When I think about the state of healthcare in this country, I sometimes describe myself as both a dreamer and a realist. I’m a dreamer because I can imagine an NHS that works again, one that feels close to the founding vision of 1948. But I’m also a realist because I know that change won’t come from wishful thinking it will come from practical, common-sense decisions about where we spend money, how we organise services, and who we put first.

Right now, the NHS is struggling not just because of limited funding, but because we don’t use the money we do have in the smartest way. Too much of it is leaking out through privatisation and outsourcing, where contracts are awarded to private companies that often provide poor value and fragmented services. We are patching problems rather than preventing them. And in the process, we are losing sight of the community-based healthcare that once made the NHS the envy of the world.

Take A&E departments as the clearest example. They are overstretched, overcrowded, and overwhelmed. People turn up there with issues that could be treated elsewhere not because they want to wait eight hours on a plastic chair, but because it feels like the only option left. If we properly invested in 24-hour walk-in clinics and community health centres, staffed by trained nurses and doctors, we could take the pressure off hospitals. A&E should be for genuine emergencies, not because a GP appointment is impossible to book or the local clinic has been closed.

This isn’t about reinventing the wheel. Other countries have shown what works. Look at the Netherlands: they have made preventative care central to their system. Around 70% of Dutch adults regularly take part in routine health check-ups. That means issues like diabetes, cancer, and heart disease are caught early, treated early, and often prevented from spiralling into life-threatening emergencies. It’s cheaper for the system, and it’s far better for the patient.

We could apply that lesson here. When I was diagnosed with diabetes at 19, I was lucky it was picked up early. If it had been left later, there’s every chance it would have been misdiagnosed as something else, or discovered only when complications had already set in. That’s the story of too many people in Britain today. We end up firefighting late-stage illness when we could have saved lives and money with early intervention.

Another example comes from Australia, where they handle something as simple but crucial as healthcare wages with more foresight than we do. Every three years, they renegotiate pay in line with inflation. That way, nurses and healthcare staff don’t fall behind, and the system avoids endless cycles of strikes. Here in the UK, we lurch from one dispute to another, with exhausted staff having to fight tooth and nail just to stop their pay slipping backwards. It’s demoralising, and it drives people out of the profession. If we had a model like Australia’s, we’d have a more stable workforce and patients wouldn’t be caught in the crossfire of political stubbornness.

This is what I mean by common sense. None of this requires ripping the NHS apart or funnelling more money into private firms. It requires us to stop wasting money and start spending it smarter. For example, why are we paying billions to outsourcing companies when in-house NHS services could do the job better and more cheaply? Why are we still using management consultants on six-figure contracts to tell frontline staff how to do jobs they already know how to do? That money could be paying for more community nurses, more GPs, more diagnostic hubs—things that actually improve patient care.

Of course, funding does matter too. We cannot ignore the reality that an ageing population, more complex conditions, and rising costs all put extra pressure on the system. But we should be honest with people: money alone won’t solve this. Without reform, every extra pound we put in risks being swallowed by inefficiency. Reform has to mean putting patients and communities back at the centre.

The truth is, the NHS doesn’t need another top-down reorganisation cooked up in Whitehall. What it needs is a return to its roots care close to home, accessible to all, designed around prevention rather than crisis. It needs investment in people: doctors, nurses, carers, and community health workers. It needs fair pay settlements that are automatic, not dragged out in disputes. It needs less bureaucracy and fewer middlemen draining away resources.

Most of all, it needs leadership that is willing to admit the obvious: the NHS is broken, but it can be fixed if we’re brave enough to act. The Tories won’t do it. Labour shows little appetite for real reform. That leaves it to us in the Liberal Democrats to make the case for common sense. We can’t just tinker at the edges or throw slogans at the problem. We need to lead with practical, workable policies that put communities first.

I believe in the NHS not as some abstract idea, but as a lifeline I’ve seen in my own life and in the lives of those I serve. It is part of the social fabric of this country, but fabric wears thin if you don’t look after it. We have a choice: let it fray until it unravels completely, or stitch it back together with care and common sense.

For me, the choice is clear. The NHS is worth rebuilding. It’s worth fighting for. And with the right ideas many of which are already out there we can make it once again the envy of the world.

* Mo Waqas is a vice chair of the Liberal Democrats' Racial Diversity Campaign and was the PPC for Middlesbrough and Thornaby East.