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Erika Bannerman, managing director of NHS Shared Business Services, writes that fixing the foundations is one of the most direct and practical ways to improve care.
At the start of a shift, a clinician logs into multiple systems before seeing their first patient. Information is entered, checked and chased across platforms that barely connect. It is slow, repetitive and, far too often, accepted as part of the job. By midday, valuable clinical time has already been lost, not to care, but to navigating processes never designed to work together. This is the lived experience in today’s NHS.
We tend to group finance, procurement, payroll and workforce administration under the label “back office” and, by implication, treat them as peripheral. They are anything but. Their effects are felt every day in delayed discharges, duplicated effort and clinicians pulled into tasks that add little value for patients. What appears administrative on paper translates directly into clinical impact on the ground.
The Ten Year Health Plan is clear in its ambition: care closer to home, sustained gains in productivity, and far better use of data. These are not goals that clinical effort alone can realise. They depend just as much on whether the NHS’s operational core is coherent, consistent and built around the realities of how people work. Without that foundation, ambition fragments into local workarounds and marginal gains.
Costs rise
The cost of neglecting this layer is increasingly visible. Corporate costs across the NHS have risen by £1.85 billion, a 40% increase since 2018/19, while productivity remains below pre-pandemic levels. By mid-2024, the service employed significantly more staff than in 2019, yet was treating only marginally more patients. That gap tells a simple story: when investment flows into fragmented systems, complexity grows, effort is duplicated, and the return on every pound diminishes.
Recent analysis suggests NHS staff spend around five additional hours each week on work created by inefficient processes, equivalent to 7.5 million hours of avoidable effort every single week. That is time that could be redirected to patient care, service improvement or supporting front-line teams. The consequences are visible in patient flow. In February 2025, on any given day, around 13,740 patients were medically fit for discharge but still in hospital, tying up the equivalent capacity of 23 hospitals. Clinical readiness is only part of the equation; the rest is operational friction.
When that friction is removed, the impact is immediate and measurable. At Central and North West London NHS Foundation Trust, automating a single consent process released the equivalent of 56 clinical hours a day. In Sussex, the introduction of an “anytime” payroll model improved both accuracy and staff satisfaction. These are not abstract efficiencies; they are hours returned to care and confidence restored across the workforce.
A useful test is to ask which work truly needs local judgement and which doesn’t. Across the NHS, the answer is strikingly consistent. Around 20% of activity depends on local nuance, clinical judgement, community relationships and service design. The remaining 80% is standard: paying suppliers, processing invoices, managing payroll and ordering common goods. Yet too often this standard work is redesigned repeatedly across organisations. The result is variation where there should be consistency. Where common processes are standardised and shared, capacity is released and redirected back into care.
Technology has a central role, but it is not a shortcut. Digitising a flawed process simply accelerates the flaws. It is the equivalent of one wheel on a car spinning faster than the others: motion without direction. The more effective approach starts with the workflow itself. Understand it, redesign it with the people who use it every day, and only then apply technology to reduce friction. The results can be transformative. At Lewisham and Greenwich, automating a targeted pharmacy invoice process reduced a task that once took around an hour to just minutes, without introducing additional complexity elsewhere.
Operational data is another underused strength. Workforce, finance and procurement information often signals pressure months before it appears in clinical metrics. In one organisation, workforce analytics predicted with 95 per cent accuracy which staff were at risk of leaving, early enough to act before it affected waiting lists. The NHS already collects this data at scale. The challenge is to make it consistent, timely and genuinely useful, treating it not as retrospective reporting but as a live management tool.
Benefits accrue
None of this is straightforward. The costs of change are immediate and borne locally, while the benefits accrue across the system over time. Without governance that recognises that imbalance, even well-intentioned collaboration can stall. What works is shared purpose, clear accountability and genuine partnership, with local leaders shaping solutions rather than having them imposed upon them. Where that balance is struck, change becomes both possible and durable.
The Ten Year Health Plan calls for coordination across organisational boundaries at a scale the NHS has not previously achieved. That coordination depends on an operational layer that works consistently across the system. Where that foundation has been built, the gains are already clear. The task now is not to reinvent, but to extend what works, collectively, consistently and at pace, rather than continuing to solve the same problems in isolation at considerable cumulative cost.
When the back office works well, it is invisible, and that is precisely the point. Clinicians keep more of their time. Patients receive more of their attention. The system functions as it was always intended to. Fixing the foundations is not an administrative exercise; it is one of the most direct and practical ways to improve care.
