The start of July saw the NHS celebrate its 60th birthday. It began as a system funded largely by taxes and available to all at the point of need, irrespective of the ability to pay - and, to the envy of much of the world, has basically survived as such through the past six decades. However, outside of this over-riding principle, there have been major changes.
Perhaps the most obvious is that we no longer truly have a single national health service. The differences start at the funding level, with per capita funding (2006/07) ranging from £1,915 in England to £2,313 in Scotland, largely dictated by different levels of deprivation and need enshrined in historical allocation levels.
But the differences continue into how resources are divided up within each country (England is about to unveil a new resource allocation formula) and how the resources are used. For instance, there are significant differences in approaches to prescription charges, care for the elderly and even car parking charges, plus different priorities and performance levels in areas such as waiting times.
In England, we have seen major reforms based on the concept of 'the money follows the patient'. Payment by results perhaps underpins these changes, but practice-based commissioning (PBC), Patient Choice, foundation trusts and independent sector providers also have a major part to play.
An assessment of these reforms is vital if we are to understand what works, I hope enabling cross-fertilisation of ideas across the four home nations. What works in England may not be right for Scotland, and vice versa, but this needs to be based on sound evidence and evaluation.
The Audit Commission and Healthcare Commission made a major contribution to this much needed evaluation by giving a progress report on the English reform programme to date. They conclude that management of the health service has improved under the reforms, although more time is needed to deliver significant benefits for patients.
There are signs, they say, that patients are starting to benefit from a diverse range of providers and that Patient Choice - if only the fear of it - is driving a positive change in attitude among providers. Payment by results and FT status have also improved financial management and improved the clarity around hospital funding.
Of course challenges remain, as the two watchdogs identify. We need greater engagement of GPs in commissioning. We still need to take the opportunities offered by the 'new' workforce contracts to improve productivity. We need to see innovative models of patient care emerging from FTs as originally anticipated. Choice needs to be more universal and commissioning needs to raise its game.
Finance professionals can add to this list. We need to extend PBR to community, ambulance and mental health services, starting with identifying workable currencies. And we need much better data - especially at service-line and patient levels - to help managers and clinicians work together to deliver better, more cost-effective services.
And what is the biggest challenge? Well for me it is to take the more than one million employees through the changes. We should celebrate what the NHS has achieved. But our main focus should be on the future and aiming for a health service that is not only free at the point of need, but as good as - if not better than - those provided anywhere in the world.
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