Quick Wins & Quiet Fails: 10 NHS Reforms That Shouldn’t Be Controversial

 

For a system often described as “on its knees,” the NHS could stand tall if it stopped stumbling over low-hanging fruit. While politicians promise mega-hospitals and AI miracles, some reforms are quietly waiting to be picked off the floor. They’re small. Affordable. Pragmatic. And they remind us: the future of public health isn’t always about innovation—it’s about execution.

Here’s the list.

1. Fax Machines—Time to Cull the Dinosaurs

Over 8,000 fax machines were still active in NHS trusts as recently as 2019. While efforts to eradicate them began, full digitisation stalled post-COVID. Why? Procurement gridlock, outdated security policies, and leadership hesitancy.

Quick win: Mandate electronic referrals and internal messaging across all trusts by April 2026. Zero fax tolerance.

2. Scanners per Hospital—A 10-Year Freeze

The UK ranks lowest in the OECD for scanner availability: just 10 CT scanners and 8.6 MRI machines per million people. Many hospitals still operate 1 scanner per 1,000 beds—often over 10 years old.

Quick win: Equip all major hospitals with minimum 2 modern scanners per 500 beds, prioritise AI-enabled systems.

3. Queue Transparency—Where’s the Real-Time Data?

NHS waiting times for diagnostics and treatment vary wildly by region. Yet patients often navigate blind: no live dashboards, postcode-level comparisons, or queue position updates.

Quick win: Introduce dynamic waiting time maps—geo-visualised by trust, specialty, and urgency.

4. The 8am Appointment Scramble—A Ritual of Inequity

GP practices still drop daily appointments at 8am sharp, creating stress, inequality (for shift workers and carers), and clogged phone lines.

Quick win: Transition to 24-hour digital booking, triage by symptom severity—not speed-clicking.

5. Seven-Day Week Services—Reform Without Staffing

Community Diagnostic Centres promise 12-hour, 7-day service. But radiologists and diagnostic staff are 30% short nationwide. The model exists—but the muscles don’t.

Quick win: Link scanner investment to staffing guarantees, not just infrastructure grants.

 6. 8am–8pm Neighbourhood Care—Success in Pockets

The extended-hour care model is proven in pilots—but patchy elsewhere. Many patients still face walk-in clinics closing before 6pm or GPs unavailable on Saturdays.

Quick win: Make 8am–8pm care the contractual default for new Neighbourhood Health Centres.

7. Physician Associates—Clear Roles or Creeping Confusion?

Over 4,000 Physician Associates operate within the NHS—but many lack defined scopes, aren’t regulated by GMC, and risk confusion with junior doctors.

Quick win: Publish national PA scope framework with governance, training tiers, and patient info leaflets.

8. Hospital Car Park Fees—A Tax on the Vulnerable

Despite reductions in England since 2020, car park charges still exist in over 100 trusts. For regular visitors or patients with chronic illness, it’s a financial punishment.

Quick win: Scrap all public-facing hospital parking charges—cover costs via procurement savings or access levies for private contractors.

9. Amina Web Portal Closed—Where’s the Replacement?

The closure of Amina, once used for patient access and trust transparency, has created a data vacuum. There’s no unified successor.

Quick win: Launch PublicCare v2.0: a centralised NHS web platform for appointments, queries, and trust-level service metrics.

10. Second NHS Website? Fragmented Digital Identity

Multiple NHS portals exist—, NHS App, trust websites—each with overlapping functions. For patients, it’s confusing. For reformers, it’s a branding nightmare.

Quick win: Consolidate core functions under one umbrella and sunset outdated portals.

From Measles to Mone: How NHS Reform Forgot Its Public

When NHS web portals close quietly—like Amina did without a national successor—something larger collapses too: public identity. These portals aren’t just digital tools. They’re civic mirrors. And when they vanish, what else do we lose? Access to appointments. Transparency of wait times. The digital handshake between trust and citizen.

Now layer that onto a system where surgery hours remain as rigid as post-war rationing, and dentistry has become the most glaring postcode lottery in public health. In 1948, the NHS launch guaranteed “care free at the point of use”—and yes, it included dental and optical services. Fast-forward to 2025, and you’re lucky to find an NHS dentist within 50 miles if you live in Liverpool, Hastings, or outer Kent.

Digital booking systems exist, but unevenly - what website except Amina would close(!) with surgery hours? Utter madness. Dentistry deserts worsen chronic health issues. And community health centres, while promising in pilot form, remain underfunded and inconsistently deployed.

Where’s the push to integrate 8am–8pm neighbourhood care into every borough? The data’s been piloted. The demand is obvious. Yet delivery limps.

Public Health as a Political Afterthought

Let’s talk about Liverpool. Once a bastion of municipal health innovation, it now hosts some of England’s worst measles outcomes due to public health service attrition. Between 2012 and 2022, £1 billion was culled from council-based health budgets. That’s everything from vaccination outreach and TB screening to pest control and prenatal services.

This isn’t theoretical. In 2023, Liverpool saw its highest measles death count in decades and deaths of 2 children. Not because of vaccine refusal—but because local health infrastructure couldn’t reach people - and 73% vaxx coverage not the full-fat WHO 95% was somehow brushed under the carpet. Public health wasn’t “too expensive.” It was too quiet to protect.

Pandemic Memory: PPE Scandals and What Comes Next

As we plan for the “next pandemic”—a term now comfortably used in policy memos—the shadow of Michelle Mone’s PPE profiteering still hangs heavy. £200 million in contracts, £29 million in profit, offshore holdings, all while frontline staff repurposed bin bags and ski goggles.

Where’s the national pandemic prep audit? The risk registers, the public procurement scorecards, the citizen watchdog dashboards?

Where’s the FOI-accessible supply chain map that shows who’s delivering masks and swabs in 2025? We’ve learned little—at least systemically.

 Final Thought: Reform Begins with Recognition

From measles spikes to digital decay, from dental deserts to PPE scandals—these aren’t crises of technology. They’re crises of priority and philosophy. If the NHS is to be rescued, it won’t be by billion-pound AI systems. It’ll be by small reforms that remember the public exists.

A website. A weekend surgery. A working scanner. A car park that’s not £16 per day. A canteen meal for patients/visitors that isn't more expensive than staff meals. Or vending machines of chocolate and crisps. The next pandemic will come. The question is: will dignity arrive first?