The NHS is on the brink of a transformative era, driven by the need to adapt to escalating system pressures and evolving patient needs. The Government has outlined three fundamental shifts to underpin this transformation: a move from analogue to digital enablement, a clearer focus on prevention and a shift of care toward community settings.
These shifts are not just strategic aspirations; they are essential course corrections for a health and care system that has become overly reliant on hospital-based treatments and reactive interventions.
To achieve these shifts, the NHS must move beyond isolated programmes and adopt a comprehensive, system-wide reorientation of planning, resource allocation, workforce support, performance monitoring and change management. Traditional, fragmented approaches anchored in organisational silos and rigid annual cycles will not suffice. Instead, our Five-Lever Lock Framework offers NHS leaders a strategic structure for planning and managing five critical domains:
- Financial stewardship
- Demand and capacity management
- Workforce planning and development
- Productivity and efficiency
- Performance and outcomes assurance.
The framework is inspired by the precision and assurance of a five-lever mortice lock – the gold standard in home security. While each lever can be ’locked‘ to safeguard stability or ’unlocked‘ to enable rapid adaptation and innovation, the true strength of the Five-Lever Lock Framework lies not in addressing each domain independently but in orchestrating them together.
1. Financial stewardship: realigning investment with strategic purpose
Effective financial stewardship is the cornerstone of sustainable system transformation. Historically, NHS funding has favoured acute activity and short-term pressures, often at the expense of preventive services, community support and digital infrastructure. To realise the three shifts, financial strategy must unlock investment for innovation and prioritise upstream interventions.
Arden & GEM's Integrated Business Planning (IBP) Tool enables NHS organisations to analyse financial flows in real-time and model diverse investment scenarios. Leaders can assess the cost savings of reducing high-intensity reactive care and redirect resources into digital monitoring platforms, virtual wards or community-based multidisciplinary teams. This approach allows funding to be dynamically reallocated according to population needs and measured outcomes.
Crucially, financial planning must become more agile. The IBP Tool’s capability to forecast, monitor, and adjust budgets throughout the year ensures that resources can be deployed responsively rather than confined to static cycles. This flexibility supports the rapid scaling of proven pilots, the targeted rollout of digital solutions, and the expansion of community capacity to meet seasonal demand.
2. Demand and capacity management: coordinating services to meet needs proactively
Balancing health service demand with available capacity remains one of the NHS’s most enduring challenges. Fragmented planning often leads to gaps in community or mental health services while acute sites become overwhelmed. To deliver the three shifts effectively, capacity must be rebalanced across the system and demand anticipated through collaborative, system-wide planning.
The IBP Tool allows health systems to model both current and future service demand across all care settings and align capacity accordingly. By integrating data from multiple providers, it can forecast pressures arising from seasonality, population health trends and service reconfigurations. These insights enable resources to be redirected to primary care, community services and digital-first interventions before crises occur.
For example, if the tool projects a winter surge in diabetes-related needs, the health and care system can pre-emptively enhance community podiatry clinics, deploy digital monitoring for vulnerable patients, or establish virtual education sessions.
3. Workforce planning and development: enabling the frontline to deliver transformation
Many of the roles vital to prevention, digital engagement and community-based care – such as general practitioners, advanced care practitioners, community mental health professionals, care coordinators and digital navigators – remain scarce or overstretched.
The IBP Tool enables health systems to align workforce planning with service strategy and population requirements. It supports scenario modelling for new care models, allowing leaders to forecast the staffing implications of initiatives such as seven-day community services, hybrid digital clinics or expanded intermediate care teams. The tool also evaluates the affordability of different staffing configurations within existing budgets.
Crucially, the platform links workforce data to patient outcomes, demonstrating how staff deployment affects service quality, access and overall system resilience. This insight allows NHS organisations to move beyond simple vacancy tracking towards capability planning, identifying where upskilling or role redesign can deliver the greatest impact on care delivery.
4. Productivity and efficiency: transforming pathways to deliver greater value
Productivity in healthcare is not simply about doing more with limited resources; it is about optimising processes, pathways and interactions to generate the greatest value for patients, staff and taxpayers. Within the NHS, inefficiencies such as fragmented discharge arrangements, repeated assessments and poorly utilised digital tools contribute to unnecessary escalation of care and weaken system resilience.
The IBP Tool enables detailed mapping of operational performance, allowing leaders to assess throughput, length of stay, referral-to-treatment times and pathway fragmentation. These insights reveal bottlenecks and process weaknesses that compromise care quality or drive up costs.
Through scenario testing, the platform also lets NHS organisations model the effects of service redesign. Whether trialling integrated discharge models, new triage protocols or automating administrative workflows, these simulations ensure that productivity improvements remain focused on patient outcomes rather than activity alone.
5. Performance and outcomes assurance: aligning planning with purpose
The ability to track and assure performance against outcomes is fundamental to delivering genuine transformation. Realising the three key shifts demands impact not merely increased activity; measured through better patient experience, reduced inequalities, fewer unwarranted admissions, improved condition management and clear system-wide value.
The IBP Tool facilitates outcome-based planning by linking service activity to key indicators such as equitable access, digital engagement, readmission rates and patient-reported outcomes. These measures span acute, primary and community settings, providing a comprehensive view of system performance. It also underpins intelligent target setting, rooted in local data and strategic objectives.
By shifting from punitive performance frameworks to a culture of learning and improvement, health and care systems can track outcomes transparently and align assurance processes with their core mission.
Realising the vision for an adaptive, empowered NHS
The NHS stands at the threshold of a new operating model; one that must be preventive, digitally enabled and grounded in community strength. Achieving these priorities will not result from statements of intent or isolated projects but from a system-wide approach to planning, action, learning and continuous adjustment.
The Five-Lever Lock Framework, supported by the IBP Tool and underpinned by an embedded culture of innovation, provides health and care systems with a practical, operational pathway to realise this vision. It enables leaders to coordinate activity across finance, operations, workforce, productivity and outcomes in concert rather than in isolation.
By adopting this framework, NHS systems can move beyond annual planning rounds to become genuinely adaptive, empowered and transformative. A change that will ensure the shifts to digital, prevention and community-based care are not merely introduced, but fully realised.
Read more about how adopting the Five-Lever Lock Framework can support transformation in this document. Or contact the Strategy, Planning and Innovation team for more information.
