Why can’t the UK National Health Service change?

underlying-reasons-for-resistance-to-change-300x300Many within the NHS feel it is in a state of constant change, but this is an illusion.  It’s based on changing superficial things; the classic, ‘rearranging the deckchairs on the ship’.  There is an appearance of change, and when it’s your job to move the chairs, it feels like a big change-around, but the reality is that the ship ploughs on. The fundamental forces that power the ship’s direction, (the engine, propellers and rudder) remain determinedly fixed.

It’s easy to prove that this is true.  Just consider the general process of healthcare:

  • The patient thinks something is wrong
  • S/he goes to see a General Practitioner (GP)
  • The GP performs an face-to-face interview
  • The GP may or may not refer to a specialist
  • The specialist is visited by the patient and definitive treatment is eventually planned

The whole thing takes weeks.  If you went back in time a hundred years in the UK, you would see basically the same process happening.  Similarly, take a UK citizen from 1950 and show them the current UK health system, and they would understand immediately what was going on.  No real change.

As a nationalised monopoly, the NHS has no ability to change itself.  The ‘rules’, which are de facto, laws, won’t allow it.  For example,

  • No money can change hands (services are ‘free’)
  • Patients can’t access specialists without permission from a GP
  • Diagnostic services are inaccessible directly (you can’t find out what’s wrong with you on your own volition)

The insurance industry was a bit like this 30-40 years ago.  A man with a briefcase would come to your house, fill out forms, and return weeks later with an insurance policy.  Nowadays, insurance is purchased online in a matter of minutes, because the rules were changed.  The ‘man from the Pru’ has disappeared.

In order for change to occur, the ‘rules of the game’ must change.  Powerful vested interests resist this as much as possible: the medical profession, especially GPs, could easily disappear, so resist fiercely all reform.  The politicians, who are in charge, fret about re-election.  The patients, who are vulnerable, don’t know any better.

The solution of the NHS’s problems are the same as those that have worked in other service industries, namely, change the rules.  This is known as ‘deregulation’; it’s not rocket-science.


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