Thread by @nedwards_1

Let's put aside the usual question about their funders & use of data and take the argument on its own terms 1/9

I can agree the NHS has some significant dysfunctions and is burdened by its very centralised nature and the overly close involvement of politicians. .

https://twitter.com/iealondon/status/1159102111147266048

Having worked in really broken systems I can tell you that the sort of change that IEA advocate would require 1) a major expansion of staff especially doctors, nurses and other staff
You cannot have Swiss results with UK staffing levels

2) huge capital investment to undo decades of underinvestment - we are down the bottom of the OECD league on capital >> low levels of CT, MRI etc. The IEA solution requires capacity to allow competition - you also need radiologists to read those images (we haven't got them)

3) culture & governance changes that are difficult tor impossible in our system - IEA ignore path dependency - e.g. complaining that we have not developed reserves like Germany. True but a) too late to change and b) we do have not German attitudes to the long term

4) It would require major changes in the culture of UK medicine including not being part of a global market where unlike Spain, France and Germany many other countries that speak English have better jobs for health professionals that pay more

5) It would be nice to have the Dutch system but IEA offer no transition path or ideas on how to achieve change. When I asked IEA responded that they didn't need to think about these issues & they were 'boring'. This probably true but in the real world it is what is required

6) Any structural change causes huge disruption. The NHS is probably the most reformed health system anywhere in the world but a) they are poorly designed b) underpowered c) rarely completed d) assume it's a uniform system e) you get the idea. Most designed transformation fails

Unlike the IEA I am nervous of big policy led reform. Transformation by big bang change, rather than incremental improvement fails much more often than it succeeds

It's worth having ones views challenged and some of @KateAndrs points about size and complexity mirror my concerns. BUT offering solutions that don't work and can't be implemented is not very helpful (although there are consulting companies that have monetised this big time).

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