Theresa Wyles, Chief Operating Officer (COO) of the Berkshire Healthcare NHS Foundation Trust

At eleven on a Sunday night, a man with a locked lower back opens a web portal on his phone. He answers a series of questions, software sorts his symptoms, and a registered physiotherapist stands behind the outcome. Nobody has telephoned a surgery or waited weeks for a call back. From November, that sequence becomes a commissioned service in Berkshire, where the NHS foundation trust has awarded Flok Health a £400,000 contract for digital musculoskeletal triage and management.

The sum is small by NHS standards. The pressure it answers is not. The trust faces an initial income and expenditure planning gap of £15 million for 2026/27, and tariff assumes two percent annual productivity growth. Community physiotherapy is a high-volume pathway with steady demand and a thin workforce. Round-the-clock triage and remote treatment are an attempt to release clinical time and shorten access, the kind of efficiency the 10 Year Plan has in mind when it speaks of moving care from hospital to community and from analogue to digital.

Many trusts announce such ambitions. Fewer manage the contractual detail that makes them safe. Here the supplier takes full responsibility for clinical outcomes, patient management, incident reporting and service governance, and must integrate with existing systems and accept referrals through the electronic referral service. The evaluation gave half its weight to technical compliance, capability and quality assurance, and a further 15 percent to data and system security. Price carried a quarter. In a year when financial strain pushes many procurements towards the lowest bid, that balance stands out. The term runs for twelve months with an option for another twelve, so the trust can test the supplier's claims against live performance before committing further.

Decisions of this kind sit within the remit of the chief operating officer, a post Theresa Wyles has held since 2025. She qualified as a mental health nurse in 1994 and moved through a series of management roles, most recently as divisional director for mental health. That background matters. Someone who has run services where risk and demand cannot be deferred tends to read a procurement as a clinical safety exercise before a savings exercise. The structure of this award is consistent with that instinct. The trust's earlier market engagement spoke of triage "without human intervention". The contracted service retains oversight by HCPC-registered physiotherapists, which keeps a named professional accountable for what happens to the patient.

Credit should be measured. The contract has not yet started, and a digital front door brings familiar hazards. Patients without a smartphone or the confidence to use one may struggle to get in. Complex presentations can be under-triaged by an algorithm. A self-referral portal may increase demand as well as manage it. NHS leaders elsewhere will recognise the underlying exposure: accountability for outcomes tends to return to the provider of record whatever a contract says. A capable operations director plans for that, and the audit of triage decisions, incident reporting and equity of access data will show whether the planning was sound.

For policymakers the lesson is practical. The centre asks trusts to find productivity through digital tools and leaves them to work out the safeguards locally. Health-tech suppliers meet a more demanding buyer where operational leaders insist on integration, security weighting and clinical accountability, and that is a healthier market for companies with credible products. Patients benefit most when the discipline is applied before go-live, because remedies after harm are slow and uneven.

Berkshire's contract will be judged in late 2027 on access and safety, and on which patients the triage missed. If the figures hold, the achievement will belong to operational leadership that wrote the terms carefully when it would have been cheaper to write them loosely. Wyles's record so far suggests that is the standard she applies.