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Is the NHS broken? If so, who should fix it?

Is the NHS broken? If so, who should fix it? These are the questions being asked in policy-making circles right now after four recent events added to the confusion:

1. NHS is number 1

A report by the Commonwealth Fund analysing the best healthcare systems in the world has ranked the NHS number one, above countries such as Sweden and Canada – long held up as exemplars of good healthcare provision.

2. NHS is broke to the tune of £2bn

The new top ranking however, was swiftly juxtaposed with the news that the NHS in England faces a funding gap of £2bn next year, a serious issue even if it wasn’t enough to place it top of the Fund’s health spend rankings (unsurprisingly this went to the USA).

3. NHS is doing it wrong

A report from The Kings Fund, called Reforming the NHS from Within, added to the debate by arguing that targets and performance management, inspection and regulation, and competition and choice were the wrong incentives. Instead there should be “much more emphasis on bringing about improvement and change locally from within, and less emphasis on the use of external stimuli.” It also called for the engagement of doctors, nurses and other staff in improvement programmes and learning from high-performing organisations.

4. The NHS should support innovation

At the recent HSJ Innovation Summit in Reading, a number of people (including ZPB’s Alex Kafetz) were invited to discuss new approaches to improving patient care. They clearly hadn’t read The Kings Fund report however, as most of the attendees were from the private sector with only a few ‘doctors, nurses and other staff’, including those named in the HSJ Top 50 innovators. Lots of ideas were discussed and developed in small working groups, including how to help innovators find the time and headspace to develop their ideas. This might include hospitals back-filling their day jobs to give them time to progress an idea, or foundation trusts helping innovators to spin their idea out into a business with shared ownership of the intellectual property.

So what does all this tell us?

Well firstly that the NHS is neither rock bottom, nor best in class. The funding gap is a problem and for more than two years people have been telling us why: an ageing population, overcrowded A&E’s and inappropriate hospital admissions. Reports have been commissioned and service re-design teams have come and gone, but there is not enough support, funding and development of the people who probably already know what the answers are: The doctors, nurses and managers in the NHS who aren’t given the support they need to spread ideas as well as do their day jobs. Secondly there is no them and us, or within or outside. The best contributions at the HSJ Summit came from the CEO’s of a number of SME’s, all with different funding mechanisms, who had taken the plunge and quit other jobs to set themselves up to solve one of the NHS’s problems. And to suggest that the NHS needs to be solved from “within” can’t be the right answer. The private and third sectors have a crucial role to play and are prepared to give up the time to do this.


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