Moving Forward after 40 Years of Misguided Decline

A poll in January 2023 concluded that the majority of the public feel that the NHS is safe neither in the hands of the Conservatives nor of Labour. But the daunting reality is that, despite the dedicated hard work of our doctors and nurses, the abysmal track-record of NHS Management in attempting system reform is such that its future is not safe in their hands either.

Despite this, the Labour Party are correct in stating that the NHS must now “reform or die”. However, they are incorrect in their implicit supposition that NHS Management have the professional competence to achieve it. A Management that has led the NHS to become the most unfair system of healthcare in Europe via misguided, overly-expensive systems of commissioning and to its current level of unsustainable inefficiency. One that and has already wasted many millions of taxpayer money in misconstrued and mismanaged National Programs.

Only GBI, by establishing a professional services company at the heart of Government, will have the expert professional resources to drive the reforms we now urgently need. To completely reengineer the NHS’s funding (from general taxation to 2 levels of NI), its administrative processes and organisation, guided by EU14 Best Practice and advice from Expert Groups.

If elected, GBI will publish a National Health & Social Care Strategy as a White Paper for feedback from Professionals and Taxpayers prior to finalisation by 2026 (the date of the Post-Reform General Election). This will be supported by detailed designs to enable its development and rollout from that time.

This strategy will be aligned with those of a Planned Economy and for the achievement of Economic Growth (previously described under “Development”) to ensure the service will be adequately and properly resourced, with all staff paid properly for their contributions to society.

The pace of deployment would then depend on the taxation levels and priority given to it by the Political Party that becomes elected at that time. But after so many years of neglect by both Parties, and misconstrued NHS Management Policies, this will come neither easy nor cheap- so planning for Economic Growth becomes essential.

Whilst it is too early to pre-empt details of the eventual design, the following points give a flavour of the reformed service we can expect from a modern system of healthcare to start to be phased-in from 2026.

THE BGI 12-Point Plan for NHS Reform

1 – Change the “its all free – who cares?” ethos of the service by renaming it to the “National Healthcare Scheme”, to be funded by 2 classes of National Insurance, (rather than by an ever-increasing slice of General Taxation).  Class 1 for NHS General Services and Class 2 for Elective Services.  Both contributions to be shown on payslips to make each employee aware of what the service actually costs them. 

2 – Publish a National Care Standard – a statement of what every citizen has a right to expect from the NHS, each receiving exactly the same level of service, regardless of where they live in the country.

3 – A Patient-Centric (rather than GP-Centric) system, enabling citizens to raise their own Healthcare Cases on-line, spawning referrals (initially to GPs or Pharmacists in most cases) and enabling on-line access to Case / Referral Status, with appropriate points of contact.

4 Streamline Service Planning, Budget Establishment and Funding channels to NHS Service providers, disbanding many of the 31,000 Administrators employed by the English CCGs.

5 – NHS Services to essentially remain “free at the point of delivery”, but only for UK citizens (via National ID) and subject to prescribed reasonable conditions of service use. However, a system of nominal charges will be evaluated for those not on benefits (e.g., for a GP Appointment or A&E visit) to help align the funding of the service with its demand and to stem system abuse.

6 A joined-up system between primary, secondary and community/social care settings.  All referrals to be available on-line, showing their pathway and current Status, with points of contact.

7 Elective Healthcare to be obtained via a single National Service Que organized by Specialty and Procedure Group, prioritized by Clinical Need, so that everybody gets treated fairly.  Each patient would be able to monitor on-line their position  in the queue, with their ETA and Provider/geographic options to expedite it.

8 NHS Class 2 Contributions to fund an Elective Healthcare Market in which NHS and Private Hospitals will compete for contracts.  NHS Hospital Trust’s will be financially incentivized to improve efficiency to generate Elective Capacity.  This “profit “would then be available to Trust Management for new equipment and/or for paying staff performance bonuses, promoting efficient team working.

9 Plan development of NHS Elective Hubs (e.g. for hip replacements).

10 – Coordinate with Social Care Strategy to minimize bed-blocking.

11- Streamline patient pathways by improved care profiles, cutting-out all unnecessary levels of bureaucracy, redirecting their costs to front-line services.

12 – Inbuilt Performance Measures (e.g. in Queue Management) to enable the optimum balance of resources and service levels.  Thereby driving increased cost-efficiency and informing policy options for increasing NI Contributions to achieve improvements in service such as required for new medicines or healthcare technology.

GBI objectives are therefore, not only to deliver a superior democratic structure of government than of any in the EU, but also superior healthcare system – one setting a new global gold-standard as our original NHS once did.

© Albert Smart 2023

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