Health of the Health System Index

First Annual Health of the Health System Index

This Health of the Health System Index is UCL’s Global Business School for Health first annual iteration of a new research initiative designed to understand the underlying ‘health’ of the NHS as a system. Developed in collaboration with the Health Service Journal (HSJ), the Index brings together quantitative indicators and the lived experience of more than 850 senior leaders from across the English NHS.​

Drawing on insights from a national survey of more than 850 senior leaders from across the NHS and qualitative interviews with leaders from across integrated care systems (ICSs) and provider organisations, the Index looks at the leadership, workforce, and organisational conditions that determine whether the NHS can sustain and improve care over time.

The index finds that leadership is being stretched across three structural tensions:

1. Managing day-to-day pressures while pursuing long-term transformation
2. Limited workforce capacity in the face of rising demand
3. Implementing national change through a local lens

The NHS continues to demonstrate remarkable commitment, adaptability, and innovation among its staff and leaders. Yet this report shows that without deliberate attention to the health of the health system itself, policy ambitions for recovery, integration, digital transformation, and prevention will remain at risk. The Index recommends that the NHS prioritises:

1. Strengthening long term system planning
2. Rebuilding workforce capacity and experience
3. Aligning digital transformation with clinical practice
4. Deepening integration across health, social care and communities
5. Rebalancing the system towards prevention

The Health of the Health System Index is designed as an annual series, creating a recurring snapshot of how system health evolves over time. The research has been undertaken at UCL GBSH, whose mission is to generate new insights into leadership, management and innovation in healthcare systems worldwide. The project reflects the school’s commitment to working alongside system leaders to better understand the conditions under which the NHS can sustain high‑quality care, deliver transformation and improve population health for the long term.​

The Health of the Health System Index – Annual Report 2025–26 is available to download here: