+44 (0)20 7799 6677

‘Modern Miracle’ Needed For NHS White Paper to Succeed – Sir David Varney

Gordon Brown’s former head of public service transformation, Sir David Varney, today writes in a piece for the independent think-tank Civitas that risks in the NHS White Paper, to be cemented in the Health Bill released today, have been underestimated or ignored. In Risk, ‘Equity and Excellence’, Varney writes:

‘The crucial point is the White Paper does not focus on the potential risks the reforms create and how these risks might be mitigated. Instead, the document appears to believe that noble ends will suffice. It pays little attention to the history of NHS re-organisations, nor does it have much time for reflection on lessons learnt.’

Ignoring the cost of upheaval

Sir David draws attention to three key concerns:

  • A failure to account for the potential impact of the NHS’s culture to ‘undermine structural reform’. Instead the White Paper assumes structural reform will change culture. (p. 3)
  • The elimination of Primary Care Trusts, the NHS budget-holders, by 2013 in favour of new consortia of GPs, at a time when the NHS is required to meet unprecedented efficiency savings. There is ‘no real quantification of the potential impact of this’. (p. 4)
  • The necessity of ‘major changes in behaviour, and a much greater understanding of core business’ if all NHS trusts are to reach foundation trust status by 2013/14 . Mergers are not an attractive solution. (p. 2)

Ignoring lessons learnt the hard way

Drawing on his experience of major change programmes in the private, voluntary and public sector, Sir David suggests:

‘When all risks are placed together, I am left with the feeling that for the White Paper to deliver as promised would constitute something of a modern miracle.

‘If the risk were assessed, I suggest the Government would realise that means other than structural change tend to be more effective in changing cultures, such as seeking to mobilise and engage colleagues to learn from “positive deviants” who are delivering superior outcomes today.’

For more information contact:

James Gubb on: 079 3024 3570

Civitas on: 020 7799 6677 or

Notes for Editors

i. Sir David Varney was: chair of Barking, Havering and Redbridge NHS University Hospitals Trust (January-June 2010); advisor to the prime minister on public service transformation (2007-2009); chair, HM Revenue & Customs (2004-2006); chair, MM02 (2001-2004); chief executive, British Gas (1996-2000); and has held various posts at Shell, including head of oil products Europe (1968-1996). He is writing in a personal capacity.

ii. Risk, ‘Equity and Excellence’: A commentary on the NHS White Paper can be downloaded below.

iii. James Gubb is director of the health unit at Civitas, a post he has held since 2007.

iv. Civitas is an independent social policy think tank. It has no links to any political party and its research programme receives no state funding. Civitas’s health policy research seeks to take an objective view of health care in Britain. It aims to offer an improved perspective on how best to deliver equitable and high standards of health care for all.

Download Associated PDF


Keep up-to-date with all of our latest publications

Sign Up Here