Imagine my surprise on joining NHS England to discover that it had a secret sugar addiction. Not the kind that you might find in staff vending machine, but the kind of sugary hit that comes for craving in-year benefits.

“What are in-year benefits?” I hear you say. To answer that question, we must enter the wonderful world of public sector programme management. Forgive me, while we take a brief detour.

Identifying benefits

A benefit is a measurable improvement to an outcome perceived as valuable by a stakeholder.¹ That is a little jargon heavy, so here’s a worked example.

Imagine that I’m employing you to help me become a faster runner. I’m your stakeholder, effectively. Together, we agree that a faster 10K time would be evidence of success in helping me achieve my goal (or outcome). In doing so, we have now identified a benefit. We know it’s a benefit because I perceive being a faster runner as valuable, and because it can be measured, in this case, in time.

Measurement is important because it means the benefit can be “realised”, which is just a fancy way of saying we can document it having happened. In our running example, we can book in some 10K races for me over the course of the year, they can be timed and we can provide evidence of that, maybe on my Strava profile.

When I first encountered the notion of benefits last year they immediately made sense to me. It reminded me of a common question in product management: “How will you measure success?” and the practice of building a financial model with leading indicators that point towards future revenue streams. In my view, centring work in the public sector around the idea of positive outcomes can only be a good thing.

But here comes the twist, and it’s the demand for in-year benefits.

What the hell are in-year benefits?

Let’s return to my running example. It turns out that I am a pretty demanding stakeholder and want to see results fast. In fact, I want to start realising the benefits we agreed on in the same calendar year that your efforts as my trainer begin. This is what I mean when I say in-year benefits.

Now for running this might be practical. The amazing Couch to 5K programme aims to take a non-runner to a 5K race in 9 weeks. But for the kind of digital transformation that is required in the NHS?

For that you need much longer time horizons.

Placing bets on the future

When I started hearing about in-year benefits my mind immediately turned (as it often does) to the 20 years I spent prior to my work in the NHS, building and investing in startups.

Whether you are building a startup, or investing in one, you are taking a bet on the future. Importantly, that future time horizon is probably 5-10 years from the moment you decide to part with your time or money. You won’t raise millions of pounds for your startup based on what it can deliver this year. Nor would you invest money in a startup if its goal was immediate profit maximisation. Publicly traded technology stocks tell the same story. Today NVIDIA is the most valuable company in the world, because NVIDIA’s products have become central to computing, but also because of the promise of a future transformed by artificial intelligence.

This idea of a bet on the future is grounded in evidence too. The diffusion of innovations theory (often referred to as the technology s-curve) shows us that new technology takes time to adopt and therefore time for its benefits to be realised. You could be blown over by some wonder tool and desperate to invest, but it is likely to spend its first years in R&D and as the plaything of early adopters.

Figma is a great example of this. Dylan Field took the first investment for his startup back in 2012. It took another four years before it hit private beta, and it wasn’t until September 2016 that it was released publicly. Dylan’s earliest backers were placing a bet on the future in which Figma was central to the way designers all over the world, work and collaborate together. That was a huge bet, and one that must have felt pretty shaky at times, but they stayed the course and today Figma is a $17B publicly traded company that has unseated Adobe’s historic dominance of that market.

On the 10 Year Plan

You might have noticed some ‘big bets’ in the 10 Year Plan for Healthcare in England. In fact, the section on the shift from analogue to digital talks specifically of big bets on AI health assistants, seamless data flow, predictive analysis using genomics, robotics and real-time care via wearables. It reads just like the pitch deck of a technology company, and I am sure that this was the vibe the document was intended to give off.

It is easy to be cynical of these bets, but the ambition I heard from central government was critical to my own decision to join the NHS. I am excited by big bets and hard problems, and there is no organisation in the world that has them like the NHS.

To deliver on bets as big as these teams need the time and space to work on them, just as Dylan Field did. Indeed, it is right that these bets form part of a 10 year plan because history tells us that this is the time horizon over which they should be judged.

But the attention I have seen given to in-year benefits as part of multi-year business cases runs counter to the hope of the 10 Year Plan, and counter to everything I have learned from my career in technology to date. Seeking in-year benefits incentivises short-term fixes, not long term transformation.

To return to my running analogy, we are being entered into a marathon, but being asked to work on our sprint.

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1. For a good overview of benefits management and its history I recommend the freely accessible Breese, Richard (2012). Benefits realisation management: panacea or false dawn? International Journal of Project Management, 30 (3), 341-351. ↵