effect change because of hierarchical structures. A sense of helplessness is one of the “biggest determinants … of resilience declining and burnout increasing,” one contributor argued.
This suggests a clear link between workforce frustrations and systems failures. Organisational challenges are nothing new. Since its creation, the health service has been subject to a tussle between centralisation and decentralisation. In the 1940s Nye Bevan was confident enough in Whitehall’s capacity for “command and control” to declare that “if a bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall.” Since then, regular system changes have led—in equal measure—to silos and fragmentation on one side of the ledger, and overreach and a lack of sensitivity to local needs on the other. One result: “pockets of progress” without addressing system-wide needs.
Electronic rostering offers an example of a quick, effective and scalable way to introduce service-wide efficiencies. Yet resistance to change prevails. For a financially constrained service, prioritisation is key. “You’ve got to place bets, look at the evidence and decide what your capital
is worth.”
The adoption of technology remains a contested area, even as it appears to offer solution to some of the systems failures discussed. The introduction of artificial intelligence and the more effective use of NHS data mean faster decision-making and operational efficiencies to some. To others they introduce insurmountable governance and security problems and the prospect of “evangelical alchemy [among those] looking for miracle cures.”
On the burden of compliance, it is not the regulations that present a problem. Rather it is the bureaucratic duplication of effort—“multiple governance structures, multiple forms, multiple procedures, multiple assessments.” As for data, incentives are vital. “We need to give decision-makers the space and permission to share and use data,” advised
one attendee.
If governance matters, interoperability might matter more if health service data is to break free of its silos and vendor lock-in. (Ironically, one of the unintended benefits of fragmentation is greater data security. If the data is siloed internally, gaining illicit access from the outside becomes more difficult.)
Even enthusiastic proponents of AI urge technology providers to better understand the culture of the health service. One supplier, advocating AI-driven processes as a cure-all, underestimates the effectiveness of, and attachment frontline staff hold for, traditional ways of working. Exhibit one—the humble whiteboard. For system change to succeed, those looking to embed resilience into healthcare must be sensitive to existing norms. Systems change, yes, but not without taking the workforce—and the public—with you.
“Building resilient healthcare for the future”, part of Prospect’s Resilience Series and jointly hosted by Behavioural Insights Team (part of Nesta), took place on Wednesday 10th June 2026
