Darzi set out some significant challenges for the NHS yet nothing in the report was considered new and surprising 1 2 3 4. Wide ranging problems have been growing in plain sight for some time. We know that individual heroes will not solve our problems5, nor will tinkering around the edges. Darzi may have given us a mandate for change – but if we want to get different results, we need a new way to deliver it. There is now a pressing need to build collective action to address the significant challenges we face, and to evolve the way change is delivered.
It no longer makes sense to talk of “step changes.” Across society, we are experiencing a constant series of upheavals and interdependent, systemic challenges. Today’s change is less of an event, and more of a state of being, happening in continuous, interrelated ways. With increasing polarisation6 and decreasing trust7, people want transparency and ways to collectively be involved in defining the destination at the same time as working out how to get there8.
There is a growing consensus that the policy making process also needs to adapt. Typically, high end missions are agreed by Ministers with lots of bottom-up projects – but in the middle, it can be difficult to connect the two. Increasingly the public sector is being called upon to act as an enabler of experimentation yet remains held back and stuck in traditional approaches. Kattel and Mazzucato9 make the case that “to tackle the grand challenges of the 21st century, innovation policy needs to shift from the existing support-and measure approach to lead-and-learn approach (create and shape markets with variety of policy instruments with open-ended impact horizons and learn through wider social engagement and coordination).” The national campaign #DoWith demonstrates growing support for the radical and hopeful change needed in how public services work with people and communities.
There is a pressing need to evolve the way change is delivered to be fit for purpose. This calls for a fundamental shift in how public services operate and how leaders adopt methods and approaches that enable rapid and effective responses.
Developing shared solutions
The biggest single resource the NHS has is the accumulated wisdom of its workforce10. To accelerate more innovative approaches and build collective action, there is a need to focus on how we harness the commitment and creativity of those working in health, care and public health. As challenges grow more complex and traditional solutions fall short, we need to convene people and organisations at scale, creating coherence from diverse perspectives.
“If you want to go fast, go alone; if you want to go far, go together”
Harnessing the wisdom of the workforce is about creating systems that actively encourage collaboration, innovation, and adaptability. The NHS must invest in structures and processes that bring together diverse voices, empower front-line staff, and encourage the testing of new ideas in real-time.
Participatory approaches go a long way, but not far enough. They only lead to change if we access the right insights at the right time which build a social movement to propel us forward. We believe there is a need to go further and enable communities to develop a consensus around what needs to happen to make progress against our shared challenges. This needs to happen at a pace which aligns with the rapidly changing health and care landscape.
Guiding principles for developing shared solutions
To respond to the multifaceted issues we face, we must ground our efforts in a clear set of guiding principles. These principles should act as a north star, ensuring that policies, initiatives, and solutions remain adaptable, inclusive, and grounded in the real-world realities. We believe in the following foundational principles:
- Prioritise learning
- Focus on relationships and trust
- Encourage experimentation
- Value local insights and contextual knowledge
- Strengthen systems to adapt and innovate in real-time
- Anchor decisions in shared values
To apply these principles effectively, we have embraced a Rapid Insight methodology11 12 – a structured approach designed to generate actionable insights in real-time by engaging diverse perspectives. Rapid Insight helps create clarity in the midst of complexity by transforming data from large-scale network interactions into meaningful insights. This process prioritises co-creation, ensuring stakeholders collectively define what matters most and uncover paths forward that are both innovative and practical. By focusing on quick cycles of reflection and action, Rapid Insight supports leaders and networks in building shared understanding and momentum for change.
The take-home message
The challenges faced by the NHS and public services are neither new nor insurmountable, but they require a fundamentally different approach to how we lead and deliver change. Real change emerges when we build the space for it. We need approaches that invite humble inquiry, value different perspectives, and focus on what unites us. By grounding our efforts in guiding principles—learning, trust, experimentation, local insights, adaptability, and shared values—and by adopting methodologies like Rapid Insight, we can harness the collective wisdom of our people and networks.
References
[1] Anandaciva, S (2024) The Darzi review of NHS performance signals why radical change is needed. The Kings’ Fund. Available at: https://www.kingsfund.org.uk/insight-and-analysis/blogs/darzi-review-nhs-performance-radical-change
[2] Healthwatch (2024) What patients want: a vision for the NHS in 2030. Available at: https://www.healthwatch.co.uk/report/2024-02-29/what-patients-want-vision-nhs-2030
[3] Bell, A (2024) The Darzi Review and its implications for mental health. Centre for Mental Health. Available at: https://www.centreformentalhealth.org.uk/the-lord-darzi-review-and-its-implications-for-mental-health/
[4] RCP (2024) RCP responds to Lord Darzi’s NHS Review. Available at: https://www.rcp.ac.uk/news-and-media/news-and-opinion/rcp-responds-to-lord-darzis-nhs-review/
[5] Wheatley, M (2010) Leadership in the Age of Complexity. Available at: https://www.margaretwheatley.com/articles/Leadership-in-Age-of-Complexity.pdf
[6] The Conversation. Is social media fuelling political polarisation. Available at: https://theconversation.com/is-social-media-fuelling-political-polarisation-232749
[7] 2025 Edelman Trust Barometer Global Report. Available at: https://edl.mn/4iPYeyf
[8] The King’s Fund (2025) Do With: A call to action. Available at: https://www.kingsfund.org.uk/insight-and-analysis/projects/do-with
[9] Kattel, R and Mazzucato, M (2018) Mission-orientaed innovation policy and dynamic capabilities in the public sector. Available at: Mission-oriented innovation policy and dynamic capabilities in the public sector | Industrial and Corporate Change | Oxford Academic
[10] Cook, S (2024) Fixing the NHS – it’s not all about money. BMJ Leader. Available at: https://blogs.bmj.com/bmjleader/2024/11/20/fixing-the-nhs-its-not-all-about-money-by-dr-susy-cook/
[11] Yearsley, L. Rapid Insight: the missing piece in how we lead large scale change. Published 9 July 2024. Available at: https://horizonsnhs.com/metaphors-for-understanding-rapid-insight/
[12] Karakusevic, S., Yearsley, L., & Maddocks-Brown, L. (2024, May). Networks, the clear blue water of change or the “wave tops” on the sea?. In Healthcare Management Forum (Vol. 37, No. 3, pp. 164-167)
Authors
Laura Yearsley
As the Associate Director of Insight, Laura is known for her expertise in creating Rapid Insights; a powerful approach that turns data generated from large or complex network interactions into actionable insights. She provides advice, guidance and training on Rapid Insight, and has been part of creating transformational change alongside leaders of health and care systems in the UK, America and Canada.
Laura has been working within health and care for 20 years. Prior to joining Horizons, Laura worked in policy and strategy where she led large-scale change initiatives on sepsis, the quality of NHS investigations and NHS complaints, and helped facilitate reform of the public health system. She also spent some time in the US where she led a start-up at Vanderbilt Medical Center in Nashville, to improve engagement in clinical research by pioneering new approaches to community engagement. Her roots are in the voluntary sector where she led award winning campaigns to improve access to medicines, including a coalition of 80+ charities to shape how NICE engages the public in generating national guidance.
Laura is passionate about working alongside others to help make sense of what is emerging, and to use her wider system knowledge to develop incisive insights communities can use to take action. She wants everyone in improvement to be able to practice the art of rapid insight, and believes it is the missing piece in how we practice large-scale change. She reaches other improvement and insight practitioners through teaching, connections, virtual presentations, commentaries and blogs.
Marc Harris
Marc is Head of Insight and Impact at Horizons. Marc blends psychological and sociological theory with an extensive background in research and evaluation. Marc holds a PhD in sociology and has published more than 15 academic papers in peer-reviewed journals. These publications span areas such as behaviour change, programme implementation, motivational theory, gamification, alcohol and substance use, physical activity promotion and research ethics. Marc has a passion for applying quantitative and qualitative research methods to real-world settings and using the results to create actionable insights which drive behaviour change.
Declaration of interests:
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.