Reform the NHS by all means. I have no knowledge of how the NHS operates and limited experience of using the service,but logic tells you that in any organisation of 1.5 million employees spending ÂŁ130 billion per year there might be room for improved procedures, purchasing protocols etc.
So who will identify the reforms necessary and implement them? The NHS itself? Private businesses looking at individual 'profit centres' and adjusting investment accordingly? Academics taking a non-partisan view of all NHS sectors and making recommendations based on need?
My guess is that even setting the guidelines for any reform would be so complex that it will never be done. Which leaves us with three possible scenarios:
1. Continue as we are, with the NHS haemorrhaging funds and being 'topped up' by whatever peanuts the government of the day can move from other budgets;
2. To increase base rate tax by, say, 2p in the pound (and who would object to that?) to at least give the NHS adequate budget to reduce waiting times at A&E and in the operating theatres. This would not solve any underlying problems of waste, but at least provide a better service;
3. Hand the whole thing over to private business. Make each Trust - or even individual hospital - responsible for balancing its own books, ensuring that any part of the NHS that doesn't generate a profit is punished. Privatisation is already happening via the back door, including US companies, so let's expedite it for the good of the country.
There might be other options. Any ideas?
4. Taking the NHS out of the hands of the Westminister Govts and set up a cross party Parliamentary/Independent Board that oversees strategy that feeds down.
De-politicises the issue and allows the organisation to make radical decisions/changes (if/where necessary) which at the moment are difficult or unlikely to happen due to the pressure of politics.I have a very brief experience of this where a radical new approach to partnership working was stopped for political reasons albeit at a local level. I also have experience of some radical changes (for the NHS/local Govt) and they worked well early on until politics screwed them up as well.
As part of this facilitate closer partnership working between the NHS/Local Govt and switch appropriate budgets between the bodies or create joint organisations that then take control of those budgets. This can be done as I have experience of this between Local Govt and the NHS. For example, all health funds and Social Care funds in Local Govt should get transferred to the NHS so that a joined up system can be formed rather than a sticking plaster approach that has gone on since the 90s. This would long term, with planning imo (and that of a lot of my ex-colleagues in Social Services too) free up bed blocking etc if funding was moved into this process of which would could come from savings in the same people bed blocking (by home care etc).
Joined up policy between all civic authorities (Local Govt, NHS, Police etc) must be introduced and that did happen, although maybe not to low enough level within the various organisations though, when we had the NHS Strategic Planning Authorities*.
Properly funding areas with joined up policy that are peripheral to Hospitals/Doctors like home care (under my plan now under the NHS) will also in the long term save money as it is vastly cheaper to treat people at home rather than in a residential home. There are areas in the NHS and Local Govt that need to be properly funded which will ease the pressure on the Hospitals, doctors and other public services ultimately saving money, such as properly funding mental health (save some of the pressure on Police for instance) and areas like this:
https://www.bbc.co.uk/news/education-48498763. This is front loading cost but ultimately makes greater long term savings as demand is reduced which allows the Hospitals to plan its resources strategically and tactically reducing waste etc. This will also have long term benefits for other civic bodies (such as described in the above article) and for other areas of society.
*The Tories changed these into the Clinical Commissioning Groups which was a pointless change, when in reality all they needed to do was to place a Strategy board above the existing structure that is made up of Doctors etc which would have done the same job. I know of plenty of staff who were made redundant from the original body with a pay off that then immediately got employed by the new body. This is the classic issue of politicising the NHS where one Govt does one thing and the next Govt rather than see if the changes are working (in this Strategic Planning Authority it seemed to be) they immediately change it for dogmatic political reasons (all Parties have done this). By not allowing previous changes to structures and working practices to go through the full change process, any potential benefits are lost and this has been my experience of working in Local Govt, which is basically being in a continuous change process without ever ending.
