Where is the NHS now, and where is it going?

I pose this question in response to two recently published documents regarding the NHS:

• Figures from NHS England suggesting that hospital Accident and Emergency Departments may be performing better this winter; and
• The NHS long term plan – specifically designed “to get the most value for patients out of every pound of taxpayers’ investment”.

But what is the detail sitting behind these two reports?

Is Accident & Emergency provision getting better?

Well, the NHS England figures for the “here and now” appears to show fewer Accident and Emergency Department closures and ambulance delays than the same time last year. This is put down to good planning and hard work by staff, which is undoubtedly true, but what we cannot lose sight of is that there were still cancellations of non-emergency operations and reports of large numbers of patients queuing in corridors. There was also the ongoing missing of the waiting time targets in 3 key areas – Accident and Emergency, cancer and routine operations.

It was also noted by Dr Nick Scriven, President of the Society for Acute Medicine, that the NHS remains under considerable pressure as the winter progresses, and that it would not take much for things to deteriorate.

So in short, there is some cause for optimism with the NHS at the moment in particular with Accident and Emergency services, but there are still underlying and fundamental threats to the service.

The long-term plan – good news for patients?

What about the highly anticipated NHS long term plan to provide improved patient care over the next 10 years? Well, I defy anyone not to welcome the following initiatives:

• Improving safety during pregnancy and childbirth – this is particularly welcome from the medico-legal perspective as it will target the very high value birth injury claims which continue to drive up the compensation bill for the NHS. Therefore, if this ambitious initiative can be delivered, it will not only improve patient care but also reduce financial pressure upon NHS resources generally.
• Increased funding for mental health care – this has become a particularly high profile topic over the past couple of years, quite rightly so, and one which is backed up by companies like our own being further engaged with Mind the mental health charity and looking at employees’ health and wellbeing.
• Increased funding for primary and community care – given that this is partly credited for the NHS England reported improvement in Accident and Emergency Department performance so far this winter, this is evidence that current initiatives, especially if increased in scope, can continue to deliver widespread benefits.
• The emphasis upon preventing illness – as someone once said, prevention will always be better than the need for a cure.

However, the key to the success or otherwise of this is set out in the plan itself: to turn the ambitions into actual improvements in services in every part of the country.

In the context of improving service provision, the following is of more concern in terms of the long term plan:

• There is much talk of having Integrated Care Systems (ICSs) and Sustainability and Transformation Partnerships (STPs) – this is a fine idea, but will require lots of organising and funding in order for these acronyms to become a reality in respect of improved quality of patient care.
• There are ambitious plans to increase and improve the NHS workforce – what is not clear is how this will solve the current staff shortages which continue to threaten the sustainability of the NHS, not only over the next 10 years but also here and now.
• Making better use of data and digital technology – this is always a good idea in principle, but the NHS has a terrible history with technology; for example who can forget the £10 billion failed project to digitalise all patient records a few years ago?
• Targeting NHS spend better including reducing duplication in how clinical services are delivered – again, this is a brilliant idea, but it needs to include a management overhaul throughout the NHS in terms of the duplication of management costs across multiple Trusts. The leaderships in those Trusts are unlikely to be “turkeys voting for Christmas”.
• The biggest and most significant omission from the plans however is the lack of mention of making things safer for patients. The NHS can treat more people, and in more different ways, but if patient safety is not ensured then the foreseeable costs of poor patient care will continue to exist, including in the form of medical negligence claims, and is likely to increase into the future.

So, according to the NHS long term plan, the NHS is heading into a brave and positive future over the next 10 years. However, one thing is for sure, and that is that the future is not just about money. With ongoing difficulties providing services and chronic staff shortages, to name but a couple of issues, the NHS still faces an uphill journey to turn the ambition of the 10 year plan into a reality.

These recent announcements from the NHS are promising, but the hope is that these suggestions of success and plans for the future really deliver for patients across the UK. It is imperative that, whatever pressures are piled onto the NHS in the coming months and years, patient safety is prioritised – after all, a health service, however well it performs financially and technologically, is only as good as the outcomes it delivers for patients.