So: is the NHS working?

This is the question I – perhaps over-ambitiously – want to address. By working, I mean producing the desired outcome. Not working as in “working hard,” which it most definitely is doing.

Achieving the goals set out by the seven principles is the desired outcome in this assessment. But this isn’t a conventional test. Six out of seven might normally be a respectable score.

In our case, surely failure to achieve any single one of these goals would represent a significant problem at the core of NHS healthcare provision? In addition, a shortfall in one area would undoubtedly compromise the ability of the NHS to deliver on the others. Things don’t work in isolation.

When tackling a complex issue such as this, I like to adopt the idea of ‘chunking.’ This is a commonly used tactic based on research into working memory – working memory being the cognitive workspace in which we do all our thinking and active memorising. Chunking refers to the idea of assimilating smaller units of information into larger understandable ‘chunks’ which have some over-arching relationship or meaning: for example, letters becoming words becoming sentences.

The seven principles are already chunks to begin with. Within each principle, there is an immense amount of detail, thought and consideration chunked into one pithy sentence.

But we can do better! The principles can be grouped into two broader roles the NHS serves, as outlined below:


Principles 1-4 are concerned with ‘The NHS as a Healthcare Provider’ – how the NHS ensures adequate access to healthcare (principles 1 and 2) and delivers excellent healthcare provision (principles 3 and 4).

Principles 5-7 are concerned with ‘The NHS as a Public Body.’ A public body is defined by the cabinet office a “formally established organisation that is (at least in part) publically funded to deliver a public or government service, though not as a ministerial department” (as outlined in a rather dry – yet informative – document found here). NHS England is the largest public body in the UK, and is accountable to the Department of Health via the NHS mandate (although the relationship between NHS England and the DoH is far from a clear or simple one).

In its role as a public body, the NHS needs to communicate with other public bodies and governmental departments which are critical for service delivery (principle 5); to spend money effectively (p6); and to be held publicly accountable for its decisions (p7).

It is important to stress that these artificial groupings I have concocted are not wholly independent of one another – for example, achieving high standards and clinical excellence (p3) both requires and facilitates the efficient use of resources and effective spending of taxpayers’ money (p6). I hope to cover these interactions in subsequent posts but the topic is immensely complex – there is enough material to write a thesis (or a hundred). Without a little bit of coarseness and simplification the whole point of this blog – to provide some simplicity and clarity – would be lost.

In the next blog post, I want to explore the principles concerning access to healthcare, which are crucial part of the NHS’s role as a healthcare provider.

Is the NHS a comprehensive service?

Is access solely based on clinical need, or are other factors at play?


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