The covid-19 crisis has brought with it disruptive transformation. Dr Ben Horner, Stephen Sutherland and John Gooch explore ways to ensure that the positive transformative changes are not lost, and ways in which the NHS can take steps to lock-in these improvements

As the NHS plans for its recovery from the first wave of the covid-19 crisis, many organisations and health systems are not seeking to return to their pre-covid ways of working. Instead, they should use the recovery as an opportunity to transform. They are building on the changes brought about by the crisis to enhance patient care and lock-in operational improvements, while also managing the backlog of non-covid patients and building resilience for future covid waves.


Time is of the essence for designing and implementing an effective recovery and reset plan. The next three to four weeks — as the UK starts to pass the peak of the crisis —provides a unique window of opportunity. Success requires an empowered frontline clinical staff that is working toward clear goals, as well as strong, executive-led governance of the programme.

Healthcare reimagined — in a matter of weeks

Ben Horner 3x2Ben Horner

The pace and extent of disruptive transformation driven by the covid crisis would have been unimaginable just three months ago. Since the pandemic erupted, organisations and networks across the NHS have implemented, almost overnight, many transformation initiatives (such as tele-health) that have been in planning stages for months or years. It has also broken previously inviolable rules (for example, staffing ratios), and has radically redesigned ways of working (for example sub-specialty boundaries). These changes have led to a fundamental rethink of both the speed and level of change that is possible.

Stephen Sutherland 3x2Stephen Sutherland

To ensure that the positive transformative changes are not lost, the NHS must take steps to lock-in these improvements moving forward. Recovery planning should encompass three dimensions:

1. Embed the covid-driven transformation

john Gooch 3x2John Gooch

As organisations shift into the recovery phase, they must maintain the positive elements of the covid-driven transformation while acknowledging that some new ways of working must be discontinued due to unsustainability or quality risks. Hospital CEOs should work with their frontline staff to reflect on and learn from what has and has not worked during the crisis period, identify the top five to 10 high-impact initiatives to embed now, and establish an agile programme to deliver the changes.

2. Manage the backlog

The NHS faces a mounting backlog of non-covid patients whose treatments have been delayed during the crisis. They have also seen a significant decrease in visits to emergency departments — down by approximately 50 per cent in April 2020 compared with the same month last year (including drops in conditions such as heart attacks) —suggesting that patients are forgoing much-needed treatments, even at the risk of dying. The NHS needs to address this backlog efficiently and systematically; risk stratifying by clinical need and planning for increased demand in specific areas (such as mental health).

3. Prepare for the second wave

Until a vaccine is available, there will be further waves of covid infections. The NHS needs to build resilience for a second wave, embedding the lessons learned into ways of working, business continuity plans, and future pandemic responses. Maintaining high levels of critical care capacity is an essential element of preparation. Hospitals must also have in place supporting structures—such as command and control, workforce models, patient transfer networks, and links with community services — to enable a flexible response to demand surges.

How to recover and reset at the right pace

To pursue these imperatives, healthcare organisations must juggle several competing priorities: planning for recovery while continuing to treat covid-19 patients; reinstituting previous transformation plans while pursuing new crisis-driven opportunities; and clearing the backlog while ensuring resilience for future waves.

To decide how to strike the balance among these priorities, an organisation must answer a fundamental question: How do we want to use recovery planning to reach our future target state? For organisations that have faced sustainability challenges or had planned to undertake large-scale transformations before the pandemic, the best path forward may be to design a single transformation plan that encompasses recovery to ensure a cohesive strategy for both recovery and transformation to the target state. However, the approach must maintain three core elements that ensured success in the covid crisis:

Empower frontline clinical staff. Ensure the frontline clinical community identifies and delivers the changes, and break down organisational silos that impeded collaboration before the crisis. In recent weeks, frontline clinicians have driven forward the changes using a multidisciplinary approach. In order to maintain the pace and engagement and ensure the success of recovery plans, clinicians need to not only be sources of ideas but also leaders of implementation initiatives.

Set clear goals. Recovery and reset activities will range from rapid impact initiatives to be implemented in the short-term to more strategic and transformational long-term initiatives. Plan and implement these short- and long-term initiatives in parallel rather than sequentially. Select which rapid impact initiatives and quick wins to pursue during the next two to four weeks, such as tele-health for outpatient appointments, community collaborations, and critical care capacity management. Take more time for strategic and longer-term decisions, such as clinical service configurations at a system level and specialty pathway optimisation. These strategic and longer-term decisions need to be effectively prioritised and sequenced to ensure sufficient organisational capacity and deliver the intended benefits.

Establish robust but agile governance. Most organisations have set up a “command and control” structure for their covid response. This will likely need to remain in place for the short-to-medium term to ensure that a governance structure is in place to manage any future covid-19 waves. Although this is well suited for day-to-day crisis management, it may not have sufficient capacity to manage all elements of a recovery and reset programme. Recognising the shortcoming, many organisations have set up robust but agile executive-led governance for the programme, closely coordinated with covid governance.

The recovery from the initial wave of covid-19 presents a unique window of opportunity for the NHS to truly and rapidly transform. The health systems that gain the greatest resilience and agility will be those that not only recover from the acute crisis of the past weeks and plan for the short term, but also permanently change the way they work.

Dr Ben Horner is a managing director and partner in the London office of Boston Consulting Group and a leader of their NHS practice

Stephen Sutherland is a partner in BCG’s London office and a core member of the Health Care practice.

John Gooch is a senior partner and managing director at BCG and leads the company’s healthcare practice in the UK

The authors would like to thank Cassandra Yong and Graham Rich.