Whither Our UK NHS ? Consultation Responses
Editor's note: I can now confirm from personal experience that the situation with respect to availability of 'routine' appointments is truly dire.
I attempted to book one at our local GP practice over the counter yesterday and was told '...sorry, there are no available appointments on my system'. An attempt today to book an appointment online via the SystmOnline software our practice uses for bookings showed no appointments available in the period where booking was available, ending mid-September (i.e. at least an 8-week wait!).
This is clearly unacceptable and confirms that a policy of 'Rationing by Availability' by the NHS is in force. On the basis of recent media reports, I suspect this is country-wide and not just an isolated case.
The government has emphasised the need to keep the population healthy to help the NHS, and we are regularly encouraged not to delay if we detect anything 'out of the ordinary' with our health, as this could indicate a serious underlying problem.
How on earth does this square with a complete unavailability of any opportunity to provide this information to our GPs ?
It's one way of reducing the 'excess' elderly population, I suppose.....
Self-treatment would therefore appear to be the only option. Hope I'm successful......if not, this blog may finally go quiet....
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The NHS has never been more ripe for reform. I published my ideas on this initially in a 2022 blog,
and the content has been updated periodically to take into account such progress as
was made by the previous government.
The present government has accepted that the service is 'broken' (all the fault of the Tories of course!) and decided to request input from the public and NHS staff
before attempting to implement any major reforms. This was a welcome development
and did the new minister and his department credit. However, in the interests of
openness we need to ensure the responses are actively considered, and where
appropriate, acted upon. There needs to be a mechanism for providing confirmation
of this, and feedback on ideas suggested /implemented.
In my previous blog, the main message that emerged from a hard look at the current system was
that a new funding model will be
essential if our NHS is to become fit for purpose again, and remain so. We have only to look at those of our nearest European neighbours with similar population sizes and demographics to convince ourselves of this. Although our healthcare spend as a proportion of GDP at 10.9% is comparable to other developed countries, the difference is that we fund this entirely out of taxation. Demand is projected to increase by ca 2.5% p.a., so the problem is only likely to get worse.
Unfortunately, a projected UK population of 75 million plus
by 2030, with its ageing demographic and poor general state of health, cannot be provided with
effective modern healthcare via public taxation alone – at least not at the
levels of overall tax burden that our electorate would tolerate. This will inevitably mean
involving private finance, some form of Government-sponsored health insurance, and commercially-funded hospital/community facilities. The arguments for
this are quite compelling, and I’ve already considered them in depth elsewhere, so will not
repeat them in this blog. Please use the link above to the original 2022 article for more details.
I’ll use this new blog to consider some suggestions about
the detailed changes to the various parts of our healthcare system
proposed by government. I’ll also attempt to assess their merits, and provide
some caveats on the practicalities of implementation.
1) Shifting healthcare from hospitals to the community. This is a laudable aim and one which will be key to effective reform of the system. Most patients would welcome treatment in a friendly local setting they’re used to and can access easily, rather than in a noisy, overcrowded and impersonal large hospital setting, already on its knees trying to cope with demand. Traditionally, in the early years of the NHS things were done much more locally, with GP surgeries dealing with most of our ills, and relatively few patients even being referred to their local hospitals, which were smaller and more locally-based than today's centralised behemoths. Unfortunately, between the 1960s and 1990s as we got older and more numerous, and medicine became more centralised, costly and tech-oriented, the emphasis shifted to large regional hospitals, with the old local District and Cottage hospitals being scrapped on grounds of cost and inefficiency. This, coupled with chronic overload on GP surgeries and a lack of UK in-house medical training of sufficient new hospital doctors and GPs, has resulted in the system we have now, which is clearly not fit for purpose. The transition back to more localised healthcare will not be easy, as it will require new infrastructure and a radical change in organisation of the system. The key feature for it to work must be integration of services. The idea of collecting all healthcare services under the same roof locally is a good one, but could lead to large and unwieldy conglomerates, and will require much new building. This may not be easily affordable in the short term, (or indeed practicable, given the chronic shortage of skilled labour in the building industry and competition for it by Labour's requirement for 1.5M new houses by 2029). Funding for the infrastructure needed for these new facilities is also likely to be resource-hungry….and subject to both cost and time over-runs. There must therefore be a more pragmatic interim solution to integration to help ‘get things off the ground’. Above all else, we must also ensure, as do our EU neighbours, that Adult Social Care (including hospice provision) is properly integrated into the new system - see below for more detail on the importance and practicalities of this. We will also need to provide adequate funding, and of course the well-paid, motivated and skilled staff, to make all this happen – which brings us back once again to the need for a sustainable funding model.
2) Centralisation of digital records:
As with any growth process, keeping tabs on, and interpreting, all the data the system generates as it grows
and reforms is an essential requirement. The NHS will be no exception. What we
have now is a ‘hotch-potch’ of historical IT systems extensively patched
together and barely functional. This type of arrangement provides an easy target for hackers, whether
state-sponsored or seeking ransoms, as we have seen on a number of occasions
recently. Any new system must at its core consider security first – the next
world war will probably be fought largely in cyberspace and we need to
ensure our healthcare system is as resistant as possible to external attack
going forward. Any new system is only as good as its weakest link, and for the 'new' NHS we must
ensure that link isn’t its IT infrastructure. It’s also essential that all elements of any new digital healthcare
software are exhaustively tested before ‘going live’ – I’m well aware from my
own efforts in writing code for software applications intended for use by others
in the pharmaceutical industry how important this is. Always ask naïve members
of your organisation, or better still the public, to test your program or app before releasing it – if it can be broken,
you can be sure they’ll break it for you – and also tell you in no uncertain
terms where your design is going wrong! The new IT system must also take into account
that it will also need to be accessed by people with a wide range of digital
experience and skill, from the highly ‘tech savvy’ to someone in their 80s or
90s who has never used a computer and doesn’t want to start now…(one particular issue that has already surfaced is access to the new 'all-singing-all-dancing' NHS app. Looking at its applicability, the latest version of the app appears only to be available to devices running Android v8 or Ios v15. Many of the NHS's older 'clients', will have older devices runing significantly earlier vesrions than this, so will be excluded 'at source'. Since these are likely to be the service's most frequent customers, this particular planning error does not augur well for 'digital integration'....the only solution is to ensure that the app is downward compatible (at least to Anrod 5.0 or Ios v10)).
3) Holistic approach to medicine:
Our western European neighbours have long realised the importance of keeping their
populations healthy, particularly the Scandinavian countries, where holistic
medicine now forms the backbone of their healthcare systems. Our own population is
now acknowledged to be one of the ‘sickest’ in Europe…and is getting sicker.
This is not just a result of the natural ageing process, but reflects our
increasingly sedentary and unhealthy lifestyles and eating habits, and our lack of understanding of the implications. It is also
rooted in the poor availability of healthcare; access to GP surgeries is
now severely rationed 'by availability’, thus making rapid diagnosis, and
treatment where necessary, a thing of the past. This has already had major implications in outcomes and survival rates for potentially fatal conditions such as cancer. Various attempts
by governments and healthcare professionals have been made over the years to
address our population's poor general state of health, but fundamentally change will only occur if
we change our own attitudes, and can also get access to, and support from, our
GPs when we feel we need it (and not months later, when we've either died, or forgotten what we made the appointment for !). We will also need to ensure everyone has the
opportunity and funds to afford healthier foods, jobs and living conditions. To
do them justice, most GP practices are already embracing the idea of keeping
their patients healthier, with many already offering periodic health checks to
the over 65s, blood pressure and cholesterol checks, etc. but the impression is that this may be adversely affecting availability of routine appointments. It’s also important to ensure that patients don’t find this new approach intrusive, or
feel they are being told how to run their lives…or even spied upon. Persuasion
is the key to patient ‘buy-in’, rather than compulsion – it will simply not
work otherwise. An important part of the process will be patient education, with easy and
unfettered access to their records by patients when they need them to understand
and follow their own treatment programmes. Patients must also have the opportunity to contribute to the treatment planning process when and if they want it. As a reasonably ‘tech-savvy’
pensioner myself, I can confirm that the current online access system is unnecessarily difficult to
navigate at the best of times and does require a degree of ‘digital tech competence’,
involving as it does multiple levels of registration and security, and of course access to a
smartphone with an internet connection. Any new system must be reliable,
seamless…and accessible to all on
request. ‘Wearable Tech’ has been suggested as a way of monitoring patient
health remotely – again a nice idea, but fraught with potential implementation problems
and cost implications. Patients will certainly not want to feel they are being ‘tagged’
and spied on, as is done with some offenders released into the community.
4) Adult Social Care (ASC): As discussed, this must be integrated fully into the ‘new NHS’. The arguments for this are overwhelming, and are supported by the success of our EU neighbours in managing the health needs of their own elderly citizens. At present in UK we have the entirely unacceptable situation of inadequate residential placements and a chronic lack of home support, largely due to Local Authority budget cuts. This has led to extensive hospital bed-blocking, ambulances queuing to release their patients to A&E wards, and patients spending days in hospital corridors....and sadly sometimes even dying there! The only way of alleviating this lamentable state of affairs is to focus on keeping the elderly supported in their own homes for as long as possible, and providing sufficient residential places for them to go at the end of their lives when they can no longer cope. The role of unpaid carers is particularly important and needs to be recognised, and adequate support provided for them to continue in their vital support to the NHS. Hospice care is also seriously underfunded and largely run by charities. Their provision also needs to be enhanced, given the change in demographics and increased demand for end-of-life care. The debate about assisted dying may also figure in decisions on future healthcare provision. As discussed, a well-funded ASC system with well-paid and motivated staff is also key to efficient functioning, and would solve many of the problems our hospitals are facing today, by keeping as many of us as possible out of expensive and scarce hospital beds.
F Final Thoughts
I hope this blog provides some useful ideas on the
reform of our NHS, which cannot come soon enough. If the current government, with its super-majority, does not 'grasp the nettle' and engineer radical change, the system will continue to teeter on the brink of collapse, and may actually go over the edge at any time. Amongst other implications, this would effectively break the government's contract with its NI contributors, who have paid for a healthcare system which is free at the point of need, and could lead to legal challenges in the courts.
The key message still has to be the need for a change of funding model – only this will enable the changes discussed to be fully and sustainably implemented. Meanwhile, dissatisfied and often desperate patients are turning to private medicine for relief in droves, and the NHS itself is calling on (and paying through the nose for!) private facilities in an attempt to fill the gaps in public provision and reduce the now colossal waiting lists.
Reform of funding now could actually save the majority of UK healthcare provision from 'going private by default', and leaving a substandard and ailing 'bottom tier' for those who can't afford it.....given their socialist ideology, and the obvious current dissatisfaction with their progress so far, one for our political masters to consider carefully, I would think.
First Published 23.10.24; Revised 9.7.25
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