NHS needs to be refounded to reach the end of the decade – here’s how

In many ways we should be living through a golden age of healthcare.

Technological and scientific advances have dramatically changed our understanding of disease and our ability to treat illness. We have decoded our genome and are in the process of doing the same for the proteins which determine our health on a daily basis. We can detect disease earlier and fight cancers more effectively thanks to advanced diagnostics. Artificial intelligence enables us to discover new drugs faster and help run healthcare more effectively. Perhaps most importantly, we have learnt that the wider determinants of health account for the majority of sickness and drive health inequalities.

Why is it then that the NHS is in such a precarious state?

Over six million patients are on waiting lists and this number will only increase. Health outcomes in many areas are amongst the worst internationally. And there are over 100,000 vacancies in the NHS. It is therefore unsurprising that public perception of the NHS is at a 25-year low.

Covid has undoubtedly had an impact on the long queues and increasing numbers of staff who are leaving due to exhaustion.

The lack of investment over the past decade has also meant that the NHS has fallen further behind other OECD countries in areas such as diagnostic and bed capacity. Germany, for instance, had five times as many ICU beds at the beginning of the pandemic as the UK.

But this is not the whole story.

Healthcare is a notoriously late adopter of innovation and has proven resistant to change all around the world. Health systems are complicated and often fragmented and health needs are complex, making systematic change hard.

This is particularly true of the NHS, whose flaws lie in its very DNA – centralised and with an overreliance on top-down performance management as the main system of accountability.

Aneurin “Nye” Bevan, the founding father of the NHS, famously said the sound of a dropped bedpan in Tredegar (his Welsh constituency) would reverberate around the Palace of Westminster.

Seventy-four years into one of the greatest social experiments this country has seen, we have an abundance of evidence that command and control does not unleash transformation on the scale needed – even with more funding.

Moving towards greater local integration of services as envisaged by the latest round of structural changes to the NHS is the right direction of travel. But we should not stop there. Simply integrating what we have now is not going to address the fundamental challenges we face. We need genuine innovation and disruption of care that utilises technology, data, and participation with patients and communities.

This will only happen if we let go of an overly centralised system – a scary prospect to many in Whitehall given that healthcare accounts for nearly 44 per cent of day-to-day government spending. The public rightly expects strong accountability for their tax money. The culture of micromanagement runs deep.

In my new report for the Tony Blair Institute, “The NHS refounded – delivering a health service fit for the future”, we show that greater autonomy to innovate does not need to mean a reduction in accountability. The same forces that drive transformation in healthcare provide opportunities for a much more distributed accountability system. Instead of the long screwdriver from Whitehall, a rewired NHS bureaucracy would rely much more on data transparency to enable learning, and strengthen patients’ voices, as well as the active participation of citizens in shaping services.

One such example is to actively tell patients what good care looks like and whether they received it based on their actual medical health records. Making this information available to patients before they see their healthcare provider is a powerful reversal of roles and direct form of accountability. But this also increasingly works the other way around with smart devices recording patient activity and adherence to care plans in real time.

More money alone will not drive the transformation our healthcare system needs. Bevan’s model has served us well for many decades, but it is now time to re-found the NHS. Trusting and empowering those who need to invent tomorrow’s NHS is essential for this endeavour.

Dr Axel Heitmueller is a senior fellow at the Tony Blair Institute.