Building a world-class NHS


Any discussion of UK healthcare should begin with the clinicians. Doctors and nurses remain hugely committed to their patients. They put in long and stressful hours. But they are being let down by a system that is dysfunctional. This Government has bravely decided to take on this dysfunction. It is committed to reform. Many of its reforms are absolutely right, and its commitment and good intentions are beyond reproach. However, the reform process is in mortal danger of failing.

The objective of this pamphlet is to offer the Government recommendations for how the reform process can be saved from failure. The stakes are high – if reform fails now, then the healthcare of two or three generations to come will be compromised.

The author of this pamphlet believes passionately in the National Health Service. It will only survive, and be true to its founding principles, if the reform programme is driven forward. The principles that should underpin the NHS are, in essence, Nye Bevan’s founding principles of the NHS:

  • Free at the point of need.
  • Paid for from taxes to a single tariff.
  • Delivering high quality, efficient and transparent clinical and “public health” outcomes. The core objective of the healthcare system is to constantly improve patient value – defined as the clinical outcome for defined medical conditions over a full cycle of care, and at the best cost.
  • Delivery of healthcare should be subject to the choice of the citizen who, acting on fully transparent and available information, can put poor (dangerous) performers “out of business”.
  • Unrestrained competition at the level of patient value, such that good performers can quickly and easily replace poor performers. The right to provide care should be based on performance in delivering patient value, not on being a public sector organisation.

Over the decades, we have moved away from these principles. The rights of the patient and the citizen have been usurped by the rights of those who operate a customer-unfriendly monopoly which protects “rights” to job security and generous pensions, undermines accountability, and, in particular, prevents the disciplining effects of competition. Civil servants are, inevitably, lukewarm about reform, because reform is deeply threatening to their position. The unions claim that the reforms the Government is trying to introduce are “privatisation” and that the Government is betraying Nye Bevan’s founding principles. On the contrary, it is they who have betrayed the founding principles, and it is this Government’s reforms that are getting us back to the basics – to a National Health Service that serves the British people, and not the sectional interests of monopoly providers. In fact it is the failure of reform that will create “privatisation” as people become increasingly frustrated by, even scared of, a system that is underperforming, and then choose to spend their own money to purchase this vital service privately.

Doctors and nurses labour every day in a system that is poorly managed, that has some of the most dysfunctional organisational dynamics of any organisation in the world. This is not what Nye Bevan intended. We are at a crossroads. We have to dismantle the NHS monopoly, we have to create a system that operates in the interests of patients and taxpayers, and we have to create an organisational dynamic that supports good managers in doing their job, and which is intolerant of poor management at all levels.

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