Letters Improving the health of the NHS

Improving the NHS demands more than just extra money

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3338 (Published 24 June 2015) Cite this as: BMJ 2015;350:h3338
  1. Terry Young, professor
  2. On behalf of Steve Allder, consultant neurologist, Plymouth Hospitals NHS Trust; Sally Brailsford, professor of management science, University of Southampton; Rob Berry, head of innovation, KSSAHSN; Harald Braun, operations director, i5 Health; Claire Cordeaux, executive director, Health and Social Care, Simul8 Corporation; Thierry Chaussalet, professor, University of Westminster; Keith Davies, managing director, i5 Health; Laurent Debenedetti, CEO, Gordian Laser; Mike Farrar, independent consultant; Paul Harper, professor of operational research, Cardiff University; John King, founder, ETHOS Partnership; Peter Lacey, founding partner, Whole Systems Partnership; Loy Lobo, founder, Wegyanik; Justin Lyon, CEO, Simudyne; Adele Marshall, professor of statistics, Queen’s University, Belfast; Sally McClean, professor of mathematics, University of Ulster; Douglas McKelvie, partner, Symmetric Partnership LLP; David Paynton, GP, Southampton; Adam Pollard, research director, Pollard Systems; Paul Schmidt, consultant in acute medicine, Portsmouth Hospitals NHS Trust; Sada Soorapanth, associate professor, San Francisco State University.
  1. 1Brunel University, UB8 3PH, UK
  1. terry.young{at}brunel.ac.uk

We read your recent editorial with interest,1 and recall G K Chesterton’s observation that, “The Reformer is always right about what is wrong. He is generally wrong about what is right.”2 So we endorse the diagnosis—lucid and persuasive—while questioning the prescription. We can understand the call for more money, less interference, and, given recent history, a preference against top down restructuring and competition.

Our question is, will this be enough or is the challenge even bigger than we imagine? We seem to believe that more money with less central interference can provide sufficient motive force to overcome:

  • Our inability to manage demand

  • Our failure to develop systems that align payment with the outcomes we require

  • The continued waiting and waste in too high a proportion of pathways

  • The lack of …

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