Is there anything we can learn from NHS reform?

By Andy Bagnall, Director General, Rail Delivery Group

Even those slightly less obsessed with news than me (I keep telling myself it’s just a healthy curiosity) couldn’t have failed to notice when Matt Hancock recently stood up in the House of Commons to introduce the Government’s White Paper on the Future of Health and Social Care.

An announcement like this would’ve caught my attention at any time. Right now, though, given everything that’s happened in the UK in the last twelve months it made me stop and focus on what the Government was doing and why they were saying they were doing it. On a more personal level, given how imminent the Rail White Paper now is, I’m spending a lot of time thinking about large-scale reform.

I was struck first by the different starting points. With the NHS, it’s hard – less than a decade on – to find anyone willing to speak up for the reforms made by the Coalition Government in 2012. But in rail, the model (or, at least, the model in place pre-pandemic) actually delivered a great deal in the first decade and a half and had only gradually lost its fitness for purpose, to the point where many – obviously including RDG – had been calling for reform.

Listening to what the minister said, I was struck by the objectives for the White Paper he chose to emphasise. He talked about the need to bring different parts of the system closer together, recognising their interdependencies and creating the conditions for far greater collaboration. He talked about empowering those who work in the system. About a focus on outcomes and of the need to embrace technology and innovation. Above all, about the need to serve people.

It’s not much of a leap to apply similar objectives to rail reform. Although the scale of the NHS is far greater than even the railway, they are both complex public services, and they matter – not just to the people who use them but the people who don’t.

Rail needs more collaboration. We need frontline managers to be empowered to make decisions that benefit customers. We need contracts with a far greater focus on outcomes rather than tight specifications – contracts which drive collaboration between track and train. We need a model that incentivises the adoption of tech and innovation – based on the up-to-date data and insight of what our customers’ needs are. And, if we are to genuinely serve our customers, we need root and branch fares and retail reform. We need the Rail White Paper to set out a clear direction of travel in each of these areas.

Of course, there are also clear differences with NHS reform to what I believe is the right way forward for rail. The minister talked about accountability and how “medical matters are matters for ministers”. Of course, rail matters are matters for ministers too. The railway needs government to set out its objectives – not just for rail but for how rail can contribute to wider objectives (economic, social, environmental…). It needs government to be clear how much money is available to deliver those objectives.

But I strongly believe we need a new, genuinely independent national rail body – equally balanced between infrastructure provider and service operator - to take forward the job of developing the strategy to deliver those objectives, and to provide the clear accountability that’s essential. In the past, this has all got a little fuzzy, with the DfT overseeing and over-specifying operators’ franchises and the ORR overseeing Network Rail’s regulatory targets, making a consistent approach to delivering clear strategic objectives much more difficult and making difficult issues much easier to avoid. And with Ministers left having to manage the political fallout.

We don’t know yet if the Rail White Paper will propose a new national rail body, what form it will take if it does and how it will be accountable. But any new body needs to be free from day to day interference from government – we’d certainly be cautious about the language Matt Hancock used like “give direction” and “intervene when necessary” if applied to rail.

This doesn’t mean ministers should set the objectives and the funding and then walk away for five years – clearly that wouldn’t work, as ministers can’t avoid getting involved more frequently and we must be conscious of, but not wholly driven by, the political cycle.

But rail is not just a minute by minute operation, it’s a decade by decade industry, and the best way of securing its future is through a clear strategy that tackles the biggest issues systematically. Decisions taken – for whatever reason – without a clear sense of their strategic value or cost are often bad ones, and the railway has paid the price for this too many times before.

Much of this should be a lot clearer very soon, as we shouldn’t have to wait too much longer for the White Paper to be published. Like many people in rail, I’m champing at the bit to get going – why not, when we have the opportunity to shape a whole industry’s future for decades to come?


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