Cart Before the Horse: Why the NHS Must Redesign the Work Before It Can Re-Engage the Workforce

The publication of the Health Foundation's NHS Productivity Commission's report, Breaking the Cycle: How to Build a More Productive NHS, on Tuesday 22nd September, deserves the attention it will undoubtedly receive across the sector this week. Anyone who works in or around the NHS should read it, not because it says anything especially new, but because it says the familiar things with unusual clarity, and clarity is precisely what a debate this cluttered with competing agendas and half-finished reform programmes has been missing (Health Foundation, 2026). More stable, multi-year financial flows so systems can plan rather than react. Measures that follow patient outcomes rather than the mechanics of managing funding. Conditions that let the people delivering care actually redesign the pathways they work in, rather than being handed someone else's redesign to implement. None of this is a revelation to anyone who has sat in an NHS finance meeting or a service improvement workshop in the last decade. What the Health Foundation have done, with their usual aplomb, is clarify the arguments and make clear to policymakers exactly what action may now be required.

What struck me most, and what I want to spend this piece on, is where the report chooses to place its emphasis on people. It would have been easy, and arguably safer, for a Commission convened to examine productivity to default to the mechanical view: more capital, better technology, tighter management of activity. Instead, the report states plainly that sustained improvement in productivity depends on the NHS rebuilding the psychological contract with its workforce, giving staff the headroom, authority and trust to drive change themselves rather than have it done to them (Health Foundation, 2026). That is a genuinely different starting point, and it is one worth unpacking properly, because if workforce really is one of the four core drivers of productivity, alongside capital, technology and transformation, then the question that follows is uncomfortable and practical in equal measure: what should we actually be doing now to prepare that workforce to be the agents of the change everyone agrees is needed?

The diagnosis is familiar, and that is the point

The report's section on barriers to productivity lays out the workforce problem with a bluntness that will feel entirely recognisable to anyone who has read an NHS staff survey in the last five years. Strong management, leadership and staff trust are consistently associated with better organisational performance, and yet the evidence cited suggests the NHS remains undermanaged, with management capability varying enormously between organisations (Health Foundation, 2026). Around three in ten staff report thinking often about leaving their organisation, and fewer than half feel meaningfully involved in decisions that affect their own work. Staff leaving for reasons of work-life balance and health have grown sharply over the last decade. General practice has been losing experienced GPs faster than it can replace them with newly licensed ones. None of these figures are new to anyone reading this. What the report does usefully is name the underlying cause rather than just the symptoms: a culture of blame that discourages learning, and an implicit social contract between the NHS and its workforce that shows, in the Commission's own words, clear signs of fracture.

The thing I keep returning to is that this is not a workforce shortage story, or at least not only that. It is a story about what happens to discretionary effort, to the willingness of good people to go slightly further than the job description requires, when the conditions around them make that effort feel unrewarded or unsafe. As Mark Britnell, Chair of Health Innovation Manchester, put it to the Commission during its evidence gathering, “productivity is all about liberating skills and talents and bringing joy into work” (Health Foundation, 2026). It is a deceptively simple line, and it happens to be exactly what the wider research on people and productivity, most of it published very recently, has quite a lot to add to.

What the wider evidence says about people and productivity

Gallup's ongoing global engagement research remains one of the largest bodies of evidence anywhere on this relationship, and its most recent findings are, if anything, starker than earlier waves. Business units in the top quartile of employee engagement now outperform bottom-quartile units by 18% on productivity in sales-type environments and 14% in production settings, with 23% higher profitability and 78% lower absenteeism (Gallup, 2025). This is not a soft or peripheral finding tucked into an HR conference slide deck. It is one of the most replicated results in organisational research, and the direction of travel in health and care specifically is reinforced by Michael West's recent work on compassionate leadership, which argues that rebuilding trust, support and continuous improvement into the relationship between the NHS and its staff is not a wellbeing nicety sitting alongside productivity, but a precondition for it (West, 2021). In other words, the psychological contract the Commission worries about fracturing is not a nice-to-have alongside the “real” productivity drivers. It appears to be one of them.

The Commission's report gestures at why this relationship holds when it talks about the conditions needed for improvement, citing purpose, autonomy, psychological safety, recognition and opportunities to learn as the levers that direct professional motivation towards continuous improvement, alongside rather than in place of the more conventional tools of targets and financial incentive (Health Foundation, 2026). A recent review of self-determination theory published in Nature Reviews Psychology makes essentially the same argument from the research side, showing that when people's needs for autonomy, competence and meaningful connection to others are met at work, the result is measurably better performance, lower burnout and reduced turnover intention, and that this holds with particular force in jobs, like most NHS roles, that involve complex judgement rather than routine tasks (Gagné et al., 2022). You cannot incentivise your way to a redesigned care pathway. You have to want to build one, and that wanting depends on feeling that your judgement is trusted enough to be worth exercising.

A recent evidence synthesis focused specifically on healthcare settings adds the missing piece about why so many good ideas from front-line staff never surface. Reviewing over sixty studies across nineteen countries, it found that psychological safety, the belief that it is safe to speak up, question established practice or admit a mistake, is strongly linked to the willingness of clinical teams to learn and improve, and that where it is absent, staff routinely stay silent about problems they can see clearly (Grailey et al., 2021). A culture of blame, which the Commission identifies as a real and current feature of NHS organisational life, is the precise opposite of psychological safety. It does not just make people unhappy. It switches off the exact behaviours that produce the efficiency gains everyone is looking for. And underpinning all of this sits the latest update to the job demands-resources model from its original authors, which explains burnout not as an individual failing but as the predictable result of job demands consistently outstripping the resources, including autonomy, support and manageable workload, available to meet them (Bakker, Demerouti and Sanz-Vergel, 2023). Read against that model, the Commission's finding that burnout and weak basic workplace factors, such as team stability and decent line management, are undermining productivity is not a separate observation from the engagement story. It is the same story from the other direction.

Put these threads together and the picture that emerges is not really about the NHS needing to be kinder to its staff as some kind of ethical add-on, welcome though that would be. It is that engagement, psychological safety and well-designed jobs are themselves productivity infrastructure, in the same category as capital investment and digital systems, and arguably cheaper to fix than either. Britnell's line about liberating skills and bringing joy into work is not a soundbite sitting slightly apart from the evidence base. It is a fair summary of it.

All of that is a reasonably comfortable place to stop, and it is roughly where the Commission's report does stop. But there is a harder question sitting just underneath it, one the report gestures towards without quite asking outright, and it is worth asking plainly, because some of the sharpest evidence for the answer comes from the Health Foundation's own research, published elsewhere and, curiously, not drawn into this report at all.

The same people, a different result

Here is the harder question. Why can the same clinicians who move slowly through an NHS elective list suddenly deliver considerably more through an insourced session, using the same operating theatre, the same equipment and, often, the same colleagues either side of them? Why did a health service that is by most accounts chronically undermanaged, target-driven and risk-averse manage to stand up new facilities, redeploy thousands of staff and approve clinical trials in days rather than years during the early months of the pandemic? If NHS productivity really were mostly a matter of engagement, trust and headroom, we would expect both of these episodes to look unremarkable, because nobody rebuilt anyone's psychological contract over a bank holiday weekend in March 2020. Something else was clearly happening, and it is worth resisting the temptation to reach for whichever explanation is most flattering to whatever we already believe about the NHS, whether that is give people autonomy and watch them fly, or the private sector is simply better run.

The Health Foundation's own analysts, working separately from the Productivity Commission, have produced some of the best causal evidence anywhere on a live version of this question. Their evaluation of England's high-volume, low-complexity surgical hubs, which ring-fence staff, theatres and beds for a narrow band of routine procedures such as cataract removals and hip replacements, found that in their first year the thirty-one trusts that opened a hub delivered 21.9% more of this kind of elective surgery than they would otherwise have done, around 29,000 additional procedures. Trusts with hubs already running before the pandemic went on to deliver 11.2% more elective surgery of all kinds in the year after the last lockdown, alongside shorter hospital stays (Health Foundation, 2024). None of this required new staff, new pay structures or a national culture change programme. It required taking broadly the same clinical teams and giving them one thing to do, protected from the queue-jumping emergency admission, the cancelled list and the daily renegotiation of priorities that defines a typical acute ward.

Insourcing tells a similar, if messier, story. Providers who bring their own clinical teams into NHS theatres out of hours, typically to clear long-waiting elective lists, report that the arrangement works best when local NHS staff and the insourced team are allowed to become a genuinely trusted, planned unit rather than a bolt-on service parachuted in for isolated sessions (Watts, 2024). That account comes from someone with a commercial interest in insourcing succeeding, so it deserves the scepticism any vendor testimony deserves, but the mechanism it describes rhymes closely with the hub evidence: a defined task, a stable team and protection from the wider system's competing demands.

The pandemic is the largest version of the same experiment. A recent qualitative study of how the surgical hubs programme was actually implemented found that the scale of reconfiguration achieved was possible largely because crisis conditions temporarily suspended the normal rules, and that what made the change durable once the crisis passed had more to do with clinical buy-in, reliable performance data and hands-on, improvement-focused oversight than with the emergency itself (Lampard et al., 2026). In other words, the pandemic did not simply unleash some latent reserve of goodwill and flexibility in NHS staff, although it may have done that too. It removed, temporarily, the usual apparatus of competing priorities and let people organise around a single, urgent, unambiguous task.

So, different incentives, an absence of blame, or freedom from targets getting in the way: which is it? The honest answer is probably all three play some part, but not as separate ingredients so much as different names for the same underlying condition, which is focus.

What the evidence actually points to

There is a much older piece of management theory that explains this more parsimoniously than any of the individual factors taken on its own. Writing in the Harvard Business Review in 1974, Wickham Skinner argued that a factory asked to do many different things well would inevitably do all of them only averagely, because every additional task, product line or exception it had to accommodate added complexity that degraded performance on everything else, and that a factory focused narrowly on one well-defined task would consistently outperform a more versatile one, even using near-identical machinery and comparably skilled workers (Skinner, 1974). It is a fifty-year-old idea, offered here deliberately as the theoretical root of the very recent evidence above rather than as a replacement for it, since the current health economics literature on surgical hubs draws on precisely this logic to explain what it finds. A general hospital ward is, in Skinner's terms, about as unfocused a factory as it is possible to design: elective and emergency patients competing for the same theatres, straightforward and complex cases sharing the same lists, planned care perpetually vulnerable to being bumped by the unplanned. A surgical hub, by contrast, is close to a textbook focused factory. The clinicians did not become more talented or more engaged when they moved into it. The work got simpler.

This does not mean the workforce evidence discussed earlier is beside the point, and a recent, rigorously specified study of NHS Trust-level data between 2018 and 2023 is a useful corrective against reading the hub evidence too simply. Analysing every English NHS Trust delivering elective surgery over that period, the researchers found that a one percentage point rise in medical workforce sickness absence was associated with a 4.4% fall in completed elective cases, and that gains in administrative staffing, rather than clinical headcount, were what reduced backlogs most reliably, concluding that “workforce expansion alone will not resolve NHS elective surgery backlogs” (Tealdi et al., 2026). That finding sits well alongside the hub evidence rather than against it. A focused, protected, undisturbed team is also very likely a less burnt out, less frequently absent team, because it is not being constantly interrupted, redeployed or held responsible for demand it cannot control. Work design and workforce health may turn out to be the same lever, described from two different directions, rather than rival explanations competing for credit.

Read together, the evidence suggests that the conditions the Commission's own report values, purpose, autonomy, the removal of a fragmenting, blame-heavy culture, are real and do matter, but they may be as much a consequence of good work design as a precondition for it. It is hard to feel meaningfully involved in a decision when your day consists of a dozen decisions imposed on you by other people's emergencies. Autonomy is not primarily a mindset the NHS needs to cultivate in its staff. It looks increasingly like a structural condition that disappears the moment a team is asked to hold six competing priorities at once, and reappears, quite quickly, the moment that stops (Gagné et al., 2022).

Does Breaking the Cycle get to the nub of it?

Here is where I think the report, for all its clarity, pulls its punch. The words hub, insourcing and focused do not appear anywhere in its discussion of workforce barriers, despite the hub evaluation being, on the Health Foundation's own numbers, some of the most robust causal evidence anywhere on what actually moves NHS productivity in practice. The report also treats the pandemic almost exclusively as a productivity shock, a period in which activity fell and has not fully recovered, rather than as the largest live demonstration in the NHS's history of what becomes possible when competing priorities are temporarily stripped away. Both omissions point the same direction. It is considerably easier, and less institutionally uncomfortable, to commission and publish a report about rebuilding trust, listening better and improving leadership than it is to commission one that asks why the acute medical take, the elective list, the outpatient clinic and the mandatory training day are all still routinely scheduled to compete for the same consultant's Tuesday.

I want to be fair to the report here, because the charge is not that it is wrong about engagement, purpose and psychological safety. It is not. The evidence discussed earlier in this piece supports every one of those claims. The charge is narrower, and I think more useful: that a report willing to be this clear about financial flows and outcome measurement becomes noticeably more cautious exactly where the evidence is sharpest and most structurally uncomfortable, which is the question of how work itself is organised, sequenced and protected inside NHS organisations, as distinct from how the people doing that work feel about it.

The workforce and the work are not the same problem

This brings me to the question worth asking directly, and it deserves a direct answer rather than a diplomatic one. Yes, I think the productivity debate, including a fair amount of my own writing on it, has become too comfortable talking about the workforce and not comfortable enough talking about the work. Making people's experience of an unredesigned job better, through better leadership, more trust and a stronger sense of purpose, is a legitimate and evidenced thing to do, and none of the research earlier in this piece should be read as an argument against it. But it is not the same intervention as redesigning the job itself, and the hub, insourcing and pandemic evidence all point to the uncomfortable possibility that redesigning the work does most of the heavy lifting, with a better staff experience following as a welcome consequence rather than arriving as the precondition everyone assumes it to be.

The strongest counterargument, and it is a real one, is that this is a false choice dressed up as a hard truth. The hub programme did not implement itself. It required clinicians and managers willing to reorganise how they worked, and staff went along with it, in no small part, because it visibly removed a source of daily frustration. Work redesign is, on this reading, itself a workforce intervention, just a more concrete and less sentimental one than a leadership programme. I find this fairly persuasive, and it changes where I would put the emphasis rather than abandoning the workforce argument altogether. The practical implication is not that engagement and culture stop mattering. It is that engagement and culture initiatives aimed at making people feel better about a badly designed job are a weaker bet than initiatives aimed at redesigning the job, and that any workforce plan serious about productivity should treat the second as the primary lever and the first as something that will substantially follow from it, rather than the other way around.

Where does the cycle start, and who gets to break it?

There is a sharper version of this argument worth taking seriously, and a paper doing the rounds on LinkedIn this month from the consultancy Emergence Advisory Labs makes it more bluntly than I have so far (Perry, 2026). Its critique of the Commission's report is not that the diagnosis is wrong, the report's own title is Breaking the Cycle for a reason, but that the remedies on offer still operate inside the cycle rather than escaping it. The paper's core claim, once stripped of its own considerable conceptual apparatus, is that strain on the system triggers extra oversight, that oversight eats into the very capacity that might have relieved the strain, and the resulting weakness only invites a tighter grip next time round. Even the report's most people-centred principle, treating productivity as a people agenda, ends up steadying that loop rather than opening it, because rebuilding trust and improving leadership are still things done to a workforce rather than changes to the loop itself. I think the underlying claim holds up well, even where I would not follow every conclusion the paper draws from it.

Here is why the underlying claim holds up. A team whose job demands, conflicting priorities, mounting bureaucracy, the daily work of managing the failure demand a badly designed pathway creates, consistently exceed the resources and discretion available to them is, by the same job demands-resources logic discussed earlier, a depleted team (Bakker, Demerouti and Sanz-Vergel, 2023). Depleted people do not lack the insight to see how their work should be organised differently. Frontline staff in the NHS, on the whole, know exactly where the waste is. What they lack is the bandwidth, the mandate and the protected time to act on that insight, because all three have already been spent holding today together. Asking a depleted team to also become the architects of tomorrow, through better leadership and a stronger sense of purpose, mistakes the symptom for the cause. It is a bit like telling someone drowning that what they really need is a course in coastal navigation.

This reframes the question this piece has been circling. It is not simply whether to prioritise the workforce or the work, as the previous section put it. It is where in the cycle an organisation needs to intervene first, and the hub and pandemic evidence both suggest the answer is at the point of redesigning the work itself, because that is the intervention that frees up the capacity everything else depends on. The Emergence paper puts a version of this shift in a useful shorthand: moving from Human Resources, people planned, supplied and developed from above, to Resourceful Humans, people trusted and equipped to redesign the work they are closest to (Perry, 2026). It is a good phrase, and it names correctly what the report's own workforce chapter still assumes: that people are something the organisation plans and develops, rather than something the organisation frees to act.

But naming the shift is the easy part, and this is where a harder, more practical question belongs. If redesign has to start with the people delivering care, how do they actually get positioned to do it? Three things have to be true at once, and none of them is optional.

First, it has to be funded honestly rather than assumed to be free. The report itself notes, almost in passing, that senior clinical leaders commonly carry responsibility for large numbers of staff with little protected time for management or improvement at all (Health Foundation, 2026). If that is true at senior level, it is truer still further down, where the people who actually see the waste sit. Redesign time that is not explicitly backfilled or ring-fenced does not happen. It gets quietly reabsorbed into the next emergency, which is precisely the mechanism the cycle depends on.

Second, it has to happen alongside the day job rather than instead of it, which is a scheduling and governance problem as much as a cultural one. The surgical hub model offers one answer: ring-fence a slice of time, capacity or caseload explicitly, with someone senior enough to defend that ring-fence when the rest of the system tries to reclaim it under pressure, which is exactly what the recent implementation research found sustained the hubs once the initial crisis pressure had passed (Lampard et al., 2026).

Third, the training question needs a more precise answer than it usually gets. The instinct is to send people on a quality improvement or Lean course, and there is nothing wrong with the methodology itself. But a detailed case-study analysis of QI projects across six NHS trusts found that technical training and fidelity to a formal improvement methodology mattered less than a distinct set of organisational skills: reading and shaping the environment around a project, managing the emotional and political rollercoaster of trying to change something, framing the problem correctly, getting the right message to the right people, and turning the experience into learning that outlasts the individual project (Wright, Gabbay and Le May, 2021). None of that is taught on a two-day PDSA course, and none of it is delivered by a better leadership programme either. It is a specific, learnable, under-recognised skill set, closer to organisational diplomacy than to project management, and it is currently left to develop by accident rather than by design.

A caveat, offered carefully

There is a section of the report that deserves more attention than it will probably get, tucked into the discussion of what the Commission calls the capability to improve. It makes the point that even where NHS staff and organisations can see exactly what needs to change, they often lack the skills, capacity and infrastructure to make that change happen, and that this capability gap covers both technical disciplines, such as operational management, and the people skills needed to lead genuine cultural and behavioural change (Health Foundation, 2026). The report's recommendation is to rebuild graduate, clinical leadership and senior talent pipelines rather than simply patching the gap, and to focus the forthcoming workforce plan on capabilities like improvement science, service redesign and demand management rather than headcount alone.

I want to raise something adjacent to that, gently, because I suspect a fair proportion of the people reading this will recognise themselves somewhere in it, and that is not my intention. Anyone who spends time on LinkedIn will have noticed that the market for NHS transformation expertise, temporary and permanent, has become remarkably crowded over the last couple of years. Some of that is a natural consequence of NHS England's reorganisation putting a great many genuinely capable, experienced people back into the market at once. Some of it is people who have become disillusioned by exactly the fractured psychological contract this report describes, and who have understandably decided that consultancy or interim work offers more agency than staying put. Both of those are entirely legitimate routes into this line of work, and I include myself in that broader category.

But the report's own framing is a useful test to apply, including to ourselves, and the evidence discussed above sharpens it further. The capability gap it describes is not simply a knowledge gap that can be closed by someone who has spent twenty years inside NHS structures explaining how those structures work, and it is not closed by someone whose main offer is a better conversation about culture, either. It is a gap in the ability to design and lead genuinely different arrangements of the work itself: which tasks get ring-fenced, which competing demands get removed rather than merely acknowledged, which lists stop being interrupted. There is a meaningful difference between deep NHS knowledge, which is valuable and hard won, and the demonstrated ability to help an organisation redesign how a piece of work is actually structured. The system does not lack for people who can describe its problems fluently, or facilitate a thoughtful conversation about psychological safety. It has rather fewer people who can show, with evidence, that they have taken a fragmented, interrupted service and made it a focused one. If the workforce plan the Commission calls for is going to invest seriously in leadership and improvement capability, that investment should be judged against this test, not the gentler one, whoever is asking to be part of it, myself included. Increasingly, that test should also include a plain answer to a duller question: who is paying for the protected time this redesign will need, and who has the authority to defend it when the rest of the system tries to take it back.

What this means for now, not just for policy

The Commission's recommendations are aimed squarely at DHSC and national policy, which is appropriate given its remit, but the underlying argument travels a long way down into how individual organisations, and the people advising them, should be thinking right now, well before any national workforce plan lands.

A few things follow, and they are more specific than the ones I would have written before working through the hub, pandemic and quality-improvement evidence properly. Organisations serious about productivity should audit how many competing priorities their clinical and managerial teams are expected to absorb, and treat the fragmentation of attention as a productivity metric worth measuring in its own right, not just a source of stress worth being sympathetic about. Where redesign is asked of front-line teams, it should arrive with an explicit, backfilled budget of time rather than an assumption that people will somehow find it, and with a named sponsor senior enough to protect that time when the rest of the system tries to reclaim it. Training for that work should be built around the organisational and political skills the evidence says actually matter, not only the technical methodology. Staff engagement remains worth treating as a leading indicator, because the evidence for it is real, but it should be read as a signal of whether work has been well designed, not primarily as an intervention target in its own right. And anyone brought in, whether as an employee, an interim or a consultant, to lead redesign work should be judged on evidence of having reorganised how work actually gets done, including having secured the funding and protection that made it possible, not on their fluency in describing why the system feels difficult.

None of this is complicated, which is rather the point the Commission itself makes about the wider productivity argument. We have known most of this for a long time, in patches, without quite letting ourselves put it together. What we have lacked is the will, and increasingly the excuse, to ask the harder structural question rather than settling for the more comfortable cultural one. This report removes a good deal of that excuse. It does not, quite, ask the sharpest version of the question itself. Britnell was right that productivity is about liberating skills and talents and bringing joy into work. It might be worth adding that the fastest way to do both is very often simply to stop asking the same team to do six things at once.

References

Bakker, A.B., Demerouti, E. and Sanz-Vergel, A. (2023) 'Job demands-resources theory: Ten years later', Annual Review of Organizational Psychology and Organizational Behavior, 10(1), pp. 25–53.

Gagné, M., Parker, S.K., Griffin, M.A., Dunlop, P.D., Knight, C., Klonek, F.E. and Parent-Rocheleau, X. (2022) 'Understanding and shaping the future of work with self-determination theory', Nature Reviews Psychology, 1, pp. 378–392.

Gallup (2025) State of the Global Workplace. Washington, DC: Gallup Press.

Grailey, K.E., Murray, E., Reader, T. and Brett, S.J. (2021) 'The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis', BMC Health Services Research, 21, article 916.

Health Foundation (2024) 'Surgical hubs: key to tackling hospital waiting lists?', Health Foundation blog, 5 September. Available at: https://www.health.org.uk/news-and-comment/blogs/surgical-hubs-key-to-tackling-hospital-waiting-lists (Accessed: 24 September 2026).

Health Foundation (2026) Breaking the Cycle: How to Build a More Productive NHS. London: Health Foundation, NHS Productivity Commission.

Lampard, P., Scantlebury, A., Sivey, P. et al. (2026) 'Understanding implementation of the ‘high volume, low complexity’ surgical hubs programme in England: a qualitative study', BMJ Open, e119396.

Perry, R. (2026) Stewards or Architects: Why Breaking the Cycle Is Written for the Stewards of the Status Quo, and What It Will Take for the NHS to Grow Architects of the Future. Emergence Advisory Labs. Shared via LinkedIn.

Skinner, W. (1974) 'The focused factory', Harvard Business Review, 52(3), pp. 114–121.

Tealdi, C., Madia, J.E., Shah, A., Sheikh, A. and Nicodemo, C. (2026) 'Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs', Journal of the Royal Society of Medicine. Online first.

Watts, M. (2024) 'How insourcing models can be better integrated to support wider NHS services', HSJ, 2 October. Available at: https://www.hsj.co.uk/workforce/how-insourcing-models-can-be-better-integrated-to-support-wider-nhs-services/7035589.article (Accessed: 24 September 2026).

West, M.A. (2021) Compassionate Leadership: Sustaining Wisdom, Humanity and Presence in Health and Social Care. London: Swirling Leaf Press.

Wright, D., Gabbay, J. and Le May, A. (2021) 'Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies', BMJ Quality & Safety, 31(6), pp. 450–461.