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Imagine the chair of an airline announcing that its maintenance records are unreliable, its flight plans are guesswork and nobody has calculated the fuel requirements.
A Ratner moment.
Passengers might reasonably ask; what are you doing about it?
Which brings me to Penny Dash… again. I'm surprised she's not in A&E, with a gunshot wound to her foot.
In a gob-smacking £walled Financial Times interview, the chair of NHSE describes an organisation making enormous strategic decisions without the analysis needed to support them.
A mental health strategy without a proper understanding of spending, workforce or estate.
Urgent care centres planned without comparing alternative locations, costs and outcomes.
Dash finds the absence of strategy staggering, but…
…hang on...
... she's the chair, the boss of the organisation she condemns!
Not a commentator, consultant or a retired executive. She’s the person paid to provide leadership, challenge and oversight… in plain English; to make stuff work and get stuff done.
In evidence to MPs in May 2026, she accepted that ultimate board accountability rested with the chair, while distinguishing that from executives' responsibility for operational delivery.
She accepted the unplanned abolition of NHSE with no complaint and it’s a tricky time, but …
…leadership isn't about explaining why things are difficult. It's about making things happen despite the difficulties.
Dash spent years advising healthcare organisations at McKinsey and previously led NHS strategy.
She must stop rolling out criticism and start rolling up her sleeves to get things done.
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What has she changed?
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What has she stopped because the evidence wasn't there?
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What’s her action plan?
At NHSE's October board meeting, directors acknowledged that flagship technology programmes, including the NHS App, single point of access and federated data platform, were progressing… ‘more slowly than anticipated.’
The board's digital committee identified inadequate operational plans, disconnected projects and benefits arriving too slowly. Dash called for acceleration, but…
… acceleration isn't a strategy.
Technology is supposed to be one of the three great shifts underpinning the ten-year plan. Yet...
... NHSE charged with delivering it apparently cannot consistently connect technological ambition to operational reality. It’s not a shift, it’s barely a shuffle.
Dash is an enthusiast for shifting care out of hospitals into neighbourhoods, but …
…here we encounter an inconvenient economic truth. Transformation costs money before it saves money.
You can’t close a hospital ward on Friday and open a functioning neighbourhood service on Monday.
- Premises,
- staff,
- technology,
- clinical pathways and
- Relationships…
… all need sorting out.
Meanwhile, hospitals must continue functioning. For months, perhaps years, we must pay for both. Double running, and there's no spare money.
The NHS is being asked to finance tomorrow's services from savings on yesterday's services before what we're doing today, can safely close.
That's not a strategy. It's a funding problem with no answer, and …
…there’s the last three feet.
That unpredictable space between patient and practitioner where healthcare actually happens.
Moving services around an organisational chart is easy. Changing relationships, professional practice, trust and clinical routines is much harder.
Preventing an admission doesn’t automatically release cash from a hospital.
Buildings remain.
Staff cover rotas.
Emergency departments stay open.
Fewer admissions might improve care without releasing enough capacity to close a ward.
Better outcomes? Possibly. Cash savings? Not necessarily.
This is precisely the whole-system analysis Dash says is missing.
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Where is the transition budget?
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Who pays for double running?
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When do savings materialise?
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Who carries the risk, and…
… who is responsible for delivering the answers? I begins with a ‘D” and in this case it’s not dunno…
Start with the patient and work backwards… design the service, establish capacity, fund the transition, then safely release hospital resources.
Dash says we can’t simply blame politicians. We can. Ministers make bonkers policy… mostly unchallenged by civil servants.
It’s NHS leaders who are stuck with testing feasibility, identifying risks, challenge assumptions and explain consequences… on top of the day job.
Politicians announced NHSE's abolition before the new operating arrangements were settled.
Where was the homework?
The NHS has no shortage of people like Dash, who can describe what's wrong… staff live with those problems every day.
They need something different from national leaders…
- Decisions.
- Priorities.
- Protection from political distractions.
- The courage to say no.
- The determination to get things done.
The NHS doesn't need a person at the top making a dash for a headline.
It needs someone at the top making ready for a marathon, to get stuff done.
More leadership. Less commentary.
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