It is time to bring about a fundamental shift in how the NHS is reformed, learning from what has and has not worked in England and elsewhere. Politics and policy work on different cycles, which results in short-term political initiatives getting in the way of the long-term policy commitments needed to deliver transformational change. Large-scale structural reforms under successive governments have proved a major distraction and should be avoided in future. Transforming the NHS depends much less on bold strokes and big gestures by politicians than on engaging doctors, nurses and other staff in improvement programmes. A new settlement is needed in which the strategic role of politicians is clearly demarcated to avoid frequent shifts of direction that create barriers to
transformational change. NHS reform has relied too much on external stimuli such as targets and performance management, inspection and regulation, and competition and choice, and too little on bringing about improvement ‘from within’.
Oct 2021. A Debate on the NHS
