The Governance Gap in the NHS Ten Year Plan & Reforms
The NHS Ten Year Plan creates more organisational boundaries, not fewer. Why boundary governance is the missing layer — and what the Seven Flows methodology reveals about the structural gap.
Why organisational boundaries are the blind spot in NHS reform, private healthcare governance, and clinical safety frameworks. Analysis and methodology from Inference Clinical.
Every major NHS reform — neighbourhood health centres, Integrated Health Organisations, outcomes-based commissioning — multiplies the organisational boundaries where governance must function. Yet no existing framework (CQC, DCB 0129/0160, PSIRF, DSPT) addresses what happens between organisations. This series examines the structural governance gap at organisational boundaries, how the Seven Flows methodology reveals it, and why the Constitutional Transition Matrix shows that not all boundaries carry equal risk.
Analysis of governance at organisational boundaries
The NHS Ten Year Plan creates more organisational boundaries, not fewer. Why boundary governance is the missing layer — and what the Seven Flows methodology reveals about the structural gap.
For 90 hours after a Friday discharge, a patient had no named responsible clinician. MVRT failures are structurally embedded across seven healthcare boundaries — NHS, private, and the interfaces between them.
Healthcare data sharing isn't blocked by technology — it's blocked by constitutional authority. The Constitutional Transition Matrix reveals why cross-domain governance fails and what infrastructure would make it work.
14,747 active digital health deployments across 239 NHS organisations. 70.1% have no documented clinical safety assurance. The real risk is at organisational boundaries — where no framework assesses what happens between organisations.
Julian Bradder
Founder & CEO, Inference Clinical
julian@inferenceclinical.com
Take the free Boundary Risk Score to see where your organisational boundaries stand — or explore the full Boundary Risk Assessment methodology.