Public Policy Projects argues that patient flow across the NHS needs to be reframed as a whole-system challenge, rather than being treated narrowly as a bed management issue.
There needs to be a rethink of patient flow management across the NHS with whole-system approaches that leverage digital intelligence to tackle persistent bottlenecks and deliver better care outcomes.
Based on a high-level roundtable with senior NHS, local government, academic and industry stakeholders, Public Policy Projects (PPP) argues that there is a need to move beyond traditional bed management strategies to operationalise whole-system flow through digital intelligence.
The policy advisory and development organisation in the health, care and local government sectors underscores how governance reform, cultural change, and user-centric digital tools can enable the NHS to deliver on the 10 Year Health Plan’s three major shifts: hospital to community, analogue to digital, and sickness to prevention.
“One of the most compelling sentiments shared by participants is that patient flow is fundamentally a governance challenge. Technology alone cannot solve systemic issues,” said Victoria Betton, director for data, digital and AI at Health Innovation Kent Surrey Sussex, who chaired the roundtable.
“It must be embedded within redesigned workflows and governance structures that clarify accountability and enable teams to apply actionable intelligence. Without this alignment, even the most advanced digital tools risk becoming underutilised or misapplied,” she added.
Governance failures
The report identifies governance failures as a key barrier to effective patient flow, with misaligned decision rights and accountability creating bottlenecks across acute and community settings. Roundtable participants called for governance structures that clarify who holds responsibility at each stage of the patient pathway and empower integrated neighbourhood teams (INTs) to act on real-time insights.
It recommends first that NHS organisations should ensure that flexible governance structures empower local integrated neighbourhood teams with decision-making authority, clarifying accountability for cohorts at every step of their care journey.
Then, that commissioners and procurement teams must ensure that tenders for any electronic patient record or other digital tool include explicit, testable interoperability use cases, aligned to national standards (e.g. UK Core FHIR), with pre-defined acceptance criteria, open APIs, and financial/contractual penalties for failure to deliver functional interoperability in real-world workflows.
It also suggests that NHS England funding earmarked for digital transformation in community settings is properly allocated to equip neighbourhoods with digital tools that support cohort segmentation, risk stratification, and preventative management, enabling healthcare teams to anticipate demand and proactively advance population health improvements.
Finally, it argues that any NHS digital transformation project must be overseen by a multidisciplinary change management team. This team must ensure that tool implementation is driven by continuous engagement with clinicians, technical staff, and patients to align digital solutions with real-world workflows, localised workforce strategies, and targeted training through a sustained user-feedback loop.
Healthcare technology company Alcidion provided sponsorship for the report and the roundtable from which it draws.
