Transformation and change for a better health and care delivery system have been the driving forces behind UK’s government initiatives and investments during the past decade. Questions have been raised in terms of how successful these investments have been and to what extent they have delivered their strategic step changes and benefits to the community and to the healthcare system in itself as a whole. The need to identify a process that will manage and deliver those benefits as well as managing any unanticipated impacts is now greater than ever. This paper investigates the need for a new thinking behind transformation and change and argues that the answer is a benefits driven mindset. A Benefits Realisation Management Process (BRMP) should be the leverage behind any decision making mechanism. It should provide the justification and give purpose to any project or programme no matter how big or small. This paper presents results from a literature review and a case study methodology approach focusing on why healthcare infrastructure and service delivery programmes or projects need to be benefit driven in order to have a better chance on achieving the required results for all stakeholders involved throughout the process.