Reform Failure: Lessons from the history of health service reforms – and how not to repeat them

Despite broad agreement that public services should be more preventative, integrated and people-centred, reform too often stalls when it meets the realities of government. Drawing on three major waves of NHS reform since 2000, this report explores why ambitious reform agendas so often fall short in implementation.

Published as part of Demos’s Powering Public Service Reform programme, the report uses the 10 Principles for Liberated Public Services to assess both the ambition and delivery of successive NHS reforms. It argues that while the language of reform has evolved towards more relational, locally empowered public services, entrenched systems of central control, fragmented accountability and short-term incentives continue to hold back meaningful change.

The report identifies practical lessons for implementing the NHS 10 Year Health Plan and sets out recommendations to help build the system conditions needed for lasting public service reform. As part of the wider Powering Public Service Reform programme, it contributes to Demos’s work to understand and overcome the deep, systemic barriers that prevent reform from taking root, helping build a more preventative, joined-up and citizen-centred state.