Whither Our UK NHS ? Consultation Responses

 

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' and decided to request input from the public and NHS staff before attempting to implement any major reforms. This is a welcome development and does the 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 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 our near neighbours with similar population sizes and demographics to convince ourselves of this.

Unfortunately, our UK population of 70 million plus with its current demographic and 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 mean involving private finance and hospital/community facilities. The arguments for this are quite compelling, and I’ve considered them in depth, so will not repeat them in this blog. Please use the link above to the original article for 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 more locally, with GP surgeries dealing with most of our ills, and relatively few patients being referred to their local hospitals, which were smaller and more local. 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 cost grounds. 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 may not be easily affordable in the short term. Funding for the infrastructure needed for these new facilities is also likely to be resource-hungry….and subject to both cost and time overruns. There must thus be a more pragmatic interim solution to integration to help ‘get things off the ground’. We must also ensure, as do our EU neighbours, that Adult Social Care 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 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…

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!). 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 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 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 quite 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 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. T

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. 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 service from 'going private by default'....given their socialist ideology, one for our political masters to consider carefully, I would think. 

First Published 23.10.24