Intended for healthcare professionals

Observations The Best Policy

NHS transformation: radicalism needs realism

BMJ 2017; 356 doi: (Published 29 March 2017) Cite this as: BMJ 2017;356:j1570
  1. Nigel Edwards, chief executive
  1. Nuffield Trust, London
  1. nigel.edwards{at}

Wishful thinking may undermine NHS initiatives to do more with less

The NHS across the UK faces an intractable set of problems that is all too obvious to those on the health service front line. After years of rising demand for services but flat healthcare funding, we seem to be nearing a point where it is no longer possible to meet the public’s expectations with the money, staff, and beds available. The main response has been to look to ways to change how services work, shifting the balance away from costly and intensive care provided in hospitals. The hope is that providing care earlier, in or near people’s homes, offers a way to do more with less.

The goals are highly ambitious. In England, the local sustainability and transformation plans (STPs) aim to reduce forecast activity by up to 30% …

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