South West London Collaborative Commissioning

We must help our NHS adapt in order to keep it healthy

Writing for a national newspaper, Professor Keith Willett, NHS England’s Medical Director for Acute Care said:

Up and down the country, our GPs, community services, NHS111, ambulances, A&E departments, and hospital services are under intense pressure. The problems are complex but must be – and are now being – addressed urgently.

The NHS of today is still based on its original 1940s design.  Every industry needs to adapt, and the NHS – at the forefront of innovation and technology – is no different.

As a population, we have changed considerably.  We are all living longer – over the next 15 years the population aged over 65 is projected to increase by 40 per cent, which is good news.

But our health and care needs are greatest in the later decades of life as we accumulate multiple ageing disorders that can affect our independence as much as our wellness.

Right now our health and social care system has an inbuilt default mechanism. When society cannot meet our personal care needs at home, we are moved, often distressingly for us, to a hospital medical setting, the only way to provide that care.

The NHS has around 100,000 beds, which is enough for the medical treatment of our patients.  But what we are increasingly facing is using a large proportion for ‘personal care’ – dormitories of older people.

Medical care is also advancing dramatically.  Today, a paramedic or GP can undertake tests and treatments in our homes or their surgery that 10 years ago we could only do in a hospital.

Likewise there are treatments now available in specialist centres that change patients’ lives and survival that are impossible in local hospitals.

As a doctor I cannot deny that offer to patients who suffer a stroke, heart attack or major injury. In London this has saved the lives of 100 stroke sufferers a year and across the country the odds of surviving a major trauma have risen up to 50 per cent.

The opportunities for bringing about a shift in care from hospital to home, or close to home, are enormous.

Our frail and elder patients would be particularly advantaged – hospitalisation often disorientates them – physically, mentally and socially – and puts them at unnecessary risk.

To tackle these issues, NHS and local authority leaders have come together for the first time across England to plan future services with their communities, producing what we call sustainability and transformation plans (STPs). Such collaboration will give nurses, doctors and care staff a better chance of succeeding.

Finally we have an opportunity to deliver long-promised expansions in general practice and truly responsive and hooked-up community care services.

Through extra investment, we also now have the opportunity to make common sense improvements to the way services work such as making it easier to see a GP, speeding up cancer diagnosis and offering faster help to people with mental ill health.

Now what we need in every part of England is evidence-based debate about what our local authority, community and health and care leaders are suggesting.  I am sure those ideas can be improved but they deserve a fair hearing.

We cannot just ignore what we now know, or how needs are changing. When it comes to healthcare, inertia can be truly harmful. It is no longer realistic to say ‘if it’s not broke don’t fix it’ – believe me it is breaking.

What I most fear is an overly-politicised conversation that seeks to damn every proposal as a “cut” and paralyses progress. None of that is going to help the staff who are committed to caring within the NHS, nor their patients – that’s you and your family.

These are societal issues and very personal to us.  In the past we have often been told what was right for us without reference to those of us in the NHS who live and breathe these issues on a daily basis, or those who experience services as patients or carers.

Everyone in the NHS wants to ensure that every person in this country can access high-quality care whenever it is needed.  But to keep our NHS healthy, we have to help it to adapt to the way medicine and all our health and care needs are changing.

Reproduced with permission from NHS England.  The original blog is available on the NHS England Website and this piece also appeared in the I Newspaper in February 2017.