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

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.