The National Health Service – 1

So, the NHS is 70 this year (2018)?  It is an amazing institution with thousands of dedicated and hard working staff, from consultants to general practitioners, from administrators to cleaners and a whole host of other people.

I have been a recipient of their services many, many times over the years and I am grateful for their assistance.  But, as demand increases and the rate of innovations multiplies, along with rising costs, it is creaking at the seams.  Staff are overstretched and running it gets more and more bureaucratic.

It is about time that a ‘root and branch’ review is undertaken.  I understand there has been a number of reviews, but they ended up being half measures.  Then there is the debate about the gradual privatisation of the NHS and the implications as to whether the service can continue to be basically free.  I would like to suggest that a Royal Commission is set up with its membership coming from the professional bodies, trade unions, practitioners, patients, the public, financial specialists, scientists, policy bodies, faith groups and others to make sure it is inclusive and truly representative of UK citizens.  And the public from throughout the UK and beyond is encouraged to submit their constructive suggestions to improve the NHS. As regards its remit, this will need to be comprehensive to make sure it is fit for the future.

Areas to be covered include the following:

What should the NHS be doing and not doing? (For example, should its only focus be on preventative, ‘healing’ people from illness and disease? As part of that, should social care and others come completely under the NHS? Should procedures like IVF be done in the NHS, or even abortion?  Should Hospices become part of the NHS?)

How should the NHS be organised? (Should the current Trusts and other structures continue – are they the most efficient way of co-ordinating services and facilities?  Do we need so many ‘bodies’ like NHS England, Commissioning Trusts, etc?  Are there more efficient ways for undertaking the administrative side of things? How much of the NHS could be put into the community, like General Practitioner Medical Centres?  To help patients be more in control, what is the role of self-recovery, doing things at home and community support?)

How many and what staff does the NHS require? (For example is the current structures suitable?  Are there quicker and better ways for training staff (so as to speed up the process of getting them working (without compromising standards)) other than what is currently on offer, making it easier for transferring between disciplines? How can pay, conditions and personal development be vastly improved to encourage better work/life balance and retention?)

How can the NHS improve its use of technology? (For example, better integrating patient records and getting them onto easily accessed computers, using software that is intuitive?  How do we make sure that Data Protection is made more secure to prevent hacking or abuse by staff, without making things complicated?  How do we make sure that entries made in patients’ records are easily understood by everybody who needs to know, including the patients themselves? How can technology be ‘joined’ up without the system ‘overheating’ (like a previous system did)?)

What can be done to improve the stay in hospital or the visit to community facilities? (For example, the design of the wards to improve privacy and noise, procedures used to improve efficiency and help patients have a more restful time from entry to discharge, time in the wards and operating wards (and to also facilitate reducing waiting times for any actions like operations when in hospital), to follow up (like discharge into a care home?  And what about the overall design, including the signage of the buildings used, as well as where facilities are located to make it easy for staff and patients to access without travelling far (from where they live and within the buildings)?  How are the transport links to be improved  and to better cope with disabled and others who are ill, making sure that staff manning such facilities are trained to enable such passengers to get the best of the journey, thus reducing stress?

How best to fund the NHS? (For example, should there be a revision of the taxations system so that money for the NHS and Social Care is ring-fenced? How can the NHS get better prices for the medications and equipment it buys?  How can it make sure there is proper funding for specialist treatment, including medication, and for encouraging innovation and ethical research?  Who should decide on how the money is used, both nationally and locally?  How do we improve the huge amount of waste, without compromising hygiene?  What about making all facilities self-sufficient in their energy use?)

Who decides what is ethical and sustainable in procedures, research, use of treatment, etc? (For example, who how does one decide on what is ethical – professionals, faith groups, philosophers, public opinion, etc?  How is that managed to make sure everyone keeps to ethical and professional standards, and what to do if they are not)

What is the role of the private sector, if any, and what do we mean by the term? (Should there be private hospitals?  How do we make sure anyone practicing privately in the area of health is properly monitored and is professionally and ethically trained and registered?  What about how they should be covered from an insurance point of view?

What about health and safety? (Are buildings designed to facilitate quick evacuation in the event of a fire or other incident (including whether buildings should be higher than two to three stories? Are procedures under the various Health and Safety at Work Act and other legislative and NHS procedures clearly followed by staff?  Should there be others, and can they be all integrated and clearly understood in Plain English?

I am sure there are other areas that I have not mentioned.  So you can see there is more than money needed to make the NHS ‘fit for purpose’ for the next 70 years and beyond.  Hopefully, this may encourage a wider debate, including how we can also use lessons from overseas, and ‘export’ what we do to other countries to help their citizens live long and healthy lives (including staff exchanges and voluntary support in emergencies in crisis areas).

Any comments welcome.