Document Type: Perspective
College of Human and Health Science, Swansea University, Swansea, UK
Swansea Bay University Health Board, Swansea, UK (retired)
Throughout the United Kingdom, the National Health Service (NHS) struggles to meet demand and achieve performance targets. Services need to work with individuals and communities to reduce avoidable disease and dependence. All four UK nations have separately realised the need for change but 20 years’ experience suggests that vision and rhetoric are not enough. Success requires reformed systems and changed leadership behaviour to enable frontline staff to break the status quo. Top down, target driven behaviour must be replaced with a real focus on improvement, championing those who have the knowledge to deliver it.