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Where next for the NHS reforms in England?In this way, choice and competition would go hand inhand with collaboration.Moving in this direction beyond the current reformswould be a radical step. Many of our proposals have beenset out at a high level and more work is needed on thedetail. It is for these reasons that we have emphasisedthe need for an evolutionary approach that startsfrom the reforms currently proposed, modifies thesereforms in the way we have suggested, and creates abasis for further changes in the light of experience. Thiskind of approach would help to avoid further top-downrestructurings and would encourage experimentationfrom within the NHS led by innovative clinicians andmanagers. In our view, there would be merit in testingthe radical option in one or two regions to explore therisks and benefits of such an approach.Summary and conclusionThe proposals set out in this paper are offered as aconstructive contribution to the listening exercisewith the aim of building on recent progress inimproving the performance of the NHS in England andcreating the foundations on which the NHS can riseto future challenges. The proposals are intended tobe a co-ordinated package of ideas for improving thegovernment’s current plans that need to be acted ontogether. If the government’s response to this paper is totake forward some proposals and ignore others, then it isunlikely that the plans will be strong enough to addressthe concerns we have expressed in recent months. Itis also important to emphasise the need to evolve inthe direction we have proposed rather than to embarkon a rapid process of change, and in doing so to retainexperienced leaders whose involvement is essential todelivery of the Nicholson challenge.We would argue that the proposals are both appropriateand proportionate to the issues that need to beaddressed and that, if executed well, they shouldenable the NHS to meet the Nicholson challenge andabove all to improve outcomes for patients. Some of ourproposals, such as those on economic regulation, requiremodifications to the Bill, but most can and should bedealt with through established policy-making processes.The agenda set out here must be taken forward as amatter of urgency to remove barriers to the delivery ofintegrated care and to tackle the core challenge of anageing population in which chronic medical conditionsrepresent a threat to the sustainability of a universal,comprehensive, tax-funded health care system.18 © The King’s Fund 2011
The King’s Fund ResponseReferencesAhgren B (2010). ‘Dissolving the patient Bermuda Triangle’. InternationalJournal of Care Pathways, vol 14, no 4.Appleby J, Robertson R (2010a). ‘A healthy improvement? Satisfaction withthe NHS under Labour’. In: Park A, Phillips M, Clery E, Curtice J, eds. British SocialAttitudes Survey 2010-2011: Exploring Labour’s legacy—the 27th report.London: Sage.Appleby J, Ham C, Imison C, Jennings M (2010b). Improving NHS Productivity:More with the same not more of the same. London: The King’s Fund. Availableat: www.kingsfund.org.uk/publications/improving_nhs.html (accessed on 20May 2011)Appleby J, Raleigh V, Frosini F, Bevan,F, Gao H, Lyscom T (2011). Variations inHealth Care: The good, the bad and the inexplicable. 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Specialist Doctors inCommunity Health Services: opportunities and challenges in the modern NHS.London: NHS Alliance, Available at www.networks.nhs.uk/nhs-networks/nhsalliance-specialists-network/documents/Specialist%20Doctors%20in%20Community%20Health%20Services.pdf (accessed on 16 May 2011).Lewis R, Rosen R, Goodwin N, Dixon J (2010). Where Next for Integrated CareOrganisations in the NHS? London: Nuffield Trust.National Audit Office (2010). Progress in Improving Stroke Care. London: TheStationery Office. Available at: www.nao.org.uk/publications/0910/stroke.aspx(accessed on 16 May 2011).National Audit Office (2011). Management of NHS Hospital Productivity:, Reportby the Comptroller and Auditor General, Session 2010-11. Department of HealthHC 491. London: The Stationery Office.Palmer K (2011). Reconfiguring Hospital Services: Lessons from south eastLondon. London: The King’s Fund. Available at: www.kingsfund.org.uk/publications/reconfiguring.html (accessed on 16 May 2011)Porter M, Teisberg E (2006). Redefining Health Care: Creating Value- BasedCompetition On Results. Harvard Business School Press.Schoen C, Osborn R, Squires D, Doty M, Pierson R, Applebaum S (2010). ‘Howhealth insurance design affects access to care and costs, by income, in elevencountries’. Health Affairs Web First. Available at www.commonwealthfund.org/Content/Publications/In-the-Literature/2010/Nov/How-Health-Insurance-Design-Access-Care-Costs.aspx (accessed on 16 May 2011).Schoen C, Osborn R How S, Doty M, Peugh J (2008). ‘In Chronic condition:experiences of patients with complex health care needs, in eight countries.Health Affairs Web Exclusive, November 13, 2008, w1-w16. 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