2. A new approach to NHS reform

The issue

Successive governments have relied on external pressures such as targets, inspection and competition to drive reform, with mixed results. In contrast, the experience of high-performing health systems in the United Kingdom and abroad shows the value of supporting organisations to transform care themselves by ensuring continuity of leadership, engaging staff and focusing on a clear commitment to put patients first.

In recent years, the NHS has been subjected to frequent top-down structural reorganisations. Instead of embarking on further organisational changes, the emphasis should be on how services need to change, taking the new models of care outlined in the NHS five year forward view as a starting point. This means providing more care outside hospitals and delivering integrated care to better meet the needs of the ageing population and the growing number of people with long-term conditions. 

Success depends on enabling NHS leaders to develop cultures in which staff are motivated and supported to deliver high-quality, compassionate care. This means embedding a culture across the NHS in which openness, transparency and accountability are the norm. Patients should also be more closely involved in decisions about their care, with better use of data and technology to support them in managing their own health.

What must be done?

It is time to initiate a fundamental shift in how the NHS is reformed, learning from what has worked here and abroad.

  • Another top-down reorganisation of NHS structures must be avoided. Instead of mandating change from above, the government should promote ‘reform from within’ by supporting NHS leaders to improve quality of care and lead change themselves.
  • Ministers must resist the urge to micro-manage the NHS from the centre. A new political settlement should clearly define the strategic role of politicians and national bodies, and devolve more power and accountability to local NHS organisations.
  • The NHS five year forward view offers a clear vision for how services need to change and commands widespread consensus. The government should build on this by ensuring that national policies support these new models of care and extend current initiatives led by the NHS and local government to accelerate the delivery of integrated care.
  • There should be much greater emphasis on prevention, with local authorities using their responsibilities for public health to lead the way locally. Priorities include tackling obesity, reducing alcohol-related health problems and smoking, and increasing levels of physical activity.

Next priority: a new settlement for health and social care