No Image Available


Read more from TrainingZone

googletag.cmd.push(function() { googletag.display(‘div-gpt-ad-1705321608055-0’); });

Simplicity: The NHS – a sacred cow, or a dead one?


The NHS is any leaders greatest challenge - the biggest UK employer and third largest in the world, who would want to take on this 'sacred cow'? Trevor Gay considers the challenge of reorganising and reforming the NHS.

The NHS is often referred to affectionately as a ‘sacred cow’ given both its distinguished history and the considerable affection invested in it by the British people. At the same time, there is mounting consumer and political pressure in Britain to consider significant expansion of the (relatively speaking) small private healthcare sector in Britain which would in turn undermine the core principles of the much loved NHS. If this scenario were to become a reality some critics believe it would result in the NHS becoming a ‘dead cow’ rather than a sacred one.

This presents our leaders with a fascinating challenge and one that is only going to grow in complexity and importance in the coming decades. The leader’s task is going to include clarity of communication; setting out the challenges clearly; presenting options; seeking consensus to change; engaging with the workers in the NHS to implement changes and to evaluate the effectiveness of those changes. The leaders will have to be politically astute given how precious the NHS is seen by both the public and politicians.

"The NHS cow is certainly not dead in 2009 – it is not even terminally ill - but maybe it is not as sacred as it was 30 years ago."

What the healthcare landscape looks like in the long-term is uncertain but the status quo is clearly not an option. We are all living longer; advances in medical technology are happening faster than ever and there is greater consumer demand and expectation. I see the leadership challenge in the NHS as one of the greatest tests of management in the UK in the next 20 years.

The NHS story so far

In Britain the NHS is a political ‘hot potato’ that is radically tampered with by politicians at the risk of losing votes. Therefore a major change to a private health care service is unlikely to be politically acceptable in the foreseeable future.

To understand the current prevailing attitudes among British people about the NHS we have to firstly look back at least 60 years.

The NHS was created by a Labour government in 1948 as a State funded, free at the point of delivery service, for every member of the British population. It was introduced by a socialist government as Britain emerged victorious following the defeat of Germany in the Second World War (1939-45)

The population was promised by politicians of the day, that in respect of the healthcare of every member of society in Britain: ‘No longer will wealth be an advantage nor poverty a disadvantage.’

For 60 years the NHS has remained the best loved and yet the most castigated public service in Britain. Everyone seems to have a view about the NHS. Hardly a day passes without at least one major story in every national newspaper. And yet it is generally considered political suicide for any politician to suggest root and branch reform of the NHS, moving it away from a state funded service funded primarily from Income Tax to a private service.

"I see the leadership challenge in the NHS as one of the greatest tests of management in the UK in the next 20 years."

A sacred cow or a dead cow?

In short, I don’t think the NHS is either. Although the NHS is highly regarded by most patients who use it, the patient in the healthcare setting is changing. The new patient is in possession of masses of information and demands higher standards as more and more information is in their hands.

No longer is the patient a passive and grateful recipient of health care. They are well informed customers who rightly demand information about what is happening to them when they hand over the care of their body to a healthcare professional. It must be an equal partnership – not a master/servant relationship.

I am optimistic about the empowered new patient and I am equally optimistic about how healthcare professionals have responded to the challenge of the empowered new patient. I believe we can look forward to more equal partnerships as the confidence and trust grows on both sides of the relationship.

My perception is the NHS is still greatly valued by the great majority of the people of Britain. I do not believe there is a significant groundswell of support in Britain for a wholesale switch to a truly private and competitive healthcare market place.

I sense among younger people – I would say the under 40’s – more sympathy to the prospect of a mixed economy of private and public health care. There would be more market share than in the past for private healthcare. This undoubtedly suits the lifestyle of the young ‘upwardly mobile’ person in a hurry.

The NHS is a greatly valued institution. The affection and esteem that clinical staff (I would say particularly doctors and nurses) are held in by the public is awesome.

The same cannot be said about the perception of the public of managers in the NHS. The image and reputation of managers in the eyes of the public is of highly paid people who are adding little value to the patient experience. I don’t personally sign up to that sweeping generalisation. In fact the relative expenditure on management in the NHS is less than in most large organisations. Nevertheless I believe the perception of the public about management in the NHS is generally speaking negative.

"The image and reputation of managers in the eyes of the public is of highly paid people who are adding little value to the patient experience."

I think the staff who work in the NHS have become accustomed to regular tampering with the way this gigantic institution is organised and structured. Continuing improvements in patient care goes on in spite of these changes rather than because of them.

There is great loyalty and goodwill among the 1.4 million people who work in the NHS. I believe most of them have belief and pride that they are contributing to improving the health of our nation - very few work in the NHS primarily for financial reward.

We have a national health service in Britain and I feel this is a cause for celebration and not a cause for concern. The NHS has existed for 62 years and we have around 1.4m people working in it. Even though I am not a 'numbers man' that tells me we have over 60 million years worth of experience to learn from and capitalise on. We do not need to ‘throw out the baby with the bath water.’ We can learn from the past. I have never signed up to the view that ‘old is good’ and ‘new is bad’ or vice versa – Oh .. If only life were that simple.

I think we need to have sensible pragmatic debate about the options we face in the future for the organisation and funding of healthcare in Britain. We should not consider this matter from the point of view of whether we need a national service or a private service or a mixture of the two. We need to ensure that the public are presented with the facts about current funding and likely future requirements based on an accurate a picture as can be presented given all the variables we know.

The biggest thing we have going for us in Britain is that we already have a National Health Service. As a result we have a great emotional investment in making sure the focus of our politicians and our leaders remains firmly fixed on healthcare.

The NHS can only be changed with the consent of the people and I hope Britain maintains that democratic position for many years to come as we continue to explore alternative models. I am neither an advocate for the status quo nor a passionate reformer of fixing something that is not totally broke.

Managing the NHS remains perhaps the greatest challenge for any aspiring leader. I am sure the present Secretary of State for Health – and many successors - will grapple with new healthcare model options as we try to come to terms with the new health challenges. I suspect pragmatism born of necessity will win the day.

So in my view the NHS cow is certainly not dead in 2009 – it is not even terminally ill - but maybe it is not as sacred as it was 30 years ago.

NHS: The facts

  • The third largest employer in the world after the Chinese Army and the Indian Railways, employing 1.4 million people
  • The annual NHS expenditure in 2008 was over £90bn
  • The service is based on clinical need to the entire population of Britain – approximately 60.5 million people
  • Over recent years funding has been increasing by record levels. Since 1997 it has more than doubled and by 2008 the NHS budget had trebled
  • The 7.4%-a-year budget increases started after Tony Blair promised in 2000 to bring health spending as a proportion of GDP up to European levels - at the time 6.8% of GDP was spent on health, compared with 8% across the continent
  • The government is currently on target to hit 9% of GDP when the record increases came to an end in 2008. With spending hitting that level, it brings Britain closer to the top of the European health spending league dominated by the likes of Germany and France
  • More about Trevor Gay:
    I worked in the NHS from aged 16 until 2004 when, at 52 years of age and having reached a senior management position in healthcare, I decided (as my late beloved Dad would have said) that it was time for me to get a real job.

    I left my comfort blanket of NHS employment and guaranteed pension to work independently as a health care management consultant, coach, trainer and author. The time had come for me to reflect on what I had learned about healthcare in 35 years. My new world of independence enables me to write and speak to any interested audience about what I learned during my career in healthcare from 1969.

    My views expressed in this article are therefore personal, subjective, anecdotal and narrative rather than objective, rational, academic or on behalf of anyone.

    I did of course obtain the necessary academic and management pieces of paper during my long NHS management career but I still prefer learning through practical experience and reflection.

    Trevor writes a Simplicity Blog which was recently chosen as one of the Top 100 Leadership Blogs by Best – February 2009

    Trevor and his wife Annie are running the London Marathon on 26 April and welcomes donations for Carers UK the charity they are running for. Details on how you can donate are at this link


    Get the latest from TrainingZone.

    Elevate your L&D expertise by subscribing to TrainingZone’s newsletter! Get curated insights, premium reports, and event updates from industry leaders.

    Thank you!