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October 12, 2021

Say it when it matters

An irritating habit amongst former public servants who have operated at the highest levels of public service is that it’s only when they retire, that they begin to say the things that needed to be said when they had the power to make the difference. Paul Gray, former CEO of NHS Scotland, now calls for much more fundamental reform than is currently being mooted. He cites healthcare systems elsewhere that actually work and points to the one feature they all share – a degree of local control and service integration that would scare the living daylights out of our politicians.

Paul Gray

Extract from an article written by Paul Gray for Reform Scotland. See full article here

…….The real answer lies in fundamental reform of the whole system and not just parts of it.

There are internationally recognised examples of what works. A quick search of the Jonkoping system in Sweden, the Buurtzorg model in the Netherlands, or the NUKA model in Alaska, will demonstrate that health systems can be integrated and can be made to work at lower per capita cost without sacrificing quality, and with better access and better outcomes. A quick search of the official report in Scotland’s parliament or Hansard in the UK parliament will almost certainly yield glowing references to all three systems. One feature distinguishes all of these systems – they are truly local. Each system has a different approach to governance: the NUKA system is owned by the population, for example. But they involve integration and local delegation to an extent that would frighten most politicians here. And for example, Jonkoping would mean that the concept of a national health service be very different, except for the highest tariff (i.e. most serious, complex and rare) cases, because the local hospital system is part of the local delivery system and not run centrally.

One of the lessons of the pandemic is that change is possible, and that it can be made to happen quickly. Another lesson is that technology can play a bigger part in diagnosis, care and treatment, and simultaneously reduce the need for patients and clinicians to travel while increasing the efficiency of the system. Better use of technology and properly joined up, patient-centric digital systems are essential components of any development. Even the best of systems embraces the need for change in response to changing contexts: as Jonkoping’s Chief Learning Officer said, Our current system serves us well, but it will not serve my grandchildren well in the future. (And yes, they have a Chief Learning Officer at the same level as their Chief Executive Officer.)

Unless we are willing to be clear that 2019 is not coming back and we are not starting from where we were then, and that 1948 when the NHS was first established, is lost in the mists of time and demographics and public expectation, we will continue to have a political bunfight while people suffer and die. If the NHS is truly precious, it deserves a robust diagnosis, and it requires radical surgery. Whether there is the courage to take such an approach remains very much open to question……