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Britnell: the NHS performs amongst the best but it can be better

Just over two years ago, as some people knew, the NHS saved my life. My family and I shall always be grateful to it and will always support it.

I have worked in the NHS for the past twenty years and now work alongside it. During two decades of complete professional commitment to the NHS, I have worked with staff, and led organisations, that have innovated and delivered better quality care for patients, funded through taxation.

I have advised politicians from all major parties on NHS reform and now, in my global role at KPMG, can see how every developed health system is searching to provide higher quality care whilst bending the ‘cost curve’ in the right direction. Developing countries are also trying to look at global examples and work out what is best for their culture, citizens and patients. We are not alone in having passionate discussions about something that all human beings cherish - their health.

Every system has something to learn from other countries. The NHS performs among the best but it can be better. It can deliver greater efficiency and better quality through care integration and a better mix of public and private provision. Of course, the vast majority of care - quite rightly in the UK context - will always be provided by public sector organisations (currently, about 95 per cent of it) and will be paid out of taxation.

Competition is not the panacea for the NHS but can work in selected areas, especially around short, planned episodes of care. Like most other major industries, proper transformation of antiquated business models is also necessary and often disruptive innovation comes from third parties.

The article in The Observer (read online here) attributes quotes to me that do not reflect the discussion that took place at a conference last October - nor unfortunately was I given the opportunity to respond. I believe that the newspaper report was stimulated by an article that was published in the Health Service Journal last week. This article sought to place our current debate about NHS reform in a broader context. It sought to raise four important points:

  1. The NHS is planning to make efficiencies and can provide more cost effective services. In the next few years, NHS clinical developments will be funded through these efficiencies as they will be re-invested. This makes the quest for better cost effectiveness ‘mission critical’ and numerous public reports suggest this can be done. This crucial element of the debate has become too polarised and will confuse the public when difficult decisions need to be made;
  2. The NHS faces problems that other countries deal with in different ways. In the medium term, the UK will also have to consider what works well here and abroad given that all developed countries are spending more on health as a proportion of GDP. The current debate deals with a number of issues but leaves some wider issues unresolved (such as the integration of social care and NHS aged care which have different funding streams, raised through different routes). Political hyperbole is making it more difficult for the public to see some of the pressing issues facing our society, particularly ageing and chronic disease (as outlined many years ago by Derek Wanless);
  3. The issue of competition, which now seems to be conflated with privatisation, is unhelpful and misleading and, at best, only a small part of reform. Competition can exist without privatisation and the NHS can maintain its historic role in funding care while dealing with a richer variety of providers - public sector, social enterprise and private organisations. Our GPs deliver NHS funded services but this is not widely seen as ‘creeping privatisation’. Similarly, the medicines we take every day are not manufactured by state run organisations. Their innovation and effectiveness comes from their global reach and investment in research;
  4. My fourth point is that every organisation has to adapt and change to thrive and succeed. Performance management techniques that have served the NHS well during the past decade now have to be blended with other strategies and management actions. Giving clinicians greater responsibility with more accountability is a good start and is certainly part of the global quest for the ‘holy grail’ in healthcare - more accountability for financial resources by clinicians that make decisions.

Finally, and this is a personal observation, the NHS has always been seen as a hot-bed of health service reform and innovation across the world. Not all countries feel they have to adopt everything inside the NHS but they respect it. During my travels over the course of the past nine months, people have been confused about our political rhetoric. The ‘listening period’ is a good opportunity for us to celebrate all that is good in the NHS and also have the courage and will to make it even better.

Readers' comments (16)

  • phil kenmore

    Good clarification by Mark. He may be outspoken at times, and some may strongly disagree with his views, but we should not allow some poor journalism by the Observor to reflect badly on his committment to improving services, and the level of healthcare debate, which has been demonstrated throughout his career.

    It is a good thing that there is some space for reflective challenge to the polarised rhetoric and shroud-waving that characterises so much of the current discussions. The NHS has to change. The people who run it and work in it have to change to make that happen. The people who pay for it (i.e. all of us) should demand that the debate about that change is robust and wide-ranging and takes account of the full range of views.

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  • Well said Mark.

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  • What ever

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  • Where is the accountability of these so called special advisers who are developing strategy for the NHS and paid an absolute fortune.

    If the Bill goes through removing the accountability of the government in 5 years time we will be hard pressed to answer 'why was the NHS demolished and who instigated it?' Cloak and daggers - we deserve transparency, honesty, integrety and a health dose of common sense......and quickly!

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  • "Competition is not the panacea for the NHS but can work in selected areas, especially around short, planned episodes of care." This is not what is written in the White Paper. It says "any willing provider" and makes no stipulations. The WP will bring EU competition laws and will make tendering more expensive and cooperation will be refuted judicially by excluded contestants.

    Re-write the Bill and then let's talk.

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  • Well said Mark. Not being afraid to say challenging things has always been your strength - even when the attacks, as ever, become personal.
    Dont stop doing it! We need more of it

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  • ‘The article in The Observer (read online here) attributes quotes to me that do not reflect the discussion that took place at a conference last October’
    If this is intended to mean that he, Mark Britnell, did not say at any point and in any part of the conference what the Observer attributed to him, could he please make that statement unambiguously so that we can move on? The current terminology invites a range of interpretations whereas one assumes Mark sought to provide a definitive statement.

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  • ‘The article in The Observer (read online here) attributes quotes to me that do not reflect the discussion that took place at a conference last October’
    If this is intended to mean that he, Mark Britnell, did not say at any point and in any part of the conference what the Observer attributed to him, could he please make that statement unambiguously so that we can move on? The current terminology invites a range of interpretations whereas one assumes Mark sought to provide a definitive statement.

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  • Daniel Steenstra

    I am pleased for Mr Britnell that the NHS saved his life. Other patients (Stafford) have not been so lucky. And luck should not come in to it. We as tax payers deserve consistent high-quality healthcare. The previous government on our behalf nearly tripled our investment in the NHS. Managers such as Mr Britnell have not been able to turn that investment into a proportionate improvement in healthcare. It might be that a 288% increase is not enough. What is unacceptable though is that during this period Mr Britnell has not learnt what is working and what is not and that he is not able to share with us practical ideas.

    I agree with Mr Britnell when he says disruptive innovation is the way forward. Prof Clayton Christensen, who coined 'disruptive innovation’, wrote in his latest book 'The Innovator's Prescription' that “reformers in those nations (with a nationalized health system) must tackle the system head-on - which ... is a fight we wouldn't wish for our worst enemies' (p399). Prof Christensen does not offer advice or practical guidelines for innovators in the NHS. Despite Mr Britnell's many years of experience in the NHS and now as management consultant in the private sector, with whom the NHS has already invested considerable sums to little benefit, he too does not appear to have any advice to offer on innovation in the NHS. He writes as a passive observer without sharing any insights, ideas or practical solutions. What the NHS and the Prime Minister needs now is an understanding of how disruptive innovation can be implemented to provide not just more 'efficiency' but a more effective, high quality, holistic health care for everyone not just the lucky few.

    Such fundamental transformation cannot be brought about by 'third parties' as Mr Britnell suggests, but has to come from within, with the support of frameworks and methodologies and people with practical ideas and expertise. From my experience of working in hospitals and with clinicians and managers, there is no shortage of ideas, passion and desire for improvements. They need: the frameworks to put them into actions; managers that care more about improving patient care than their own jobs and salaries and facilitators that have a desire to support and guide the NHS through this difficult transformation rather than 'consultants' with their own agendas.

    The implementation of such frameworks and methodologies that have proven to be effective in other critical and complex situations for this radical transformation of processes, services, resources and values is required before any 'sophisticated discussion' on funding.

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  • ‘The article in The Observer (read online here) attributes quotes to me that do not reflect the discussion that took place at a conference last October’
    If this is intended to mean that he, Mark Britnell, did not say at any point and in any part of the conference what the Observer attributed to him, could he please make that statement unambiguously so that we can move on? The current terminology invites a range of interpretations whereas one assumes Mark sought to provide a definitive statement.

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  • I thought Mark was one of a group of, unelected, advisors who were being brought into No 10 to advise the PM. According to the PM at PMQs yesterday, he has never heard of Mark!!!

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  • The HSJ suggested Britnell was one of a group pulled together to discuss the reforms by Paul Bate (adviser to the PM), not the PM himself. Assuming the HSJ report was accurate, Cameron will have been delighted by the way the question was phrased, which allowed him to reply as he did... but was Cameron really so disinterested in the NHS whilst in opposition that he didn't know who Mark was?

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  • mike batt

    Would it be wrong to question the legacy of Britnell?

    I know he always has something to say and is eloquent and influential. Doesn't mean he is right, or has evn objectively done a good job whever he has travelled. He has now worked himself back into the NHS, but from the safety of shouting in from the sidelines.

    Why is anybody lining up to say "bravo"?

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  • Good clarification.

    Interesting to say competition works for short planned episodic care. We currently have free choice for... short, planned, episodic care. So what's to reform?

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  • Interesting that the PM says he doesn't know Mark Britnell seeing as he was the SHA CEO for the region covering the PM's constituency. Seems very unlikely!

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  • I also have been fortunate enough to meet senior managers in a number of health systems throughout the world. Unlike Mark, I am yet to find anyone who respects the NHS (as an efficient/ high quality provider - they respect the free to patient concept) or who wishes to emulate the performance achieved by the NHS.

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