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The writer is executive director of the Health Foundation, a think tank.
The NHS must “reform or die”, the Prime Minister recently said, adding that “there will be no more money without reform”. Whether a threat or a simple statement of political probabilities, Keir Starmer’s statement is tinged with urgency and frustration. The government is trying to address the NHS in all its complexity when budgets and public patience are under pressure. But what should the reform mean?
The first step is to act quickly on mandatory operational tasks. The recent review by Lord Darzi concluded that the NHS is in a critical condition but his “vital signs” are still strong. The findings will encourage Health Secretary Wes Streeting to repeat his claim that “the NHS is broken” and provide political cover for an anticipated winter crisis. But that coverage won’t extend much. There is no choice but to relentlessly focus on the public’s priorities, particularly issues in emergency care, access to primary care and hospital waiting lists, and in that order. Honestly pursued achievements, however incomplete, on these hot-button issues will provide credibility and time for greater change.
Ministers, however capable and committed, are very new to the NHS. They should trust NHS leaders to continue operational work, visibly support them and firmly hold them to account for a small set of objectives. Without much extra money, and with significant labor shortages and professional cynicism among staff, politicians should apply a positive big-tent principle (all workers valued in an emergency) and resist blame when things inevitably go wrong. evil. A positive partnership between the government and the NHS with practical help for the frontline, including a targeted investment in this month’s budget, will help unlock some of the discretionary effort withdrawn by doctors since the pandemic. Addressing GPs’ slow collective action must also be addressed before it degenerates into a full-blown strike.
The second step is to develop a smart medium-term strategy that hopes to maintain affordable, good-quality care for all. A ten-year plan for the NHS is due in spring 2025, and Streeting has outlined three changes he will aim to make: from disease to prevention; from the hospital to the community; and from analog to digital. Darzi’s review added more, including using technology to unlock productivity; clarify roles and responsibilities between NHS organisations; boost management and increase capital investment.
This may sound like a word salad made up of NHS jargon. But strategy can come down to what needs to be done and how best to do it. Streeting’s three shifts are nothing new, but they’re right. What is really needed is to think about how to make progress fast enough to offset the increasing demands placed on the NHS due to an aging and growing population, chronic diseases, medical advances and more.
By far the most active ingredient for progress in the history of the NHS has been investment – in new kits, buildings, workforce and treatments. Our analysis highlights a potential £38 billion shortfall in NHS funding at the end of this parliament. Another approach has been to adjust policy and management levers to drive the system, for example targeting, centralized performance management, and market-style incentives in the 1990s and 2000s. As in other industries, this It may have some impact, but what changes the rules of the game is technology.
There is still no clear plan for how the NHS prioritizes the adoption of new technologies, harnesses the emerging potential of AI and partners with the private sector to innovate. The urgent priority is bold investment in the NHS’s digital infrastructure and trials of technology that improves productivity.
This is a great opportunity for reform given the growing challenges ahead. Rachel Reeves told the Labor Party conference that “low investment fuels decline”, so Starmer’s mantra might need to be rephrased: “invest or die”.