England’s over-centralised health service is misfiring. That much is clear. Less clear is how to fix it. The return on public investment has weakened since the pandemic; more money is not leading to many more patients being treated overall. At the same time, people in the service are calling it quits, loudly and quietly. The challenge is huge, but decisive solutions are yet to been found.
This report attempts to break free from the cyclical history of NHS 'reform'. It puts forward a new approach that is based on ideas of democracy and decentralisation as the way to achieve better decision-making throughout the NHS. It argues the twin crises in the NHS – low productivity and poor staff retention – are interlinked and reinforce one another.
