Doomed to repeat? Lessons from the history of NHS reform

NHS leaders are now hard at work on a long-term plan for the health service, due to be published in the coming months. Those who have been involved with health care in England for some time could be forgiven for feeling a sense of déjà vu, as NHS history is littered with similar plans. So what lessons can be learned from these previous plans, and how can we ultimately ensure that this time is a success?

Since 2000 the NHS in England has seen at least six major national plans, accompanied by at least ten reorganisations at various levels. From Tony Blair’s NHS Plan to the recent Five Year Forward View, they all aimed to create tangible, widespread changes in the health service that would give patients and taxpayers a fundamentally better deal - as shown in our timeline of major NHS reforms from the 1980s to the present day.

Now the NHS is once more being asked to draw up a master plan for its future – one which will last for 10 years, and will be backed by £20 billion a year in extra funding on top of the largest budget of any public service. NHS leaders and politicians from all parties have one important advantage over their predecessors: the ability to learn from the past about what works and what does not.

This essay collection brings together our research and analysis of the key questions that should inform the new plan. What factors always seem to be forgotten, and tend to trip up even the best thought out visions for the future? What is the track record of lining up staff and money to support changes, and how could this be better? How do you choose priorities that can actually happen? We hope the essays will start a debate about the lessons the long history of NHS reform can teach us today.

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