Verma and Bhatia (2016) have made an important case for Canada to embrace the Institute for Healthcare Improvement (IHI) Triple Aim. In England, the National Health Service (NHS) has certainly benefited from the Triple Aim, but a different approach has developed, reflecting the difference in health services between the United States and the UK. The principal difference is that the NHS, like all universal healthcare systems, has an explicit and legally required commitment to cover the needs of the whole population within a defined and finite budget. For this reason, we have been working to not only improve the quality and safety of services, learning greatly from IHI, but also maximize value for individuals and populations.