Book Review: 24 Hours to Save the NHS

Former NHS England chief executive reflects on where the NHS has come from and proposes a vision for the future…

Written by the man who was jointly chief executive at NHS England and permanent secretary at the Department of Health between 2000 and 2006, 24 Hours to Save the NHS is a review of how the NHS has progressed from being a relatively overrated service in 1997 with long consultant waiting lists.

The NHS was in decline for years with falling standards and falling public support.  Then, on the eve of the 1997 general election, voters were urged to save the NHS by voting New Labour. Voters were cautioned that re-electing the government of the day would lead to the dismembering of the NHS.

Opinions of the NHS in England have been transformed since then. Public satisfaction has doubled and in 2010, the three main political parties went into the general election committed to the NHS, to developing it further and helping the services prosper. Recently the Royal Society of Medicine reported that thanks to the NHS, the UK is the second best developed country at saving lives for each pound spent, as a proportion of national wealth.

While NHS England’s core principles are still relevant - meeting the needs of everyone, free at the point of delivery and based on clinical need – Lord Crisp suggests that more needs to be done to clarify the purpose of NHS England. With his portfolio of working in community development, Age Concern and industry prior to joining the NHS in 1986, and with health systems in low and middle income countries since leaving in 2006, Lord Crisp proposes a vision for today’s NHS that is likely to resonate more with patients and could be counter-intuitive for some healthcare professionals.

He believes that NHS England exists to do more than curing illness, helping people to be healthy and providing good health services when needed. In Lord Crisp’s view, the NHS needs a deeper and wider vision to help people have as much independence as possible to live the life that they have reason to value. In his words, different people value different things and nobody can judge the quality or value of someone else’s life. 

If you are interested in finding out what it is like to be the CEO of the worlds largest integrated health system, then this book is for you. Nigel Crisp provides a unique insight into the top management role that oversaw the NHS enticing many patients to leave private healthcare during times of economic prosperity, in favour of being cared for by the NHS.

Truth is a recurring theme in 24 Hours to Save the NHS. Lord Crisp values having had people around him who told him the truth, people like Judy Sweeting. Every Friday, he visited wards, operating theatres and surgeries to see for himself, the impact of the NHS Plan, strong political leadership and the bonanza of extra expenditure that the NHS has enjoyed since 1997.

The four areas of reform are discussed in detail - improving services, organisational structure and incentives (decentralisation, choice, some external competition), workforce and evidence based care. And throughout the book Lord Crisp acknowledges the lessons that he learned during his twenty years working in the NHS and Department of Health.

Lord Crisp’s writing style is a real bonus. His 220 paged paperback translates what could easily have been a dry book into a very readable one. The experience of reading his book feels like the author is having a conversation with the reader. There are lots of anecdotes, including the Consultant who was adamant that ‘its simply not legal to allow nurses to order x-rays’. And another senior doctor who said to Lord Crisp ‘we didn’t believe you were really serious about reducing the waiting lists until the second year’

24 Hours to Save the NHS is a must-read for people working in the NHS and its critics. It reminds us of how far the NHS has travelled since 1997 - warts and all.  And more importantly it leaves us with a compelling vision for the future.

For more about Patrick Keady, click http://www.patrickkeady.org