May 08, 2025 Industry news
His address explored the current state of NHS reform, the challenges ahead and how the health service is being reshaped under the new government.
Alastair opened by reflecting on a well-worn cycle in NHS politics. "Governments come into power and say, 'We will not be doing a top-down reorganisation.' And then they get in, realise how hard it all is, and presto—top-down reorganisation.”
He questioned whether the forthcoming Darzi Review would break from this pattern. "This talk of reorganisation, it makes the Lansley reforms look like the Marshall Plan in terms of coherence. They have no plan. They are absolutely making it up as they go along."
Despite this, he noted a surge in interest across the health sector. “Since March, seven of the ten busiest days on HSJ.co.uk have happened. That probably tells you the level of interest, and the level of anxiety.”
NHS England's independence comes to an end
One of the most significant changes is the integration of NHS England into the Department of Health and Social Care. "The experiment of running the NHS via an independent arms-length body is over," said Alastair. "They're not going to do that again for at least a decade."
The senior leadership at NHS England will also see major changes, alongside a reduction in the size and cost of the central organisation. Integrated Care Boards (ICBs) will be affected, with numbers expected to fall. "The number of ICBs will fall to between 23 and 28," Alastair said. "Whether they're officially merged or just share leadership structures, who knows? But they'll be different, and their focus will be narrowed."
Their role in performance management is also being stepped back. "They're not the bosses of providers anymore. They're supposedly doing strategic commissioning. Nobody knows what that means yet, but it sounds good."
Alastair McLellan, editor of the Health Service Journal, at the GS1 UK Healthcare Conference 2025
Providers take centre stage
As ICBs take on a more focused role, providers are being placed at the forefront of delivery. "Just look at the NHS England top team. The new direction is towards accountable care models," said Alastair. "Providers being given budgets for populations and rewarded accordingly."
However, he noted that many areas are not yet ready for these models. “Most places are not ready to go the ACO (Accountable Care Organisation) route yet.”
Leadership priorities at trust level are also shifting. "The best thing you can do for your system is to make sure your organisation functions as well as possible. Don't go to the provider collaborative meeting. Don't go to the ICB meeting. Not unless you've sorted your own problems first."
"Focus, at least for the next 12 to 18 months, is very much internal."
Reform without new funding
Alastair was clear that no significant new money is coming. "There's no more money. In fact, there's less money," he said. "Elective care remains the only real government priority for the next 12 to 18 months. You'll hear about other things, but it's really elective care."
He said that while the ambition to shift from hospital to community, physical to digital and treatment to prevention remains, "that ambition is slipping away."
Major changes to financial flows, such as shifting resources into primary and community care, are not expected until at least 2027. “That might become a transition year, just like the STP-to-ICB period was.”
External factors are also shaping the political environment. "More money is going to defence. Tax receipts are down," he added.
A simpler financial model?
A financial "reset" has been promised by the government, aimed at simplifying the way money moves through the system. "The current system is full of bribes and penalties," said Alastair. "What they'd really like is something simpler: 'Here's your money. It's all your money. You're not getting more, but we're not holding anything back.'"
A new operating model for the NHS is also expected, although it has faced delays. "What are we going to do with procurement?" he said. "'We're centralising it at the ICB level.' 'Oh, we are? Who knew?' That's the state of discussions."
Further policy announcements are due, including the Urgent and Emergency Care (UEC) plan and the Integration Plan from NHS England and the Department of Health and Social Care. These are expected to provide greater clarity on the future of regional structures.
Risk and uncertainty across the system
Alastair acknowledged the disruption caused by ongoing restructuring. "Very few people at the top of the NHS haven't been affected. Many are losing their jobs, changing jobs or working for a new organisation or boss. That makes it really hard for people to focus."
He also warned that the broader economic context is leading to increased caution. "There's a lot of uncertainty," he said. "More cautious spending. Longer to make decisions. And a whole pile of unanswered questions."
Despite this, he pointed to areas where progress may still be possible. "We've been promised a new approach to capital, which might help the NHS get on with building and buying things more efficiently."
With the financial reset, performance management may also become more focused. "A more streamlined system. Fewer decision-makers. Performance management may now mean a direct conversation between NHS England and the provider concerned."
Technology and investment priorities
Digital transformation remains a key ambition for the NHS, but Alastair made it clear that progress will be shaped by tighter priorities and limited central funding.
"We're seeing a strong message from the centre," he said. "If it's EPR, FDP or an app, it might get funding. If it's not one of those, it probably won't."
This reflects the government's current focus on areas that support elective recovery, operational efficiency and measurable performance improvement. Electronic Patient Records (EPRs) and Federated Data Platforms (FDPs) are likely to remain priorities, particularly where they contribute to national delivery plans or data strategies.
However, Alastair noted that projects outside these categories may receive less attention. "There's little bandwidth for anything outside the core list," he said.
This has implications for organisations investing in areas such as procurement, inventory management or system-wide data sharing. Without a clear link to national programs, initiatives may be harder to progress.
Despite this, demand for local digital improvement continues. Alastair said, "The ambition is still there", but delivery will depend on clearer standards, simpler implementation and proven value.
This highlights the vital role of GS1 standards and interoperable systems in enabling scalable digital transformation. Programs that help deliver safer, more efficient care, such as Scan4Safety and digital procurement initiatives, remain closely aligned with NHS priorities. By providing a common foundation for automation, traceability and better decision-making, such solutions can support long-term reform while, at the same time, addressing immediate operational needs.
Audience members raised many important questions
Staying connected in uncertain times
In closing, Alastair urged delegates to stay informed and engaged.
"We now know less about how the NHS is going to be run than we did when this government was elected nearly a year ago," he said.
"It's a time of considerable uncertainty and that uncertainty is not going away.
"This is a time to really connect to what's going on. Don't make assumptions. Many of the assumptions we were all working with, me included, have been blown up in the last two months."
