Healthcare systems worldwide are under pressure. Rising costs, stretched workforces, ageing populations, and chronic conditions are pushing services to the brink. Amid this, a quiet revolution is gaining momentum—one that moves away from episodic, hospital-centric care and towards proactive, personalised, community-based health.

This is the vision behind “Shift Left, Stay Left” (SL2): a strategic reorientation that prioritises prevention and delivers care earlier, closer to home. But more than a slogan, it’s a practical framework for transforming healthcare.

What Does “Shift Left, Stay Left” Really Mean?

  • Stay Left: Support people in maintaining wellness through prevention, behaviour change, self-management, and digital engagement.
  • Shift Left: When care is needed, deliver it earlier and outside the hospital, through virtual wards, telehealth, community teams and remote monitoring.

The two are mutually reinforcing: the better people are supported to stay well, the less likely they are to require hospital care; the stronger the community system, the more confidently services can treat in the home.

A Framework Gaining Global Traction

The concept is now embedded in NHS England’s planning priorities. It is central to New Zealand’s health reforms, which aim to reduce fragmentation and address inequity, especially for Māori and other priority populations.

It’s also aligned with the “10X” model, which argues that data platforms, digital tools, and redesigned care models can deliver tenfold improvements in outcomes, cost-effectiveness and system resilience.

From Reactive to Proactive: Digital Infrastructure as the Enabler

At the heart of SL2 is the shift from reactive treatment to proactive care. This relies on:

  • Personalised, interoperable data platforms that unify information from clinical systems, the home, and wearable devices.
  • Analytics and risk stratification to target interventions before crises occur.
  • Orchestrated care teams, empowered with the tools to act early and coordinate across settings.

Digital infrastructure isn’t just a utility; it’s the operating system for a left-shifted model, as seen in living lab exemplars around the world, where innovators, clinicians, and citizens co-design solutions. Data becomes the connector between prevention, personalisation, and population health.

But Left Shift Isn’t Easy

Despite its promise, implementation has proven challenging. Policy ambition has often outpaced operational reality. NHS guidance, for instance, acknowledges repeated false starts when funding and workforce remained locked in acute care. Similar tensions exist in Aotearoa New Zealand, where health equity goals demand deeper investment in community-based, culturally responsive care.

SL2 is therefore not just a clinical shift; it’s a system reform with three critical enablers:

Three Barriers to Solve for Successful SL2

  1. Funding Must Follow Function
    Primary, community, and social care must be sustainably funded, with career pathways in place to attract and retain staff. Hospitals remain over-resourced by default.
  2. Interoperable, Trustworthy Data
    Seamless data sharing is vital for early intervention, continuity and coordination. Fragmented systems undermine timely action and trust.
  3. Equity by Design
    Digital tools must not widen disparities. Co-designing with underserved groups, developing culturally safe solutions, and implementing outreach initiatives are essential to ensure SL2 benefits all.

What Does Good Look Like?

Successful implementations share consistent characteristics:

  • Focus on high-risk populations (e.g. frailty, heart failure, COPD).
  • Use of virtual wards and rapid escalation protocols.
  • Measurement of what matters to patients, function, confidence, symptoms, not just utilisation.
  • Investment in change management, workforce training and continuous improvement.

Crucially, left shift is not about moving tasks; It’s about remapping information flows, incentives and responsibilities around the person.

The Economic Case for Shifting Left

Shifting left saves money, but not immediately. Transitional funding is essential to run old and new models in parallel until hospital demand eases. Systems that take a portfolio approach, piloting, learning, and scaling proven components, are more likely to see ROI. Conversely, bolt-on tech without pathway redesign seldom delivers impact.

The Road Ahead: Three Strategic Priorities

  1. Anchor Neighbourhood Care
    With shared records, community diagnostics, and rapid response teams, primary care becomes the frontline of crisis prevention.
  2. Build Citizen-Centred Platforms
    Integrating consented clinical and self-reported data to deliver nudges, education, and monitoring, with transparent privacy controls.
  3. Align Incentives for Prevention
    Move away from paying for activity—reward keeping people well and out of hospital.

Culture Change Is Key

“Shift Left, Stay Left” is a redesign of health system DNA. It prizes anticipation over reaction, relationships over referrals, and homes as the primary sites of care. The direction is well mapped. The challenge now is disciplined execution:

  • Funding follows function
  • Data follows the person
  • Equity is non-negotiable

If we hold the line, the leftward turn can be more than a reform moment—it can be the future of health.

Authored by Tom Varghese, Global Product Marketing & Growth Manager at Orion Health.

References

  •  Curley, Martin. The Digital Transition for Healthcare: Stay Left, Shift Left (SL2). Version 1.0f. Dublin: Innovation Value Institute, 2023.
  • Curley, Martin. “Stay Left, Shift Left-10X – A New Paradigm, Policy, Platform and Prescription for Digital Health Transformation.” International Journal of Integrated Care (presentation abstract), 2025. 
  • NHS England. “2025/26 Priorities and Operational Planning Guidance.” London: NHS England, 2025. 
  • NHS Confederation (Sansum, Jack, and Ant Tucker). “Is the Left Shift Mission Impossible?” London: NHS Confederation, 2025. 
  • National Association of Primary Care (Marshall, Johnny). “‘Left Shift’… What Could It Be?” London: NAPC, 2025. 
  • New Zealand Ministry of Health. “The New Zealand Health Strategy.” Wellington: Ministry of Health | Manatū Hauora, last updated 1 December 2023. 
  • Stay Left Shift Left 10X. “10X – Revolutionising Healthcare.” Accessed 21 October 2025.