The NHS 10-Year Health Plan sets out an ambitious vision for transformational change within the health service, underpinned by the three strategic shifts to community-based care, digital systems and illness prevention.
Delivering this level of change carries inherent risk – we can't be sure in advance that something will work as intended until we put it into practice. That is why developing and using effective evaluation frameworks is essential to track how well these shifts are being implemented across the NHS and whether they are achieving the intended outcomes.
My passion for evaluation began in my early days as a nurse, where I witnessed first hand how thoughtful reflection and evidence-based practice could transform patient care. This early experience instilled in me a deep commitment to understanding what works, why it works and how we can continuously improve the systems that support health and wellbeing. But how we do this matters, particularly when it comes to complex transformation.
Formative evaluation is an agile, ongoing approach to reviewing and learning from projects. Unlike traditional methods, it allows for real-time learning and helps teams to refine projects as they progress. This means accelerating what works, quickly identifying risks, issues and bottlenecks, and even stopping a project early if there are strong signs that it won't succeed. This approach has proven effective in national programmes like the NHS AI Lab, where projects that followed a real-time evaluation approach were more agile and better positioned to demonstrate benefits, including faster diagnosis or improved patient outcomes.
Healthcare systems are complex and often context specific. What works in one setting or neighbourhood may not work in another, particularly in areas like digital transformation, where technology adoption and user engagement can vary widely. Evaluation allows for adaptive approaches that embrace learning and flexibility. By continuously collecting and analysing data, the NHS can identify early signs of success or failure and adjust strategies accordingly. But this approach is more of a culture than a discipline. For us to truly benefit from this agile, responsive style of evaluation, staff need to have the confidence to make changes and share their learning – from failures as well as successes.
Measure what matters
The starting point is understanding what you want to achieve and setting up metrics that allow you to measure whether the change you are making is having the desired impact. This should tell you whether, and to what degree, your programme is working and the contributing factors that are having the most impact – good or bad – on the outcomes. In evaluating the national keyworking programme, our team used the programme's logic model to create an evaluation framework that was agreed by all stakeholders as reflecting short-, medium- and longer-term intentions. Where the data needed for this wasn't consistently collected or reported, new datasets were created to ensure outcome measures were valid and not just convenient.
Evaluation is essential to determine which innovations are scalable and which are not
Too often, promising pilots fail to expand due to a lack of evidence on effectiveness or cost-benefit. As the NHS invests in innovation hubs and pilot programmes to test new models of care, evaluation can provide the evidence base needed to expand successful pilots and discontinue those that fail to deliver. This prevents wasted resources and ensures that innovation is driven by outcomes, not hype.
Evaluation underpins accountability and transparency
One of the central tenets of the 10-Year Health Plan is a renewed commitment to transparency. By systematically measuring outcomes, resource allocation and patient experiences, healthcare leaders can ensure that reforms are not only well-intentioned but also effective. Transparent evaluation frameworks allow stakeholders – from policymakers to the public – to understand where progress is being made and where further intervention is needed. This fosters trust and reinforces the NHS's accountability to the communities it serves.
Change without evaluation is experimentation without learning. As we look to deliver the 10-Year Health Plan, embedding evaluation as a continuous, integral process is not just a recommendation – it's a necessity.
