We can’t fix the NHS with bigger cheques alone...

But the real crisis in the NHS isn’t just about bigger budgets, it’s about how we use the money we have already got.

The NHS is still largely built on a 1940s model, designed for short-term illness and a much younger population. Today, the system is creaking under the weight of chronic conditions, rising demand, and a workforce stretched to breaking point.

Yet the solutions we keep reaching for are the same: squeeze more out of hospitals, rather than rethinking how care is delivered.

Take the latest productivity figures. NHS England reported that hospital productivity rose by 2.7% last year - an impressive achievement. But waiting lists barely moved. That’s because hospitals aren’t the place where this battle will be won.

We can’t keep firefighting in hospitals and expect waiting times to fall. We need to ask why so many people end up in hospital in the first place and start doing more to prevent it.

The truth is, many patients are referred to hospital not because it’s the best place for them, but because it’s the only option the system allows.

A GP or paramedic may be unsure what to do, and without rapid access to specialist advice, hospital becomes the default. It feels safest, but it often turns out to be unnecessary.

With the help of technology, frontline clinicians can speak to hospital consultants for Advice & Guidance in seconds. Half of those conversations result in patients avoiding unnecessary admissions or referrals altogether. It’s proof that with the right tech and a bit of system redesign, we can manage more care in the community and reduce pressure on hospitals from the start.

To its credit, the Government has started investing in this direction. The £200 million allocated for new Neighbourhood Health Centres is a promising move. But unless these centres are embedded into local pathways, with the right technology and clear incentives, they’ll remain underused.

The real blocker is not a lack of tools. It’s the way we fund and measure care. Right now, hospitals are paid to see patients. There is no financial incentive to work differently, no reward for helping patients avoid hospital when appropriate. While GPs are now paid to seek specialist advice, most hospital teams aren’t paid to give it. That needs to change.

It’s not enough to pour money into the system. We need to spend it wisely - backing solutions that shift the centre of gravity away from hospitals and towards smarter, earlier intervention. That means rewarding consultants and Trusts for what they prevent, not just what they deliver.

We’ve had years of sticks: targets, pressure, and short-term fixes. If we want lasting change, we need the carrot. Because the real question isn’t how much more we can spend. It’s how much better we can use what we’ve already got.

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Kat James is managing director of Consultant Connect. She has worked with the NHS for the last 7 years to design and deliver clinician-to-clinician communication pathways.

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