Save the NHS from decay with a simple KISS

Parkinson's third law says 'Growth leads to complexity, complexity to decay'. It couldn't describe the NHS better - expensive, inefficient and grinding to a halt.

The treatment for over-complexity starts with an acronym - KISS: 'Keep It Simple, Stupid'. This covers three areas: structure, consistency and control.

A simple structure means a single, uniform NHS across the UK, with the DoH at the top and the primary care organisations (PCOs) locally. No need for regional committees or strategic health authorities - they just complicate communications and delay action.

KISS means simplifying the internal organisation of the NHS, to remove overlaps and turf wars. How many spheres of activity currently have two or more separate bodies governing them?

Simplicity also means consistency: rules and protocols should apply throughout the country. No postcode lotteries: treatments should either be available nationally or not at all. Mostly we don't need both national and local committees. Major policies and protocols should be generated centrally, so no one wastes time reinventing the wheel.

Simplifying the NHS means having fewer managers, faster communication and quicker decisions. This saves time and frees money for productive work. It will also improve morale among healthcare staff - if nothing else, by increasing the professional workforce.

Simplicity of control means, wherever possible, making the NHS automatic and self-correcting. Usually this means allowing market forces to act: this is the simplest way to reward workers, the most subtle way to distribute resources, and the most sensitive way to monitor activity, because it all happens automatically (provided there is adequate capacity in the system as a whole). Remove all traces of a command economy - no centrally set hospital tariffs, for example. Simplify payments in primary care using a formula which is truly workload sensitive and properly funded.

Finally, how can each of us help the NHS? When we are asked for management input, think 'KISS'. Support management proposals that are simple and self-regulating. Don't try to dot every 'i' and cross every 't', because you'll risk gumming up the works.

So if you value the NHS, KISS it better!

- Dr Lancelot is a GP from Lancashire. Email him at

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