Sarah: You’ve got to really want to help people

Board games: Harkness is a finance professional who has served on NHS boards for 20 years.

What is the future of the NHS? Sarah Harkness is on the board of NHS Improvement. She talks to The Day about management, social care, and how to finance the NHS with an ageing population.

When talking about the NHS, there are three true things that you must keep in your mind at all times, says Sarah Harkness, a non-executive board member of NHS Improvement — the body that oversees NHS trusts in England.

1/ The NHS is the envy of the world. Nowhere else gives free, NHS-standard care to every citizen and “that is a remarkable thing.”

2/ It is not run as well as it should be. It is inefficient and it can be wasteful.

3/ No matter how much money it has, “it will never be able to do all of the things that people want it to do for them.”

Harkness works three days a month for the NHS. A typical board meeting involves approving budgets for various NHS trusts, and making sure that they are running safely. But she says her best moments are when she gets to visit hospitals in person.

“Most recently I visited a youth mental health facility in Oxford,” she said. “I was shown around by two teenage girls. I was blown away by their enthusiasm for the service... It leaves you feeling very proud.”

However, there are hard moments too. The worst is when a damning report comes out about failings at a particular trust. She remembers reading about the Morecambe Bay hospitals scandal and says it is “heartbreaking” to learn that “while we’ve all been sitting in a boardroom, some people out there haven’t been treated properly.”

Harkness says she thinks it is “inevitable” that taxes will rise to keep funding the NHS. She suggests that older people who use the NHS most should be taxed more, “rather than placing the burden on young people.”

She says it is also vital to combine the NHS and social care budgets. “If you cut £1 from social services, you’re essentially cutting £5 from the NHS; it costs five times as much to look after somebody in hospital as it does in a care home.”

Does she have advice for people who want to go into NHS management? “You have to really want to make a difference, in order to put up with everything the public throws at you.” She also says that, in her experience, the best managers come from a medical background. “A nursing degree can get you through any door.”

How will the NHS look at 100?

It will still face the problems of an ageing population, says Harkness. “As technology advances and we cure more 50-year-olds of cancer, there will be more 80-year-olds with dementia who need looking after.” Hopefully, patients will be given more say in their own care, which is “one of the best ways to cut waste.” And finally, gene therapy will change everything. “I have no idea how it works,” she laughs, “but everyone I talk to tells me that it will transform the way we look after everyone — from adult cancer patients to babies with immunodeficiency.”

You Decide

  1. Do you agree that older people should be taxed more to pay for the NHS?
  2. Is the NHS getting better or worse over time?


  1. Imagine that you sit on the board of NHS Improvement alongside Sarah. Write down the three suggestions you would make to improve health care in the UK.
  2. Research gene therapy and create a leaflet or a poster that explains how it works, and the impact it will have on medicine.

Some People Say...

“Healthy citizens are the greatest asset any country can have.”

Winston Churchill

What do you think?

Q & A

What do we know?
The NHS has gone through a number of restructures and reforms in recent years to improve its efficiency. NHS Improvement was founded in 2016 to merge together five previous organisations that dealt with things like patient safety and “advancing change”. Its website says its priority “is to offer support to providers and local health systems to help them improve.”
What do we not know?
How many more reforms the NHS will go through over the next few years. While some are calling for major restructures — such as bringing it far closer to social services, as Harkness suggests in this article — no firm plans have been announced by the government. However, last month it was announced that its funding will increase by £20 billion per year for the next five years.

Word Watch

NHS Improvement
An organisation that oversees NHS trusts (see below) and foundation trusts. It helps to approve budgets, sets standards of care, and holds health care providers to account when things go wrong.
NHS trusts
NHS England is split into NHS trusts and foundation trusts. These function as independent organisations within the NHS. They are generally based on geography (for example, the Isle of Wight NHS trust) or a particular service (such as the London Ambulance Trust).
Morecambe Bay
In 2015, an inquiry found that a “lethal mix” of failures at the Morecambe Bay NHS Foundation Trust led to the deaths of 11 babies and one mother over nine years.
Five times
A rough estimate. The average cost of an NHS bed is £400 per day (or £2,800 per week), while the average cost of a care home bed is £600 per week.
Gene therapy
When missing or deficient genes in a patient’s cells are replaced with new, working genes.
When a patient’s immune system, which helps them fight off infections, is not working properly.


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