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Rhetoric about fundamental reform is a distraction. The NHS is in deep trouble, but it doesn’t need a big idea to save it. The problems are plain to see: a decade of underfunding, weak capital spending, staff gaps, neglect of social care, a tangled web of priorities and incentives, and more. The fixes are mostly unglamourous and well known: adequate investment and staffing, skills and capacity for improving services, clear and coherent national priorities, and the right blend of policy levers—such as targets, payment systems, regulation—to help achieve them. The experience of tackling long waiting times in the 2000s shows it can be done.27 28 And evidence from a long line of top down NHS reorganisations since 1990 should be a clear warning for politicians dreaming up another round.29 Instead, policy makers should recognise the value of the NHS’s single payer structure for testing and evaluating innovations in care. Reforming the NHS is often touted as the route to improving the nation’s health. Life expectancy has stalled over the past decade, and gaps in health between richer and poorer areas are widening.30 But health and health inequalities are fundamentally shaped by social and economic conditions outside the NHS’s control, such as income, education, and housing.31 32 Public services beyond the NHS have faced substantial real terms cuts over the past decade,33 and some—like social care—are ripe for reform.34 Politicians looking for radical solutions to improving health could perhaps start there instead.