Jake Waterfield: The NHS saved my life, and showed me it is need of real reform

I was failed by the NHS – and now I owe my life to them. That contradiction has shaped my view of reform, not as an ideological exercise, but as a deeply personal imperative.

This April, I ran the London Marathon to help raise money for the NHS trust that helped save my life. In November 2023 I had open-heart surgery at St Bartholomew’s Hospital in Central London and, if I didn’t appreciate it already, a 7-hour operation and recovery period in the hospital proved to me how capable and professional our doctors, nurses and healthcare staff are up and down the country. To those people I owe my life, and raising money for them was the least I could do.

However, this anecdote has a slightly more veiled history. The aforementioned surgery was to help fix a serious congenital heart defect – that is, a defect I was born with. A defect that was present in me as a child, through all initial birth screenings, and early health check-ups, and despite how serious the issue was, it was never picked-up. Over 50 per cent of those born with my condition die in early infancy, with the rest dying in their teens and early twenties. I was 26 on the day of my operation; alive only through some luck and a broadly healthy lifestyle.

The whole experience has left quite a strange taste in my mouth. On the one hand, it is clear to me that our NHS is outstanding when it comes to solving the big stuff. I had the option to have the operation privately, but I chose to go under-the-knife with the most capable, most experienced doctors in the country – and they’re in the NHS.

Conversely, it’s this very system that allowed me to slip through the cracks, because it’s bad at the everyday bits that a large majority of the population rely on it for: overwhelmed GPs, endless waiting lists, and reactive policies all contribute to an institution that is out of its depth. The ironic thing is, it wasn’t the NHS that picked up my issue, no, that was GlaxoSmithKline, a private profit-seeking Company, whom I went to for a health check up as part of a medical drug trial. And I think this is the heart (pardon the pun) of the issue – the NHS is too reactive and, inherently, behind the curve.

To be clear, we don’t need more spending, we need smarter spending. Not more centralisation, but intelligent decentralisation. Not knee-jerk performance metrics, but meaningful accountability. Our public services should be proactive and held accountable to outcomes, not effort. The UK spends over £180 billion annually on healthcare, yet up to 80 per cent of chronic conditions are preventable or manageable through early intervention – a staggering mismatch between cost and strategy.

If we’re to strengthen the NHS, we must do so through principles grounded in conservatism: fiscal prudence, decentralised governance, and personal accountability. But how do we actually do that?

1. Emphasise value for money, restraint in public expenditure, and long-term sustainability:

• Replace activity-based funding with outcome-based budgeting, ensuring NHS money supports interventions that produce meaningful health results
• Invest in predictive analytics and preventative care to reduce expensive emergency treatments and improve cost-efficiency
• Encourage competitive innovation through localised NHS pilots allowing market-style experimentation to identify best practices.

2. Prioritise personal responsibility, transparency, and performance, whilst utilising competition and incentives to drive improvement:

• Replace vague tick-box KPIs with patient-centred metrics – measure genuine recovery, early detection rates, and reduced readmissions
• Create real-time dashboards so taxpayers can see how their local NHS trusts perform. There is nothing worse than feeling like your tax is falling into a pit of anonymous spending – we should invoke consumer-style transparency
• Introduce performance-linked incentives for trusts that successfully reduce acute admissions through preventative care.

3. Favour localism over-centralised bureaucracy:

• Empower trusts to design services suited to local populations, shifting power away from Whitehall
• Expand community diagnostics hubs to bring care closer to homes, reducing hospital pressure and allowing earlier intervention

To me, policing in this country offers a clear parallel. I live in central London and it’s clear that if someone commits a major crime, the police will take it seriously – and this helps to contribute to London having one of the lowest murder rates of all major global cities. However, as we all know too well, everyday crimes such as shoplifting, nicking phones and bike theft, to name just a few, are all too prevalent and almost left uninvestigated (but that’s a story for a different article…).

The best police officers prevent harm before it happens. They intervene early, adapt to circumstances, and respond with empathy as well as authority. That’s the kind of mindset we need in every corner of public service – especially our NHS: strategic, individualised, and emotionally intelligent. Sometimes it’s a phone call, a home visit, or simply noticing what others ignore, and yet our current structures don’t always allow for this. Bureaucracy favours paperwork over impact.

There are those who see the NHS as sacrosanct and resist even modest reforms, others see public services as wasteful by default. But my story sits in the middle – I was failed, then saved. That contradiction is real, and reform must live in that space. It must be brave enough to critique without condemning, and ambitious enough to improve without destroying. We talk a lot about “levelling up,” but we rarely talk about levelling early.