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Protocols, targets and pathways save lives. They give us essential structure to deliver safe, high‑volume care with finite resources, and they have transformed the NHS for the better. But as the healthcare experience becomes increasingly streamlined, Hannah Little, Assistant Chief Nursing Officer at North Bristol NHS Trust, asks: who are we leaving behind? One size rarely fits all We often hear about what healthcare can learn from efficiency‑led industries such as automotive manufacturing, where success is defined by pace, scale and uniform outcomes. And indeed, cross‑industry learning has benefited the NHS enormously. But context matters. People are not cars rolling off a production line. We are complex, diverse human beings with individual social, psychological and clinical needs. And I wonder how far we can push a target‑driven model before we start hearing louder public concern about the fact that, in healthcare, one size rarely fits all. Finding the sweet spot As a nurse, I see individuals deliver personalised care brilliantly. I see colleagues who instinctively adapt, interpret and flex protocols to truly meet the needs of their patients and families. What worries me is not the people—it’s systems that increasingly constrains them. There is a 'sweet spot' between regulation, targets and national mandate on one side, and freedom to innovate on the other. That tension is necessary: too much control and we lose space for creativity; too little and we invite unsafe variation. When the balance is right, systems evolve safely, testing change within a clear structure while allowing for the flexibility that person‑centred care requires. The weight of national targets Standards and strong governance are essential to quality. But how do we ensure they don’t swallow the space needed for anything else? Over recent decades, the weight of national targets has grown heavier. The NHS Oversight Framework was intended to bring much‑needed clarity—a more focused set of national priorities that would reduce noise and strengthen local autonomy. At the 2026 Patient Safety Forum, national leaders spoke about a welcome cultural shift away from over‑mandating and toward local devolution. But this shift appears to be landing alongside a net reduction in resource and ever higher stakes to deliver. So instead of fewer mandates and more autonomy, we may be facing fewer mandates and less capacity for innovation. This raises a critical question: after the targets are met, is there enough resource left for the other things that matter? The things that support sustained performance? Targets tend to serve the 80% who fit neatly onto the healthcare conveyor belt. Without additional support for those who don’t, we risk widening health inequalities. Equity requires adaptability to be hard-wired into pathways—and adaptability requires headroom. The trade-offs Are we comfortable with where we are now? Has the pendulum swung into the place we need for 2026? Everyone recognises that resources are limited. But when limited resources necessitate laser focus on a small number of priorities, are the trade‑offs services have to make the right ones for population health? What will we think, looking back in five to ten years? Will we feel confident that a model which rewards optimising delivery for the majority was worth potentially widening the gap for those who didn’t fit standard pathways? Unlike other industries (e.g. Apple, which famously narrowed its product line to recover focus), healthcare cannot simply do fewer things well. Complex populations do not disappear because they fall outside a national priority. When centrally governed targets narrow without a corresponding rise in local capacity, the burden of adapting care falls to already stretched individuals. And when that happens, quality, equity and outcomes inevitably feel the strain. So what is the solution? If we care about equity and the safety and health of whole populations, resource to adapt and personalise care needs to be preserved. We need open, honest analysis of the trade-offs being made at policy level. Do we have the right set of priorities? Are we incentivising organisations to only pick low‑hanging fruit? And crucially: are we preserving the resource required to deliver personalised, equitable care? Passionate individuals cannot carry this burden alone. Flexibility must be designed into the system, not left to chance. And perhaps the answer is not fewer targets—but targets that incentivise equity as much as efficiency. Call to action Policymakers and senior leaders must prioritise embedding flexibility within national frameworks for all sectors by protecting resource for personalised care, incentivising equity alongside efficiency and enabling local systems to adapt. Without deliberate action, we risk incentivising services that work well for many, but fail those most in need.

There is currently remarkable consensus across think tanks, institutions, and political parties that a move towards a preventive state is key to creating a healthier nation. A preventive approach can help people live healthily for longer while also addressing many of the problems within the health and care system, allowing for proactive population health management and tackling of health inequalities. Creating a healthier nation needs a collaboration between people, places, the NHS, and businesses, as well as government. If the new government wants to improve the health of the nation, it should create an approach to health that spans all government departments, includes actions to reduce health inequalities, and implements measures that help people to make healthier choices. At this in-person event, the case is presented for how prevention can create a healthier nation, why it is particularly important now, and propose tangible actions for making this shift at the national, system and local levels. Join the King's Fund to understand why prevention is key to supporting healthier lives and how it can be made a reality. Join leaders and experts from across health and care, thinks tanks and politicians to explore: why moving towards a preventive state is particularly important now given the context of widening health inequalities and stalling of life expectancy how to make the shift to prevention a reality at national, system, and local levels the importance of measuring preventive expenditure the role of prevention when taking a population health approach the link between health and housing and how healthier communities can support a wider approach to prevention. how place-based approaches to prevention are key. Register

The health and care system are in crisis with staff trying to address backlogs of care and the aftermath of the Covid-19 pandemic, amid workforce shortages, financial constraints and a wider cost-of-living crisis. But how can the system move away from this new normal to a new way of working? Population health approaches offer the opportunity to move from a reactive system that treats patients when they are ill to one that proactively addresses the impact of wider social determinants on people’s heath and tackles the effects of health inequalities. Now is the time to start thinking differently about the health and care system. At this King's Fund event you will hear from local experts and international speakers about how the health and care system can begin to make this shift. It will discuss why population health offers a way to not only tackle health inequalities and improve the health of individuals and communities but can also provide solutions for a system under constant stress. New ideas will be discussed that are inspiring professionals across the sector and explore practical examples of how to address the inequalities social determinants create using a population health lens. Sharing of good-practice examples of how population health works within integrated care systems, how communities come together to promote better health outcomes for residents, and how leaders make a difference from local to national level to solve many of the problems facing the health and care system through the population health model. Register

Developing a culture of continuous improvement is an imperative as healthcare organisations face unprecedented challenges and strive for sustainability. Join an executive leadership panel for a virtual roundtable discussion and learn about crucial lessons from Warwick Business School's recently published independent study of the NHS-VMI partnership. The research reveals the effectiveness of applying a systems approach to learning and improvement across five NHS trusts in partnership with NHS Improvement. It will explore crucial lessons for leaders as they work to improve patient outcomes, population health, access, equity, and the overall patient experience, even during disruptions like the Covid pandemic. This includes: Leadership models, behaviours and practices that were observed to be essential components of leading change in organisations. How to enable “partnership” ways of working through practices and mechanisms that foster and maintain collaborative ways of working. Cultural elements necessary for the successful adoption of an organisation-wide improvement programme. Register

From 1 July 2022, integrated care systems (ICSs) will be established as statutory bodies in all parts of England, with place-based partnerships also taking on a central role in the new system. As ICSs begin the next stage of development, how can all involved ensure they are truly different to what has come before and have a meaningful impact? The King's Fund is running this virtual conference across four half-days, from 23–26 May, which will celebrate the progress that ICSs have made so far. Sharing the vision and journey of established ICSs, this conference will explore how place-based partnerships, newly established relationships and systems leadership can leverage opportunities, and navigate the risks and challenges, to deliver a step change in health and wellbeing outcomes in population health. Register

From 1 July 2022, integrated care systems (ICSs) will be established as statutory bodies in all parts of England, with place-based partnerships also taking on a central role in the new system. As ICSs begin the next stage of development, how can all involved ensure they are truly different to what has come before and have a meaningful impact? The King's Fund are running this virtual conference across four half-days, from 23–26 May, which will celebrate the progress that ICSs have made so far. Sharing the vision and journey of established ICSs, this conference will explore how place-based partnerships, newly established relationships and systems leadership can leverage opportunities, and navigate the risks and challenges, to deliver a step change in health and wellbeing outcomes in population health. Register

At a time when deaths from coronary heart disease and stroke are markedly declining, despite the COVID-19 pandemic, deaths from heart failure are increasing. The management of this devastating long-term condition is estimated to account for 2% of the entire NHS budget, with 70% of this spent on acute hospital admissions. Both prevalence and incidence of heart failure increase steeply with increasing age and with deprivation but outcomes for patients are improved with earlier diagnosis and treatment. Join the King's Fund for this free online event, where we will consider how heart failure is a growing population health problem and the solutions to help overcome the challenges this condition presents. These include preventing the underlying causes of heart failure, as well as identifying risk factors for the condition, such as access to diagnosis, particularly for older people and those from more deprived communities. Register

This free online event from the King's Fund will provide insight into the wider UK health and care landscape in 2021 and will explore how recent trends, the impact of the COVID-19 pandemic and future developments could affect people working in the sector, patients and the wider population. The speakers will discuss some of the big issues that we hope to see progress on in 2021, including health and care staff wellbeing, social care reform, population health and health inequalities, and legislative changes to support the integration agenda. Register