Professor David Colin-Thome
10-Year NHS Plan- Fit for the Future
I very much welcome the Plan, buoyed by knowledge that some members of the press and others stuck in outmoded tradition are very critical. So, some context.
The NHS has understandably held a near-mystical place in the minds of people- even beyond the UK. Who could argue with its concept, values and purpose? Yet, for years, the culture of NHS exceptionalism hid its many failures.
Then, in the 1990s, political patience ran out, resulting in the Thatcher/Clarke NHS Reform- a veritable shock to NHS complacency. I, despite my different political leanings, supported it, especially its primary care aspects. Since then, we have had the Blair/Milburn and the Cameron/Lansley versions. Despite their promise and some success- albeit not sustained- all failed to reform the NHS.
Now comes the Starmer/Streeting version, whose principles and purpose I support. But then, I have supported all the reforms! With the benefit of hindsight, the previous reforms only ‘rearranged the deckchairs.’
Why support NHS reform?
For years, its clinical outcomes have lagged behind our European neighbours, with some improvements only in the Blair years. As a nationalised industry, it is woefully weak on customer focus.
There’s more:
- A managerial operating model too focused on minor changes to the status quo enforced by a compliance-based governance that stifles energy and innovation.
- A lack of continuous improvement leadership, including among clinicians.
- A big increase in public dissatisfaction- including with the previously very popular general practice.
The NHS, once the “jewel in the crown,” now faces existential threat. More money, though welcome, is not the answer. We had a huge increase in the Blair years, but no consequent sustained improvements and yet the NHS overspent despite the significant financial boost!
Disruption in healthcare
In the commercial world, innovative benefits accrue when a disrupter successfully challenges the status quo- think Amazon, or high-tech mobile technology, and AI. In nationalised industries exemplified by the NHS, disrupters get no traction. Machiavelli’s perceptive thoughts on change abound:
“The innovator makes enemies of those who prospered under the old order, and only lukewarm support is forthcoming from those who would prosper under the new.”
Previous NHS reforms introduced disrupters, with much focus on general medical practice. GP fundholding in 1991 allowed practices to purchase NHS services, competing with larger Health Authorities. Take-off was slow amidst much GP opposition, but by its demise in 1997, most practices were fundholders.
The incoming Labour government was fundamentally opposed to a market in healthcare, although one senior figure privately referenced fundholding:
“Why are we ridding the only thing that works?”
That government substituted the market for a strong, target-driven policy. Purchasing became commissioning- still involving GPs, but in a more sanitised role. Incidentally, the Blair government made huge strides in improving clinical outcomes and thereby decreasing health inequalities. Very impressive- but I digress, as it was not a disrupter.
The next reforms still involved GPs in a stronger commissioning role, returning to a more market-based policy. GPs were still envisaged as purchasing/commissioning disrupters, while their fundamental role and forte- in provision- was not sufficiently recognised. Anyway, GP prominence was not maintained. Machiavelli was unerringly prescient.
The new proposed reforms, even before implementation, are already receiving the same negativity- couched, as ever, in disingenuous terms. Entrenched opposition has long experience of indirectly disrupting!
Enough of the history and context
The new policies are welcome, far-reaching and ambitious. There is a growing recognition that the principles enunciated are of the future- and are most likely to remove the existential threat to the NHS.
“At its core, the Neighbourhood Health Service will embody new principles that care should happen:
- as locally as it can
- digitally by default
- in a patient’s home if possible
- in a neighbourhood health centre (NHC) when needed
- in a hospital if necessary”
To make this possible to shift the pattern of health spending. Over the course of this plan, the share of expenditure on hospital care will fall, with proportionally greater investment in out-of-hospital care. This is not just a long-term ambition.”
And the disrupter likely to be more powerful and long-lasting than any previous is technology- widely used the world over but much less so in the NHS. Why the latter? A good question.
The key technological ‘game changer’ is likely to be the greatly expanded NHS App. Key features include:
- Personalised data
- Access to certified third-party services
- AI-powered navigation
Users will have more choices for their future healthcare and thereby more influence on future healthcare provision. The App, in conjunction with a single patient record (preferably digital) and a health data research service, puts information at the centre of care and innovation.
Whatever the NHS envisions the provision of health services, patients and future patients- the public- by their sheer volume, will likely reshape healthcare provision even beyond the NHS. Social care will be subject to the same forces.
The 10-Year Health Plan anticipates this new direction- a huge opportunity for community-based services. We need to prepare now.
This is the first blog in a series exploring key aspects of the Plan. Be sure to read the next posts for deeper insights and ongoing discussion.
