Riding the waves you’re given: what I’ve learned about delivering system change

“You’ve got to ride the waves you’re given.”

This was a phrase I heard Chris Whitty, England’s Chief Medical Officer, use once - and I’ve been repeating it ever since. It perfectly sums up the way I think about complex system change.

You don’t get to choose the waves - how big they are, how fast they come, or how long they last. In government, the context can shift overnight. Political priorities move. Crises arrive without warning. What feels like a stable operating environment can turn upside down in an instant.

The work is not about controlling that. It’s about learning how to operate within it. Part of that is judgement - seeing the waves as they begin to form, not just when they break. Part is choice - deciding which ones you lean into and which ones you let pass. And part of it is readiness - making sure that when the moment comes, you are in a position to move.

The Great Wave by Katsushika Hokusai. Photo by Art Institute of Chicago on Unsplash

It's often assumed that big programmes start with a clear mandate, a budget and a team - but many times they don’t. And the ‘systems’ that we’re working in don’t necessarily have to do what you ask. Within the Digitising Social Care programme we needed thousands of independent care providers, and dozens of NHS bodies, local authorities, technology suppliers, sector stakeholders - to move together towards a shared goal. The sector could ignore us. Suppliers could resist. Local systems could deprioritise. Partners could disengage.

I’ve written another piece on what we did to achieve the scaling of digital social care records. But here, I’m going to focus on how we did it and what it feels like when you’re learning to ride the waves of system change.

Learning from what’s come before you (without being constrained by it)

The Digitising Social Care programme didn’t begin with a single, neat starting point. Nothing ever does.

In 2020, when the programme started to take shape, there had already been years of work that made it possible - just not in a way that was fully connected or visible.

The technology policy mandate we were working to had intentionally included social care in its scope, even though many of the levers weren’t yet there to pull. The NHS had spent decades building the foundations of digital transformation - standards, assurance models, ways of working with suppliers - alongside a long history of national programmes and hard-won lessons. And within social care itself, an NHS Digital programme had spent the previous five years experimenting: pilots, local initiatives, early infrastructure and relationships that we were able to build on.

Then COVID-19 hit - the tsunami wave no one wanted - and with it a series of emergency interventions: getting devices into care homes, improving connectivity, trying to establish some level of visibility into what was happening on the ground. None of that was designed as a long-term transformation programme. But it exposed both the fragility of the system and the art of the possible.

All of that mattered. It created the conditions for what came next.

There is a tendency, when you look back, to tell a clean origin story. But the reality is much messier than that. Change is cumulative - a relay race. You inherit work, ideas, relationships and constraints from the people who came before you.

You will still make your own mistakes. But you don’t need to repeat anyone else’s.

Joining policy and delivery together

The programme didn’t emerge fully formed - it came from two teams working towards common goals, making the decision to join forces.

On one side, there was policy work - a team of civil servants shaping the broader agenda for social care technology, particularly in the context of COVID response and wider reform. On the other, there was an NHS delivery team within Frontline Digitisation, working directly with providers and digital social care record suppliers.

We took a leap of faith. We didn't wait for a formal instruction to merge: we aligned budgets, brought the DHSC and NHS England teams together, and began operating as a joint unit. It was, at times, messy and uncomfortable. We were learning how to work across different disciplines, expectations and ways of thinking about the problem - and across two quite distinct organisational cultures. But it was one of the most important decisions we made, because it created something that is often described but rarely achieved in practice: a rapid feedback loop between policy, strategy and delivery.

Instead of policy being developed in isolation and handed over, it was shaped continuously by what was happening on the ground. Instead of delivery being constrained by fixed assumptions, it could influence direction in real time. Strategy sat across both, connecting operational reality to a narrative that could unlock support and investment.

In practice, this functioned more like a Venn diagram. There were clear areas of ownership on each side, but also a significant overlapping space where the most important decisions were made - through shared problem-solving rather than sequential governance. Working at the overlap, or intersection, allowed us to test ideas for deliverability while they were still being formed, and to stress-test policy intent against operational reality before positions hardened. 

It was incredibly rewarding, and at times, extremely challenging. I’ve described it previously as needing to speak seven different languages: policy, digital and delivery, of the NHS and social care, of central government and local government. It’s about understanding where everyone is coming from well enough to bring them together. But that fluency takes years to build, and you’re never fully native in all of them.

A key part of making this work was the partnership at the centre of it. Peter Skinner, as Programme Director, led the delivery team responsible for the core workstreams of standards development, supplier assurance, and implementation. My team led policy workstreams like digital skills, data and infrastructure policy and focussed on building the strategic narrative.  We navigated the policy and political environment that would determine whether the programme could land.

Neither function would have worked as effectively in isolation. The space between them - the constant iteration, challenge and adjustment - is where real progress happened. It's by valuing different perspectives that you find creative solutions and avoid groupthink.

You have to create a psychologically safe environment for this to work well. There were points where the model came close to breaking - where accountabilities had blurred, concerns weren't escalated or heard quickly enough, and where decision-making risked becoming too informal. 

The model we had at the end looked very different from where we started. My conclusion was that there are limits to how ‘joint’ you can be while still working as two legal entities. Like every other part of delivery, you have to test, learn and adapt.

Building a coalition of supporters

Social care digitisation did not sit naturally as anyone else's top priority. Within social care, there were many immediate pressures competing for attention. Within technology, social care could rarely compete with the scale, visibility or urgency of NHS transformation. I would tongue-in-cheek refer to us as everyone’s poor relation.

At the outset, there was broad support for the idea that something needed to happen - but far less clarity or consensus on what that should be, how far it should go, or what level of investment it justified. In that context, coalition-building was not a communications exercise or a one-off consultation process, it was a sustained investment in relationships.

A core principle was to make the programme feel like a shared endeavour, not a centrally held initiative. That meant actively asking: what are other parts of the system trying to achieve, and how could this work help them get there?

We worked under the broader framework of ‘joining up care’, which gave permission to connect different strands of work together: running regular show-and-tell sessions to surface emerging work, demonstrate progress, and most importantly show how different pieces of activity could become more than the sum of their parts when aligned.

A key decision was to bring in stakeholder partners early, to help shape our activity. Colleagues from local government were embedded in our team, enabling them to actively shape direction rather than simply respond to it. Later on, key provider stakeholders sat on our Board, giving them a formal voice in shaping priorities. This approach helped create legitimacy - because the ‘system’ could see itself reflected in the decisions being made.

Over time, our focus shifted from building permission to proceed, to building a shared understanding of what success looked like. That required a different kind of discipline. It meant not holding the programme too tightly at the centre; being willing to adapt plans in response to feedback, and to demonstrate visibly when that feedback had been acted on. In practice, listening was not just a principle - it was how we maintained trust and momentum.

And over time, the most effective advocacy wasn't coming from the central team at all. Stakeholders who understood the risks, the opportunities and the direction of travel were carrying the message into rooms we weren't in - reinforcing the case with senior officials and ministers in ways that we couldn't do ourselves. Engagement is definitely a team sport. 

Unlocking investment: understanding what gets funded

When it came to seeking investment, we had to make choices about how we framed the programme. Different parts of the system speak fundamentally different languages of value. The Treasury requires quantification. The sector requires meaning. Neither is sufficient alone.

There were many benefits to digital social care records: improvements in quality and safety, better information sharing, a more coherent system, and a better experience for staff and families. But the case that unlocked funding was built around productivity - specifically, the time saved by moving from paper to digital systems.

Twenty minutes per care worker per shift.

It was a number that could be evidenced, aggregated, and translated into something meaningful at scale. 

But reducing the story to numbers alone would have stripped out what mattered most. No one receiving care, or relying on social care support to live their life, experiences the system in terms of productivity gains. So alongside that, we told a different kind of story - and developed a narrative about what it actually feels like when the system doesn't work.

What happens when someone is discharged from hospital at ten o'clock at night, and the care home isn't expecting them. When a care worker arrives at someone's home and spends an hour trying to work out why they're not there - not knowing they've been admitted to hospital. When the information that should travel with a person - their needs and preferences - stays behind instead.

Those are not edge cases. They are the texture of a system that isn't joined up. And they are the stories that make the abstract real - for ministers, for senior officials, for anyone who has ever had someone they love move through the health and care system.

Part of the work was learning how to hold that tension: to understand what was required to open the door, while never losing sight of what that change was ultimately for.

The art of storytelling: holding multiple truths at once

Alongside all of this is the challenge of how you talk about the future.

You need to be able to show what this work unlocks - better use of data, more proactive and preventative care - but you can’t always map out every step of how you will get there, particularly in the early stages when funding, capability and constraints are still uncertain.

Different people have different levels of comfort with that - some can see several steps ahead and are comfortable with ambiguity. Others need a clearer pathway, more detail, more certainty.

There is a constant balance to strike: you need to be ambitious enough to create momentum, but grounded enough to remain credible. You need to adapt how you describe that future depending on who you are talking to, while staying true to the underlying intent. I found those conversations were often easier in person, where you can see how something is landing and adjust in real time. In writing, it is harder to capture that nuance. But the principle is the same.

It is never enough to have a single narrative. You need to be able to explain the work at multiple levels, to different audiences, in ways that resonate with what matters to them. That means a financial case that stands up to scrutiny, a human story that makes the system real, a strategic narrative that aligns with wider priorities, and a practical explanation that makes sense to the people doing the work on the ground.

And those narratives are not static. They evolve over time. They respond to feedback, to shifting context, to what is landing and what is not. The clearest signal that a narrative needs to evolve is often the most uncomfortable one to receive.

I remember very clearly a moment - a couple of years into the programme - when someone I respected said to me: "I think I understand what you're doing. I just don't understand why it's important."

It was frustrating at the time. But it was also one of the most useful pieces of feedback I received. Because when someone says that, they are not rejecting the work - they are telling you something important about the gap in your story. 

Ideas and influence do not move in straight lines

A lesson I learned early on in my career was that influence doesn't follow hierarchies. Understanding who listens to whom, where the points of influence sit, and how messages are interpreted as they move through a system - that's a skill in itself.

If you want to get your ideas heard, you sometimes have to take a quite convoluted route.

Part of that is finding the right people - not just the right roles. The people who get it quickly, who carry energy rather than drain it, who can translate your thinking into their own language and take it somewhere you can't reach directly. Building those connections is worth investing in deliberately, not leaving to chance.

Visits matter - ministers and senior officials seeing the work in person, standing in a care home, talking to a care worker at the end of a shift. It grounds your narrative in something real, and it gives you examples you can reach for when you need to make the abstract concrete.

And part of it is accepting that points sometimes need to land from multiple directions at once. Like a spider's web - the strength comes from the connections, not any single thread. That means working through formal structures and informal ones, using the hierarchy when you need to, but not relying on it solely.

As a senior civil servant, this required treading a careful line. There are real responsibilities around impartiality and propriety that you hold. But within those boundaries there is more room than people sometimes assume - to share thinking with academics, to contribute to evaluation work, to have frank conversations with people in the wider system who are working on the same problems.

And there is something quietly satisfying about seeing your team’s ideas quoted back at you in an independent report from Baroness Cavendish or the Tony Blair Institute - having travelled through other hands and come back stronger for it. That's not a loss of ownership. That's influence working as it should.

Being ready for the next wave: signals, not instructions

Listening - or observing - is a common theme throughout my reflections. 

Something I would try to make time for - and still do - was to watch the more relevant public accounts committees, House of Lords debates or covid inquiry sessions. You pick up so much richness from what’s said and how it's received. I would often recap key nuggets back to my team with some questions it sparked.

This was part of how I tried to read the ‘room’ and get a feel for where things are going. I’m not someone who would wait to be told what to do, so this required continuous sense-making: listening to language, and emerging patterns.

Political priorities shift - towards productivity, workforce, growth, towards equity. And those shifts are not often explicitly translated into what they mean for your programme. You have to do that yourself - to then be able to respond quickly, to reframe your story so that it lands without changing the substance of the work.

It also helps to be prepared - being ready to brief a new minister, or answer questions before they are asked. Anticipating the lines of challenge, and knowing how you will respond. This is not about chasing every new priority. It is about making sure your work remains legible and relevant as the context changes.

Staying close to the people you’re doing this for

For me, to really ‘get’ what you’re here for, you need to understand the system viscerally. You have to feel the friction and the pain points - in a way that lands in your body and stays with you.

You cannot experience that fully from behind a desk. You have to get out. You have to talk to people, listen deeply, ask questions and be genuinely curious about the answers, even when - especially when - they challenge your assumptions. That means learning to be comfortable being uncomfortable. Sitting with what you hear rather than immediately reaching for a solution or a reframe. 

Understanding shapes better decisions. It also strengthens your ability to explain why the work matters, allowing you to move beyond generalisations and speak with specificity about what is happening, and why it needs to change.

I found this one of the most important aspects of effective engagement with stakeholders, senior officials and ministers.

There is sometimes an assumption in the centre that ministerial engagement is something to be managed carefully, that you need to translate everything into safe and legible terms. My experience was that ministers were often more closely connected to the real lives of the people - their constituents - than civil servants typically were. When you can show them that you understand what’s broken, what is possible, and how you intend to get there - they see it. And when they see it, they back you.

That connection to purpose is also what sustains you. When the system feels slow or resistant - and it will - it is what you come back to.

Ruthless prioritisation: being disciplined even when it hurts

One of the hardest parts of the work is not identifying what could be done, but deciding what not to do or harder still, what to stop.

There is always more that could be tackled. More ideas, more opportunities, more things that would add value. But the reality is that you cannot do everything, and you cannot do it all at once.

Prioritisation is not just a practical necessity - it is a strategic choice. It requires clarity about what matters most, what will unlock the greatest impact, and what only you - in your role, in that moment - are able to do. Part of that is recognising the role of government in creating the conditions for others to succeed, rather than trying to deliver everything directly. 

In honesty this is harder than it sounds. When you can see the potential of what you’re trying to achieve, it is genuinely painful to put part of it down. We de-prioritised things during the life of the programme that we knew needed doing - not because they didn’t matter, but because we simply did not have capacity.

One thing I tried to do - partly in anticipation of having to make those calls -  was to break work into chunks that could stand alone. So that if something had to be paused or handed on, it wasn’t all-or-nothing. You could get something out of the door, build some visible progress, and avoid the feeling that months of work were going to sit on a shelf waiting for conditions that might never arrive.

Most things we came back to. Some of the work I’m doing now, having left government, is a direct continuation of things I had to set aside - or slow down on - when I was in the role. 

Prioritisation is about ensuring sustainability, because if you try to carry everything, you will burn out (and won’t do anything particularly well).

Conclusion: the long view

The most significant change over my five years working on Digitising Social Care was not technological. It was cultural - and it showed up in the texture of everyday conversations.

At the outset, I spent a lot of time talking to people to understand their objections. Why would we invest in a private market? Is it really realistic to expect a low skilled workforce to adopt technology? Why would we want social care staff to access clinical information, they’re not clinicians?

By the end, those conversations had been replaced with: why aren’t you going faster? 

That shift is almost impossible to measure. But you feel it. You remember how difficult those early conversations were. And it’s hard to know when you’ve done enough - my goal was to reach a point where I felt like I’d baked progress into the DNA of the organisation: when it no longer needed me there to keep it alive. 

System change doesn’t happen in a single moment - or in a single programme. It is cumulative. Sometimes it feels like you’re banging your head against a brick wall, and then all of a sudden the wall is down and you’re left a bit dazed, maybe with a bit of a headache. 

Or to return to my original ‘riding the waves’ metaphor, it's like the tide quietly turning. The sea can feel rough, with strong currents, but to some extent you can learn to read the water and position yourself well. Do that consistently and you’ll find yourself a lot closer to shore.