When I joined the public sector at GDS, I didn’t understand the ‘The strategy is delivery’ sticker. Of course you deliver things. It wasn’t until I spent time in other departments that I understood. Most departments outsourced the doing. GDS built things.

This week I’ve spent a bit of time planning a session for the leadership of Digital Prevention Services to talk about strategy. We have a wider vision of the future we want:

  • people get care in a way that works for them and don’t need to understand how the NHS works to get the most from it
  • people always know what’s happening and what’s next
  • admin is taken away from staff and patients

We also have principles for how we’ll get there, like:

  • designing online and face‑to‑face care as one experience
  • putting clinical, policy and digital people in every team
  • making every system work with the others

A big part of all of this is coherence. Coherence in a system as dispersed as the NHS is hard.

I kept asking myself what’s useful about grouping things as ‘prevention’. Planning work with a prevention lens risks reinforcing silos. Cancer screening has more in common with cancer treatment than with vaccines – someone with an abnormal result needs a hand‑off to their local hospital.

We need to help teams connect care where it’s better for people, regardless of where things sit – inside NHSE, the NHS, or social care and beyond. I’m not sure we need a strategy for prevention on its own. Our work is about supporting teams in our area to design for coherence.

The NHS has many layers, and many ways of doing things. In a system that worked differently, coherence could mean flattening the layers with one big solution. We know that doesn’t work here. We need to connect across layers.

Our services will always follow how we’re organised (Conway’s law innit), but we can design our teams so they work well together. Some joins between services need people talking to each other. Many shouldn’t need a conversation at all, if there’s a shared platform or a clear standard to use instead. If we measure and reward what happens across our boundaries, that’s what our teams will build. A team that hands someone on well to a local service should count as a success, even if its own numbers are smaller.

There’s a sense that the NHS App will fix this by bringing everything into one place. I’m sure I’ve assumed that at some point. But the app can only show people what the rest of the system makes available, and those parts weren’t designed to work together. Connecting the layers isn’t a job for the app. It needs work that nobody is doing yet. There will be times we need to build new services, but connecting to what local services and the frontline already deliver should come first.

I’d like us to think about how we can remove blockers that hold us back from getting people to the care they need. For example, letting someone having remote care book with any setting that has capacity, not just their local one. Some of this already exists. People can choose where they have outpatient appointments, and book vaccinations anywhere in the country. But each works differently, and I suspect most people don’t know they can. Connecting those routes, and making them the default, would do more than building new ones.

With the leadership group I want to think about the organisational blockers to joining up and how we change those. At GDS, the strategy was building things. I think I’ve brought that assumption with me to NHSE, but I’m not sure it’s right here. Here, the strategy might be coherence, and connecting the system is how we get there.