Today’s health and care system carries a legacy of managing for functional efficiency, which is holding performance back. This seems to be commonly understood. It is now normal for managers, leaders, policy makers and others to talk about how ‘managing the parts’ has to be replaced with ‘managing the whole’. The enduring and increasing talk of ‘integration’, ‘managing by outcomes’ and ‘personalisation’ is evidence of this, all of which is hugely encouraging.


Managing by outcomes won’t work, integration is the wrong thing righter, the personalisation agenda is stalling and the assumptions that govern management for functional efficiency are being repurposed, not replaced. In other words, if we keep going in the direction we are going then tomorrow’s system will be a version of today’s. Things better (maybe!) but not better things.

Over the course of this series of articles these conclusions are explained and the groundwork for a better way is set out. En route popular improvement strategies, such as Population Medicine and QIPP, are exposed as either not helping or failing to act on the major levers for transformation.

Part 1: Introduction
Part 2: Management by Results
Part 3: Personal Outcomes
Part 4: Population Outcomes
Part 5: Principles for Better Measurement
Part 6: Integration
Part 7: Personalisation
Part 8: Principles for Successful Change
Part 9: Scale and Pace