Guest editorial Thursday 26 October 2017: Why the NHS should be run by a US sports league, by CCG Cassander

Twitter legend CCG Cassander has welcomed me back to Health Policy Insight duties with this guest editorial: his brilliant suggestion for fresh transatlantic learning opportunities for the NHS

As I write, much digital ink is being spilled over a proposed “NHS Airbnb” scheme, where private landlords would be paid to provide rooms to recovering patients.

In these uncertain times it’s comforting to know there are still bastions of reliability: the Twittersphere have been making the same joke, whilst LBC’s listenership have deduced that Those Foreigners are to blame.

The attention on NHS Airbnb will inevitably subside - at least until the first convalescent finds themselves discharged into a local production of Misery. Perhaps, though, this is a sign that we are moving back into one of those eras of health policy where the solution to every NHS problem is a concept imported from America.

If this is the case, I have just the transatlantic panacea: the NHS should be run like a US sports league.

For the uninterested observer, it may come as a surprise that competitive sport in the land of rugged free-market individualism is run along very collectivist lines.

There is no promotion or relegation in any of the major sports leagues; each team must keep their spending on player wages below a salary cap; and TV money is split equally among all teams.

Massive organisational upheaval
How could this benefit the NHS? Through a simple process of massive organisational upheaval. The NHS is coming to the end of a protracted process of trusts becoming more autonomous as they achieve “Foundation Trust” status. This should be reversed.

Instead, each NHS trust would be grouped into a Conference, determined by the type of service it provides. There would be an Acute Conference, a Community Conference, an Ambulance Conference, et cetera.

“Conference” is an ideal word for these groupings - not only is it authentic US sports terminology, but it would also lower the Google search rankings of the companies who organise NHS conferences (none of whom are brave enough to allow me to explain my paradigm-altering ideas at their events).

Within these Conferences would be geographical Divisions - a Home Counties Division, a London Division, a South West Division, and a Northern Division which would start at Watford. Trusts in a Division would compete with each other based on existing performance targets, with league tables updated every week.

Wasn't meant to follow
Staffing would also be overhauled. Each NHS trust would have a salary cap, with a minimum quota of each group of staff. Each year, graduating healthcare professionals would apply to enter the NHS Draft, a weekend-long event when trusts would take turns in picking new recruits.

The lowest-ranked trusts would get to pick first in each round, meaning that people might actually be happy that their local hospital was currently a low performer, because there’d be a chance of them drafting a dashing young Oxbridge doctor.

To help the trusts know who they should draft, there would be an annual Combine. In US sports, the Combine typically involves running, jumping and lifting weights.

This would need to be adapted to something more NHS-appropriate. Prospective surgeons could compete at a particularly twisty steady hand game, or whack-a-mole if they were going into orthopaedics.

Perhaps best of all would be the opportunity to liven up NHS branding. With the shining exception of 2gether NHS Foundation Trust, NHS organisation names are dour and functional.

Why be Wrightington, Wigan and Leigh NHS Foundation Trust when you could be the Wrightington Lightning? The improved names could even be health related: the Fylde and Wyre Femurs, the Isle of Wight Islets of Langerhans, the Skegness Skene’s Glands.

I think this is an idea whose time has come. The National Health Service is closer to being a US sports league than you might think - it already has the three-letter acronym, concern about attendance figures, and simmering racial tensions.

Perhaps the NHS is ready to try a radical top-down reorganisation for a change. Until then, I’ll be working on Uber for ambulances.