Final Report > Chapter 21: Introduction > Guiding principles underlying our approach and recommendations > Recognising the complexity of the NHS

Recognising the complexity of the NHS

10 One of the key messages from Bristol which has guided us is the profoundly complex nature of healthcare and of hospitals, and the unbalancing effect of adopting at any given time an approach to improvement which concentrates on one specific, single issue. Not only is the NHS highly complex in its processes and its organisation, but healthcare and medicine are constantly changing, as are patients' needs and expectations. It follows that this Inquiry's Panel cannot anticipate all the challenges which the NHS may face ten or even five years from now. Therefore, our recommendations are intended to be realistic and workable in the near to medium term.

11 There is no `quick fix' to the challenges which we identify. Change needs time and patience. In an organisation as large and complex as the NHS, which has deeply entrenched patterns of behaviour, forged over the 50-plus years of its existence, sustained change for the better will take years, not months. This calls for political nerve. It calls for consistency of direction. It calls not for one-off injections of funds but a significant and sustained increase in resources. It calls for sympathetic understanding, since little of lasting value can be achieved without consent and co-operation. And it calls for a reaffirmation of the values and mission which are ultimately what the NHS is about. Thus we are wary of suggesting what may be seen as grand or iconic gestures whereby the pressure for change can be bought off, but little of substance actually changes. Our approach is more to work with the grain, and to make proposals which are likely to be capable of implementation. Thus our recommendations are a mixture of longer-term `directions of travel' and a series of particular measures which are `bite-size' in nature. Taken together, over time, they can begin the process of reshaping the NHS in the manner which, we are convinced, all those who use and who work in the service would wish.