Healthcare leaders should ignore those who say radical change is “too difficult” and realise tough times in the NHS call for action, Paul Bate tells Nick Timmins

Health policy is beset by conversations that start radically and end with “but that’s too difficult”. Thankfully, Nye Bevan battled through such debates and the result is an NHS to treasure and a health brand that is globally unrivalled.

The “too difficult” argument encourages lazy thinking − if you can blame someone for an idea not working, why think through whether it really is the right answer?

Reconfiguration of accident and emergency services is a good case in point. The clinical and business cases say lives and pounds can be saved, and consultant and junior grade rotas can be safely staffed.

But what about opportunity cost? What are the other ways to improve lives and control costs − and could these bring greater benefits, take less time to implement, or better maintain people’s trust in the NHS? What else is in the “too difficult” box?

Three areas to rethink

Firstly, patient self-activation, starting with diabetes. In 2002, Derek Wanless showed the value of the “fully engaged” scenario, in which people better look after their own health: 1.9 percentage points of GDP in 2022-23, or around £20bn. We could be making this a reality through mobile internet access, personal health and care budgets and allowing people to truly own their electronic medical records. Let’s start with diabetes, a disease that accounts for approximately 10 per cent of NHS spend and for which 80 per cent of health costs are avoidable.

‘People with schizophrenia and those with anxiety disorders deserve better than to be bundled into one catch-all “mental health” clump’

Secondly, consider a fair playing field, where the best providers flourish. The differences across acute trusts in standardised hospital mortality rates and reference costs are well documented. The data is poorer in primary and community care, but few doubt the variability is there. The truth is some providers are simply better managed and led than others. But they rarely expand, and certainly not beyond limited geographical boundaries.

We need a system that cares far less about who owns the provider and far more about the quality of care they provide, and which actively encourages the good to displace the bad.

Dealing with mental health

Thirdly, get serious about mental health. People with schizophrenia and those with anxiety disorders deserve better than to be bundled into one catch-all “mental health” clump.

What is true is that people with long term mental health conditions cost more on average per person per year, continue to use services intensively for longer, and impact on a wider range of other public services than those with exclusively physical health conditions. One in six adults suffers from diagnosable anxiety or depression, and the impact of poor mental health on our economy is estimated at £12bn per year. So let’s get serious about mental health.

Tough times call for radical action, so let’s work out the ones that are both radical and right.

The full text of all this interview and others can be found in the Nuffield Trust’s Wisdom of the crowd: 65 views of the NHS at 65 report.

Paul Bate is director of strategy and intelligence at the Care Quality Commission; Nick Timmins was public policy editor at the Financial Times