Thread by @nedwards_1

THREAD: The PM is making a speech about money for the NHS and will be on #Marr tomorrow. It’s likely there will be a shopping list of reforms requested in exchange for the cash. But what have we learned about previous calls for reform in return for money?

1/9: When promising reform, don’t assume that all the new money can be used for new initiatives in the NHS. There is often a need to repair the foundations and plug financial and quality holes after years of underspending. More on this from @sallygainsbury on Monday

2/9: Beware of the planning fallacy – NHS reform proposals often contain unrealistic assumptions about the time required and the costs involved. This is often linked to failing to understand the need for headroom and spare capacity to create change.

3/9: Beware of techno-optimism – technology is going to make a big difference to healthcare but policy makers must be careful about magical thinking, timing and the exact nature of the impact (see 2/9)

4/9: Promise increased efficiency but remember that the NHS has become more efficient as it has had its funding squeezed. There may be a drop when more money comes in. Getting more efficiency improvement now requires service redesign, not just working harder.

5/9 A narrow focus on single disease areas or eye-catching targets can mean neglecting the need to strengthen the whole healthcare system. Related to this is the need to avoid one size fits all policy prescriptions for complex services.

6/9 Plans have often neglected the need to develop the workforce required to deliver the plan, including skills in actually managing the process of change - leads to too much central direction & consultancy spend

7/9: Structural change usually costs more and achieves less than promised, leads to a loss of talent and delays real reform by years

8/9: Beware of returning to previously stalled ideas without understanding why they did not prosper – personalisation, personal budgets, reducing admissions, etc

9/9: Reforms need to capture the enthusiasm and support of staff, not be seen as a burden or imposition - this is probably the most important of all

What have I missed?