Now is the moment to embrace change for a better future in the NHS
3 min read
Radical simplification is needed to streamline the NHS and remedy the fragmentation caused by the Lansley reforms, says Lord Darzi
Last week, the government made a crucial step towards securing the future of the NHS both by promising more funding and by considering reform. Both are necessary if the vision of the Five Year Forward View is to be realised. But we also need to go further.
The funding settlement is less than many have recommended and doesn’t include public health, community care, and social care. We also need to prioritise radical reform.
The Five Year Forward View successfully created a vision of healthcare that is more preventative, more joined-up, more accessible and more personal. These objectives are widely supported but progress on implementation has been slow.
Progress on integrated and preventive care is the exception rather than the norm. Care is still disproportionately focused on the acute sector, meaning that our NHS is more of an illness service rather than a health service. Looking forward, this requires further transformation into not only a health service, but a wellbeing service.
Quality of care has improved, but we are a long way from achieving parity of esteem for mental health and our record on cancer lags behind most countries in Europe. We have also seen a sharp deterioration in access to acute, primary and social care services. These deficiencies cannot be remedied without reassessing austerity, the workforce and legislation, among other things.
Funding alone is not the solution; reform is required to remedy the fragmentation of the 2012 Health and Social Care Act. Lansley’s reforms created a multitude of complex and overlapping NHS organisations. The result has been a lack of integration and clarity of responsibility. Radical simplification is required.
As my newly-released Darzi Review of Health and Care with the Institute for Public Policy Research (IPPR) argues in more detail, we should merge the national bodies of NHE, NHSI, HEE and PHE and create one NHS headquarters and simplify commissioning functions into a single structure – Health and Care Authorities – at the regional level.
But reform is about more than structures. We need to embrace fundamental levers of change. A “tilt towards tech” requires us to make the most of developments in AI and digital – prioritising digital patient records and pushing for full automation for repetitive and administrative tasks where possible to free up £12.5bn worth of staff time per year. Such automation will not crowd out the workforce, but will complement and enhance it.
We must also invest in the talent of the team, ensuring that we are never knowingly understaffed through the creation of an integrated skills and immigration policy while providing fair pay across the health and care system.
Looking beyond the Five Year Forward View requires us to take a pragmatic, long-term and innovative approach to health and care. With a growing ageing population, it has never been more important to get the funding and reform right. To stand still is to fall back. Now is the moment to embrace change for a better future.
Lord Darzi of Denham is a Labour peer and was a health minister from 2007-09. He chairs the Accelerated Access Collaborative, a joint government–industry group to speed up patient access to ground-breaking technologies and treatments
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