100 Days to save the NHS

This blog is particularly apt following the recent publication of the Darzi Report, which we will consider later in more detail.

by Dr Rupal Shah, HVHF core team member

That’s the title of a symposium I participated in as a panel member, as part of the Byline Festival in Devon. The Byline Times is an independent newspaper, funded by its readership that concentrates on accurately reporting issues that the mainstream press ignores or avoids. The symposium was organised by Mark and Shirin Thomas, from the 99% organisation. Mark is an economist who has written a report, the Rational Policy-maker’s Guide to the NHS, which he has presented to parliament. In it, he argues that allowing the NHS to collapse will lead to a collapse in our economy- economic strength is predicated on a healthy workforce. Currently, 8% of the UK population are signed off work. His conclusion is that if we invest in it, the NHS will eventually pay for itself in terms of wider societal benefits.

There were about 100 people in the audience, mostly lay people. Other members of the panel were Helen Salisbury, a GP in Oxford (and columnist for the BMJ); Stephen Reicher, a social psychologist from St Andrew’s University and Mark Thomas.

There were strong themes that arose from our discussion, on which we all agreed; and which seemed to also resonate with the audience. If I had to summarise some of these, and the key messages we would like Wes Streeting to hear, they would be:

Trust is essential in a functioning health system- if patients don’t trust the clinician seeing them, then it generates waste in the way of unused medication, unnecessary investigations and referrals. It’s hard to trust someone you have never met, especially if the consultation is remote. In a similar vein, there needs to be more trust from politicians of practitioners and a change from the existing paradigm of command and control.
The whole is greater than or at least different to the sum of the parts. Taylorization which assumes that breaking things down into their component parts and dealing with each in isolation increases efficiency may be true in the manufacture of cars but is problematic in the arena of health.
The metrics by which we judge effectiveness are not fit for purpose. We shouldn’t measure the number of appointments offered or the number of targets met in isolation -we should interrogate the meaning generated within these appointments and their outputs; and the absolute benefit of the interventions we are asked to implement.
Continuity of care most definitely reduces emergency admissions, use of out of hours services and mortality. Relational care should be at the core of health policy.
There are no quick fixes. We should avoid falling into the trap of thinking that there are easy solutions for complex problems. Private providers often cream off the easiest, least complex interventions, e.g. uncomplicated cataract surgery or diagnosis of ADHD without follow up, leaving mainstream NHS services to manage the fall-out.
Creating connected communities who are supported to look after one other will likely reduce the burden on the NHS and lead to a healthier population less in need of downstream interventions.
We should focus on health rather than illness and wasting time in the futile pursuit of indefinitely postponing death.

Perhaps before we introduce any new service or incentivisation scheme, we should ask:

In which ways and to what extent will this improve the overall health of our population?
What is the clinician time needed to treat? What effect will the intervention have overall on the system and how will it impact people who are not included in the target population (because the resource of time is being spent elsewhere)? Would the resource needed be better spent on downstream interventions such as community strengthening interventions or public health initiatives?
What impact will this have on sustainability, for our staff and for our planet?
What impact will this have on trust and on relationships between staff and patients, and on continuity of care?

Mark compared the NHS to a wounded athlete who needs time to be allowed to heal before being pushed to achieve another gold medal. Politicians would do well to spend that time listening and trying to understand what gold means and what is needed to get there.