Strategy
Commissioned by NHS South West London ICB, CF developed a 10-year transformation plan for 1.9 million people, deploying a proprietary population segmentation model to identify over £1.2 billion in opportunities across commissioner and provider organisations. The plan projects 28,000 patients prevented from developing serious health conditions, a 17% reduction in hospital beds, and a shift from significant deficit to surplus by 2035/36 — with every trust in the system now using CF’s models as the basis for their own strategic planning.
NHS South West London Integrated Care Board (ICB) commissions healthcare for 1.9 million people across six London boroughs – Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth. It commissions healthcare from 5 acute trusts, 2 mental health trusts and 4 community providers. Together, the ICB and its providers form a large health system.
The system is under severe pressure. Access to care is deteriorating, with 203k people waiting for elective treatment. Financially, the system is in deficit, with government support payments required in 2025/26. And the outlook is worsening. Without a new strategy and transformational change, the gap between what the system can provide and what the population needs will become unsustainable. The ICB commissioned us to develop a clinically led, 10-year transformation plan to improve health outcomes and secure long-term financial sustainability.
To meet this challenge, we needed to go beyond conventional planning. Traditional approaches to NHS strategy tend to extrapolate from historic trends or model demand at an aggregate level. Our approach combined population-level analytics, clinical engagement and international best practice research to build a transformation plan grounded in evidence. We built an innovative model, dividing the SWL population into healthcare segments using linked healthcare datasets. This segmented the 1.9 million residents by health need and forecast how their conditions, care activity and costs would evolve through to 2035/36. This revealed that while just 8% of the population in the highest-need segments accounted for 45% of total spend in 2024/25, this would grow to 14% of the population consuming 59% of spend if left unchecked. Through best practice research and clinician-led workshops, we identified £607m in commissioner-side opportunities – spanning prevention, timely care, health inequalities and equitable funding – and £643m in provider-side opportunities focused on bed reduction, outpatient reform, service consolidation and workforce productivity.
We translated these into a costed programme of 10-year initiatives, modelled through a novel impact calculator and a comprehensive financial forecasting tool. The projected outcomes are transformative: 28,000 patients prevented from developing a serious health condition, a 17% reduction in hospital beds needed, a 36% reduction in outpatient appointments, and a shift from significant financial deficit to surplus by 2035/36. Each acute provider in SWL received an individual analysis showing how this translated to their specific trust. This enabled them to begin strategic planning on activity, workforce, capacity and new service models.
These models represent a lasting strategic asset, increasing the ICB’s analytical capability and its ability to forecast accurately and commission cost-effective healthcare for years to come. Aligned to the priorities of the NHS 10 Year Plan, the transformation plan provides SWL with a clear, evidence-based roadmap to keep the population healthier for longer while delivering a credible path to long-term financial sustainability.
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