For NHS trust and ICB leaders, the next phase of reform is a very real management challenge, not a policy debate.

There's an expectation that care will move closer to people's homes. Services need to be co-ordinated across organisational boundaries, and at the same time, leaders are under pressure to improve productivity, protect staff time and use data better. These goals will not be delivered by front-line efforts alone. Instead they depend on the operational systems around care: finance, procurement, payroll, workforce administration and the data that connects them all.

When these systems are not working well, everyone notices. Staff navigate workarounds and spend more time away from patients while leaders struggle to see what is happening across providers. This means that decisions are at risk of being made with only partial information.

The question is what operational support gives local decision-makers the headroom to lead well.

The 80/20 principle

Shared operational services are sometimes mischaracterised as a move towards uniformity, but that is not what the evidence - or our own experience - suggests.

Clinical judgement, community relationships and local service priorities must remain local, but many of the operational processes behind care look very similar across all NHS organisations. Paying suppliers, processing invoices, managing payroll, ordering common goods; these should not need to be redesigned separately in every trust.

We can usefully apply the pareto principle here, in that most organisations are 20% special and 80% standard. The special part deserves protection, while the 80% benefits from being shared. A consistent operational layer provides local leaders with reliable platforms, comparable data and less duplication, so they can focus on care rather than administration.

What the evidence shows

There is evidence from within the NHS that better operational foundations release real capacity and create efficiencies.

For example, at Central and North West London NHS Foundation Trust, automating a single consent process freed 56 clinical hours a day for patient care. The lesson learned is that the gain came not from technology alone, but from first redesigning a repetitive process and then applying automation to reduce the administrative burden.

The same principle applies to workforce data. In one NHS organisation, analytics predicted staff attrition with 95% accuracy, months before the pressure would have shown up in waiting times. In this way, operational data, when it flows properly, can function as an early warning system, but only if it is consistent and timely enough to act on. For senior non-clinical leaders, operational data should not be a retrospective reporting burden. It should be a live management asset.

Technology is not the starting point

Technology only delivers when the underlying workflow is understood - and sometimes redesigned - first. 

Too often, organisations procure a system before fully defining the problem. That risks digitising a broken process rather than fixing it. The better sequence is to:

• understand the operational problem
• involve the people who use the process every day
• redesign the workflow
• then procure and implement technology around it
• keep improving after go-live.

A leadership issue, not a back-office issue

At NHS SBS, we are part of the operational fabric the report describes. We have learned from what has worked and, equally, from what has not. We offer our recommendations in that spirit - grounded in evidence, but shaped just as much by experience.

For boards and system leaders, there's an important shift in mindset to be made. While back and middle-office systems might be seen as less important, they should be treated as core infrastructure. In some instances, this means embracing a willingness to collaborate and building governance structures that make this more straightforward. 

The key questions to ask are: where are we solving the same problem independently across multiple organisations and which processes need local variation, and which do not? Within the NHS, proven shared platforms already exist. When adopted well and given time to bed in, there is real evidence of benefits that flow directly to the workforce and patients. The task is to deliberately extend what works with local leaders, shaping how services evolve rather than allowing fragmentation to continue by default.

When operational systems work well, they fade into the background. Staff stop battling the process. Leaders get clearer information and time is released for the work that matters most, including patient care.

Shared operational foundations are not a substitute for local judgement. They are what give local judgement the space to be exercised properly.

The report, Futureproofing the NHS, is available at https://www.sbs.nhs.uk/futureproofing-the-nhs/