This site is intended for health professionals only

Leader: Changes in the NHS

Leader: Changes in the NHS


The chair of The Commissioning Review looks at how NHS branding has changed since 1948

When a company wants to reinvent itself or distance itself from bad publicity it goes through a name change. This confuses customers for a while, and then hopefully everyone forgets and the business carries on. Those working in the company go through the emotional rollercoaster of destabilisation and uncertainty while the change happens. New roles are invented by rebranding the old ones but essentially not much changes. The reforms of the NHS follow along similar lines.

Devised by well meaning politicians driven by a desire to remain popular and get re-elected, promises are made and then left for someone else to work out how to deliver them. In these final weeks before a general election, huge sums of money are announced with no credible source other than savings or efficiencies. Care in the community and closer to home has been an agenda item since 1948 but the best brains of Britain have yet to work out how it can be achieved.

As a new GP more than a quarter century ago I was really impressed with the notion of beacon sites; where there was investment in several areas so they could transform care and share that learning for the benefit of all. Since then I have seen so many manifestations called exciting and impressive names, ‘pathfinders’ to name one. Now we have vanguard sites!

Looking through the list of successful bids there are many of the usual suspects. But the learning agenda, whereby best practice is shared, never happens as there is no funding left to raise standards across the country. These non-recurrent funding streams, though very welcome, mean the services that run as pilots never have long enough to be embedded before they are withdrawn. ‘Pilotitis’ the virus that kills innovation!

Hospitals suffer much the same fate. For 10 years they have been rebadged as foundation trusts. What’s next for those that have not made it through the pipeline. Those that have and can’t manage within their budgets are no longer given bailouts but loans. What happens when they can’t pay them back? Will they go into administration and disappear like high street stores? Or will the local population have a whip around to maintain their local service.

The NHS business model was to keep people healthy so they could pay taxes to fund the service and then do the decent thing and die at age 66 without troubling the service. The success of the service is that now people are living with illnesses years after retirement and no longer paying tax. Their social care costs are means tested but health is ‘free’. The merging of budgets seen in Manchester means the old game of shifting the deficit is pointless because health and social care are working from the same pot. Will there be a new local ‘health tax’ to pay for local services when the central allocation runs out?

The transparency over allocations and spends given by the Health & Social Care Information Centre (HSCIC) will polarise people’s views about how they are derived. The politics of envy will surface when areas compare themselves and wonder: Why, if they pay the same tax do they not share the same benefits? Why then, do we have a national service but not a national delivery? The true cost of the service will be known and then be valued. The commercialisation of the service by making every organisation compete stifles innovation, with arguments over who should fund any change. My example is being able to do a troponin test to evaluate patients with chest pain in the back of an ambulance to prevent a trip to hospital. But who will buy the machine, train the staff and, oh yes, purhcase the pesky strips.

Culture is what you do when no-one is watching. With the NHS as the major concern of the voting public, everyone is watching. Politicians can make promises and those charged to deliver them are given different allocations but are expected to produce the same outcomes. When the outcomes are different it is patients that suffer not just the balance sheets.

Rebranding works in the corporate world when there can be losers as well as winners. The NHS is a brand that is the envy of the world. We need to rediscover the values that built it and find that holy grail of integration that has eluded us for so long.


Ads by Google