Category Archives: NHS

NHS Recovery and Productivity: Diagnostics are the place to start

Drawing on his experience as a Health Minister and Chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine argues that diagnostics are the critical but often overlooked foundation of NHS recovery, productivity and prevention.

Diagnostics rarely grab headlines in the way that waiting lists do. Yet during my time as a Health Minister, and later as Chair of the Health and Social Care Select Committee, I came to a simple conclusion – if you want to improve outcomes, reduce elective waits and modernise the NHS, they are the place to start.

The reality is that no patient can begin the right treatment until the clinicians know what is wrong. Whether it is cancer, heart disease or a musculoskeletal problem, diagnosis is the gateway through which every effective pathway runs.

Too often, however, diagnostics are viewed as a ‘supporting service’ rather than the critical infrastructure on which the entire system rests.

That is why I have been encouraged by the development of Community Diagnostic Centres (CDC’s) under the last government and continued under this administration.

The concept is straightforward but powerful; bring scans, tests and investigations closer to where people live, rather than requiring patients to navigate busy acute hospitals. It is one of the clearest examples of the much-discussed shift from hospital to community becoming more than words on a page and something that patients can see.

When I was a Minister, we spoke frequently about prevention and early intervention. Now it’s the talk of the town.

For my money, diagnostics sit at the heart of both. A CT scan, MRI scan or PET scan (Positron Emission Tomography, which is particularly important in cancer diagnosis and treatment planning) is not simply a test. It is an opportunity to identify disease earlier, provide reassurance quicker, and avoid patients deteriorating while waiting for answers.

As Select Committee Chair, I often heard evidence about the pressures facing the NHS workforce and the challenge of delivering constitutional standards. The current debate about the 18-week elective target is important, but it is worth remembering that elective recovery ultimately depends on diagnostic recovery. You cannot clear waiting lists if patients are waiting months for scans, endoscopy or reporting.

That is why diagnostics should be seen as a productivity issue as much as a clinical one. Faster access to tests means quicker clinical decisions, more efficient use of outpatient appointments and better use of operating theatres. Every delayed diagnosis creates friction elsewhere in the system and, most important of all, spikes anxiety in patients. The dreaded diagnosis ‘odyssey’.

The challenge now is ensuring that CDC’s become a permanent part of NHS infrastructure rather than simply a waiting-list initiative. That means investing not only in buildings and scanners, but also in the workforce; radiographers, radiologists etc.

If ministers are serious about restoring performance (which as we will explore further in this series of blogs I am writing for GK Strategy is only part of the story), improving cancer outcomes and delivering care closer to home, it’s hard to look past diagnostics as the place where the next chapter of NHS reform must begin.

Community pharmacy settlement brings stability, but long-term challenges remain

As a former Pharmacy Minister, I watch the annual community pharmacy contract negotiations with interest because I know how important they are. This year’s settlement is notable for one reason above many in that it was agreed! That may sound like a low bar, but in today’s NHS it is anything but.

At a time when ministers find themselves in dispute with almost every part of the health workforce, the fact that Government and Community Pharmacy England have reached an agreement matters.

Negotiation remains preferable to imposition. It provides stability, certainty and, perhaps most importantly, a platform for future reform. The settlement itself is better than many in the sector (including me) were expecting. Indeed, compared with the rest of primary care, community pharmacy has secured one of the stronger funding settlements available anywhere in the NHS.

Minister Stephen Kinnock deserve praise for recognising that pharmacies cannot carry on indefinitely with rising costs. The increase in funding, the uplift in retained medicines margin and the write-off of historic over-delivery all sit on the positive side of the ledger.

But we should be honest about what this settlement is – and what it is not.

It is not a recovery plan. The uncomfortable truth is that a decade long funding gap – which I absolutely take my share of responsibility for – has not been closed. The additional investment announced for 2026/27 is largely consumed by increased activity levels and of course inflation. This matters because while the settlement should help stabilise the sector, I suspect it will not halt pharmacy closures.

There is another challenge too. I have great respect for Community Pharmacy England but there will come a point where it must decide whether it believes a deal is acceptable or not.

Last year, and now this, we hear of an agreement reached quickly followed by explanations setting out why the agreement is not good enough. I understand why this occurs, but it is not a position that can be sustained indefinitely and many in the sector will feel that. Ministers won’t much care so long as it’s done and they will come to rely on that.

At some point, the sector, government and negotiators alike need true alignment on what success actually looks like. The government’s clear priority in this settlement is independent prescribing. As a manifesto commitment and a central part of the neighbourhood health agenda, it is easy to see why ministers are keen to deliver here.

The principle is absolutely right. For years I have argued that community pharmacy is one of the NHS’ most underused assets. Everyone should want pharmacists diagnosing, prescribing and managing more patients – ‘hospital to community’ as they say.

My concern is whether the funding stamped on this settlement will be enough to deliver independent prescribing at a meaningful scale. Training people is vital. Creating the capacity, infrastructure and incentives to make independent prescribing a systemic part of community pharmacy practice is another challenge.

My verdict? This is a better deal than many anticipated and best in class in primary care. It provides some level of stability and demonstrates that constructive negotiation is still possible with this government.

But stability is not transformation.

The question facing us all is whether the settlement represents the first step towards a realised clinical future for community pharmacy – or merely another year spent managing decline, albeit a little more slowly.

This article from Steve Brine also appears at the Chemist + Druggist online magazine.

Treasury to Treatment: James Murray Appointed Health Secretary

As predicted, England has a new Health Secretary – James Murray.

Above all else, he deserves the goodwill that comes with inheriting one of the best jobs in government.

The Department of Health and Social Care is unlike any other brief. It combines immense public affection for the NHS with relentless operational pressure, difficult fiscal realities and an almost impossible expectation that Ministers can ‘fix’ deep-rooted problems decades in the making.

So my advice to James above all else would be this; you inherit a Ten Year Plan (and numerous other strategies) so don’t waste time and try the patience of the sector by re-writing them.

Focus on operationalising them and give your civil servants (as well as Jim Mackie who I suspect will be feeling deflated right now) a very clear steer from day one on your top three policy areas. Not the infamous three ‘shifts’ – they’re the means to the end – but the areas they know you personally will never drift from.

James takes office with a formidable in-tray. NHS waiting lists still high and a media (as well as a sector) that is sceptical recent falls weren’t more about politics than clinical reality.

Access to primary care continues to define the ‘retail offer’ in health, while care reform of course remains the great unresolved question of British domestic policy.

Not to mention a Ten Year Workforce Plan that remains illusive, medicine shortages (which I predict will grow as an issue in 2026) and rising demand because we are living longer, but often not healthier, lives.

And hanging over all of this is perhaps the biggest challenge of all; how we finally move from a sickness service to a genuine health service.

That is why the NHS Modernisation Bill he inherits matters. Much of the early discussion around it has understandably focused on the proposed Single Patient Record — a potentially transformative attempt to join up fragmented patient information across the NHS.

Done properly, this could save lives, reduce duplication, improve productivity and finally give clinicians the information they need at the point of care. Done badly, it risks becoming another expensive digital programme which loses public trust before it delivers meaningful change. The new Secretary of State will need Number 10 (whoever occupies it) to back him fully when the going gets tough.

But the Bill goes wider than that. It is likely to include measures aimed at modernising NHS structures, expanding the use of technology and AI, improving data sharing, reforming procurement and accelerating innovation adoption. And that’s before Labour MPs, increasingly keen to reject incrementalism, get their hands on amendments come the Bill Committee stage.

The challenge, of course, is delivery. Every Health Secretary arrives in office promising reform. Most discover the system is better at absorbing change than enabling it.

The NHS is enormous, complex and deeply institutionalised. Structural reform alone rarely changes outcomes unless accompanied by cultural change, workforce support and political honesty about priorities.

And that brings me to Wes Streeting. I know how hard it is to leave that Department so it can’t have been easy.

Politics is often too tribal to acknowledge effort when people leave office or move on from major briefs. But it is right to recognise the energy, seriousness and determination Wes brought to the health debate.

Whatever one’s politics, he helped force difficult conversations into the open — about productivity, reform, prevention and the need for the NHS to modernise if it is to remain sustainable.

Wes deserves credit for that as well as the HIV Plan, the Men’s Health Strategy and some lesser noticed progress around things like the Rare Diseases Plan or England (finally) testing newborns for Spinal Muscular Atrophy as a result of his work with Jessy from Little Mix.

The new Health Secretary will quickly discover there are a thousand competing voices telling him what matters most.

My hope is that, amid the noise, he keeps sight of a simple truth: the future sustainability of the NHS will depend not only on how we treat illness, but on how seriously we take the business of creating a healthier society in every sense of the word. We should all wish him nothing but success.

Steve Brine, consultant, podcaster, trustee, former MP for Winchester & Chair of the Health Select Committee

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