Guest Editorial > Why reforming the NHS doesn’t work: The importance of understanding how good people offer bad care. By Valerie Iles



Why reforming the NHS doesn’t work: The importance of understanding how good people offer bad care. By Valerie Iles | Lynn Young

This gem of a book is an absolute must read for everyone involved in health care in the UK. In her fascinating review, Lynn Young explains why ...

Why reforming the NHS doesn’t work: The importance of understanding how good people offer bad care.  By Valerie Iles



It was my good luck to enjoy a long career immersed in community and primary health care services. Health policy and practice issues relating to the strange, though intriguing world of health and health care outside the hospital consumed much of my energy between 1991 and 2012. During this time there were, in many peoples’ views, far too frequent NHS reorganisations ordered by Tory, Labour and Coalition Governments. While I was politically naive in my early days, by the time retirement beckoned whole scale despair over the hopelessness of NHS reorganisations demanded by the Governments of the day had taken over. So, for this reason as well as reaching a certain age it was time for me to go.


But, enough about me, here is an elegantly written and refreshing book which offers wisdom and clarity on why, for the main part, reforms fail time after time to bring the benefits to health care which the designers of reforms yearn for. For a number of reasons they tend to miss the point, are a financial waste and take up human energy which could be far better used in that most worthy of endeavours – that of health and health service improvement.


My great wish is for this gem of a book to be taken seriously by politicians, policy wonks and health managers. The insight and knowledge shown by the author and fellow contributors is impressive, offers its readers the opportunity to understand better why structural change fails and what needs to happen to health care workers if we are to have trust and faith in our NHS.


‘Why reforming the NHS doesn’t work’ is timely for a number of reasons; to name but a few – the Francis Report, the drive to enhance compassionate care, the challenge of meeting the needs of an older population and ever increasing technology within the inevitable financial constraints. Wouldn’t it be wonderful if the people who have the power to reform the NHS, including Professor Don Berwick, took time to read and inwardly digest this book? It needs to become the NHS bible, an essential read for all health-related student clinicians and managers as well as those who have been working in the health industry for a number of years. The mantra flowing through Isle’s book is that it is attitudes, relationships and behaviors which are crucial to excellent health care, rather than marketisation, tendering, competition and the demolition of organisations which were set up, only to be knocked down after a relatively short time.


Here is a book which gives us more normal folk (rather than experts, such as the author and contributors) a heartfelt but equally forensic explanation of the human reality of the NHS which sits some distance away from today’s spin, headlines and ministerial announcements.


It is remarkably devoid of pseudo management speak, the writing style is truly elegant in terms of simplicity, humanity, emotion, while at the same time being wildly intelligent. During these days of contracts, audits, bench marks, indicators, incentives and tenders the spirit is lifted when people have the confidence and conviction to write about the need for staff to flourish, to question the perceived added value of choice, how ambition can reduce humanity and the essential requirement of respectful relationships between colleagues. The warmth of human kindness and what it brings to the patient and staff experience shines throughout.


Perhaps you have gathered by now that I am a huge fan, who has a strong belief in the potential improvement which could be achieved through spreading and adapting behaviour according to the Iles et al mission.


And maybe, hopefully, this review in a small but sincere way justifies the intellectual rigour, humanity and emotional intelligence so ably expressed in this diamond of a book – the most superior by far of anything else I have read on the NHS in the last twenty years.


My congratulations go to Valerie and her fellow learning set colleagues for sharing their experience, honesty, talents, dedicated work and integrity. Just a thought, have copies been sent to Richmond House?


Lynn Young


This book can be downloaded here:

Lynn Young can be contacted at

Valerie Isles can be contacted at