I’m frequently asked by friends and colleagues why the NHS can’t sort itself out – it now seems self-evident to many that we simply can’t go on like this. Leading commentators in the media and public life now acknowledge that social insurance schemes operating in mixed healthcare economies popular in mainland Europe have both better outcomes, wider choice for patients and generally higher satisfaction scores than our ‘world beating’ NHS.
The proportion of people choosing to pay for their own care outside the NHS system is rising because the NHS simply can’t meet patient requirements. A few weeks ago I wrote a piece looking at the substantial operational challenges facing the service. This week I’d like to look at some of the inside reasons and hidden agendas which mean the NHS can’t change even if it wanted to.
Broadly speaking there are four groups who need to be onboard the change bus if structural reform of the NHS is to succeed – the electorate, the political class (cross party), the NHS management cadre and NHS professional groups. Unless all of these groups agree on both the need for and the direction of change, nothing is likely to happen. The barriers to meaningful reform are not obvious to the lay person. I have written previously about structural changes in the workforce and the increasingly intrusive burden of regulation, which hinder efficiency. In this piece I will focus on the hidden road-blocks to restructuring.