NHS England’s approach to transformational change was deeply flawed in both monitoring of progress and the delivery of intended outcomes. NHS England’s diagnostic transformation programme displayed positive features of programme management and achieved planned increases in numbers of diagnostic tests. The planned number of Community Care Centres were also delivered on time. However, the programme did not deliver the intended outcomes of reducing waiting times. Internal NHS England analysis found that there was a shortfall of 3.6 million tests. This led to the recovery target of 5% of waits for diagnostic tests being no more than six weeks being missed, with 22% of patients waiting over six weeks. These flaws have been compounded by NHS England and the Department not setting up the surgical and outpatients transformation programmes effectively enough to measure their impacts and benefits. Ultimately, the Department has approved billions of pounds of spending without sufficient focus on what exactly these programmes will deliver. recommendation The Department of Health and Social Care and NHS England should: a. Set up data collections or processes for tracking costs and benefits as early as possible when setting up new services or transforming existing services including the recent extension of specialist telephone advice to GPs. b. Focus reporting on the achievement of policy aims (expected outcomes for patients) to ensure that the capital funding provided delivers intended outcomes. 3