Rather than ‘fixing’ the NHS, we need to radically rethink our approach to health


When it was founded, the National Health Service was visionary: it offered quality and timely care to meet the prevailing needs of the populations it served. Almost 75 years later, as the country faces vastly different health challenges, it’s clear that the model is outdated.

From life expectancy to cancer and infant mortality rates, we lag behind many of our competitors. With more than 6.8 million on waiting lists, healthcare is becoming increasingly inaccessible to those unable to opt for private treatment; and the cost of healthcare is increasingly crowding out investment in other public services. The OBR now describes health spending as the “biggest – and most likely – source of long-term risk to the sustainability of public finances”.

As the demand for healthcare continues to grow, the pressure on the workforce—already on the verge of breaking down—will only increase.

Many of the responses to the health and care crisis are well rehearsed. We need to be much better at reducing and redirecting demand for health services rather than simply managing them. Much more investment needs to be made in communities and basic services to reduce our dependence on hospitals. And social care capacities need to be increased to support the growing number of people with long-term illnesses.

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But despite two decades of strategy and a number of important health care reforms, we have not made significant progress on any of these goals.

For this reason, Reform is launching a new work program entitled ‘Rethinking Health’, supported by ten former health ministers from the three major political parties. Together we are calling for a much more open and honest conversation about the future of health in the UK and an “urgent rethinking” of the hospital-centred model we are maintaining.

This must start with how we maximize the health of the nation rather than ‘fixing’ the NHS. For example, it is estimated that health care accounts for only about 20% of health outcomes. Much more important are the places where we live, work and socialize – yet there is no clear intergovernmental strategy to improve these social determinants of health. Worse, when policies like the National Obesity Strategy are scrapped, taxpayers are left with the hefty price tag of treating resulting diseases like diabetes.

“It is estimated that healthcare accounts for only about 20% of health outcomes. Much more important are the places where we live, work and socialize – yet there is no clear intergovernmental strategy to improve these social determinants of health.”

Reform wants to ask how power and resources should be distributed in our healthcare system. What health functions should remain central and what should be delegated to local leaders who are often responsible for health promotion services and have a much better understanding of the needs of their populations?

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Of course, access to quality healthcare when we really need it will always be crucial. But our current delivery model is largely the same as that introduced by Bevan in the late 1940’s. It is not an appropriate model to meet the challenges of an aging population and a rising tide of multimorbidity. As our care needs have become more complex, our workforce has continued to specialize. Between 2010 and 2021, the number of community health workers fell by 20%, while the number of hospital counselors increased by 45%.

We need to rethink our healthcare delivery model to meet the challenges of the future, rather than simply “optimize” what we already have – not least because continuing down the same path is priceless.

Rethinking the model to produce better outcomes is the primary purpose of Reform’s new program, but a truly honest conversation must consider not only the costs of providing a world-class health and care system, but also how those costs will be met. Not least because health spending is crowding out other forms of spending such as education and housing, which are critical to building good health. But in addition to asking how we increase our revenues and ensure intergenerational equity in healthcare financing, we want to ask deeper questions, such as: B. “What do we value in healthcare?” and “How do we create incentives that praise quality and patient orientation?”

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There is a broad consensus on what needs to change – less hospital care, more community and self-care – but despite this consensus, hospital spending as a percentage of healthcare spending has increased. We are looking for answers on how to achieve this change. To do this, we want to engage those who are deeply engaged with these issues from across the policy spectrum – practitioners, policymakers and systems innovators.

We know we don’t have all the answers. But in order to create a sustainable healthcare system, we need the courage to start with the right questions.

Patrick King is a researcher for the Reform Think Tank



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