Any NHS reform has to avoid a repeat of 2012

The BMA and the UK government have finally agreed about something—two things, in fact: a new pay deal and the need for major reform of the NHS.

After 44 days of strike action over the past two years, resident doctors (as junior doctors will now be known) have voted to accept the government’s latest pay offer, with two thirds of those who voted backing the deal (doi:10.1136/bmj.q2038).1

The BMA and the government also agreed that Ara Darzi’s report on the state of the health service in England underlines the fact that far reaching change is needed (doi:10.1136/bmj.q2001 doi:10.1136/bmj.q2032 doi:10.1136/bmj.q2009).234 “Without radical action, the NHS won’t survive,” said the BMA’s council chair, Philip Banfield, in response to the review, while the prime minister, Keir Starmer, said that the health service must “reform or die.”

One of many failings that Darzi highlights is the wellbeing of health service staff. “Every day, more than a million NHS staff start their shifts ready to do their best for their patients,” he writes. “All too often, they end their shift frustrated and exhausted.”

The need to improve mental health support for staff is highlighted in our feature on preventing doctor suicide (doi:10.1136/bmj.q1879).5 Ananta Dave, a psychiatrist who has published a review of suicide in the medical profession, believes that all staff should have training on mental illness and suicide prevention. “The kind of decisions doctors have to take and the kinds of things they face—death, injury, trauma, bereavement—are difficult,” she says. “They need an outlet for these emotions, where they’re able to talk openly, where they’re able to process the emotional impact of their work.”

Darzi’s review doesn’t focus on how services could be improved, and solutions to the problems identified are expected to come next year in the government’s 10 year plan for the NHS in England—“the biggest reimagining of our NHS since its birth,” said Starmer.

Some answers to today’s health problems are already under way, such as a ban on advertisements for junk food on television before 9 pm, as part of efforts to tackle childhood obesity (doi:10.1136/bmj.q2006).6 We must hope that the other solutions proposed are guided by evidence of what works, as was Nigel Klein when he studied whether children could have breaks from HIV drugs (doi:10.1136/bmj.q1882),7 and as researchers have been in their studies of the timing of embryo transfer during in vitro fertilisation (doi:10.1136/bmj-2024-080133)8 and drug management of migraine (doi:10.1136/bmj-2024-080107).9

Anyone looking for evidence on what can happen when reforms go wrong can look to the Conservatives’ 2012 reforms (BMJ 2023;381:p836),10 described by the King’s Fund last year as “damaging and distracting.” Yet it’s worth remembering that Andrew Lansley, before entering government and launching the 2012 reforms, had spent six years as shadow health secretary. During that time he repeatedly described his plans “to deliver the service we’ve always wanted in a way we’ve wanted to” and to put the NHS “in the hands of clinicians” (BMJ 2009;338:b2198, BMJ 2009;339:b4068).1112 And Labour’s goal of moving from “an analogue to a digital NHS” will remind many of the 2012 Conservative commitment to make the NHS “paperless” by 2015 (BMJ 2012;345:e6888).13

Successful reform of the NHS is simply too important to get wrong again. As the BMA and the government agree, the NHS won’t survive without it.