The key election issues for the NHS centre on how it can build on the real progress made since 1997 in the next stage of reform. With funding certain to be much more constrained than in the past, there will be major challenges in holding on to the gains of recent years, such as shorter waiting times, let alone implementing newer promises. The emphasis will have to shift from providing more of the same to doing things differently.
Innovation will be at a premium and the next government will have to be ready to support radical changes in how services are delivered. This includes planning for a future in which less reliance is placed on acute hospitals and more investment is made in primary care and community health services. New models of care will have to be developed by both the independent sector and the NHS to make care closer to home a reality.
My hope is that the next government learns three lessons from the recent past in taking forward reform. Firstly, improving the performance of the NHS is complex and there are no magic bullet solutions. Politicians need to use a judicious mix of targets, regulation, and competition if they are to move performance from good to great.
Secondly, many of the biggest challenges in the NHS require organisations to work together in local systems of care. Examples include reducing inappropriate use of hospital beds and improving the co-ordination of care for people with complex needs. Co-operation not competition holds the key to tackling these challenges.
Thirdly, increasing efficiency depends on moving all organisations up to the standards achieved by the best. This means equipping doctors, nurses, and others with the skills and information they need to reduce variations in clinical practice. The next government needs to unleash the energy and commitment of front line staff to improve care in a way that has never been achieved before.
This article first appeared in a BMJ feature ‘Election Views’ published 21 April, BMJ 2010;340:c2095.