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Healthcare delivery


Re-imagining the next decade for the NHS


Kate Woodhead RGN DMS discusses the future of the NHS and the debate around the ten-year plan. The Prime Minister has said the NHS needs ‘major surgery not just sticking plaster solutions’, but with an exhausted and demoralised workforce, will some of the proposed solutions for change be the final straw for some?


There has been a great deal of activity and many pronouncements about the future reform to the NHS after the deliberations by Professor Lord Darzi of Denham were published in mid- September1


after his speedy nine-week review. There has been a speech by Wes Streeting,2


how to fix the ‘broken but not beaten’ NHS. There is no doubt that the NHS is in some


trouble with productivity going down and waiting times for urgent care in A&E, as well as surgery and mental health, all rising exponentially. This is, as all speeches and reports say, not the fault of the clinical service and its workforce, but due to many other factors way beyond their control. There are plans to change this all by the compilation of a ten-year health plan – to be published sometime in the spring of 2025. There is an ambition to include a large range of voices in the consultation which can be added to by visiting https://change.nhs.uk and making a contribution. The public, organisations and professionals are urged to add their ideas in order to make a difference. Many of the ideas submitted based on this consultation and on the plans set out in the Darzi report will be part of the ten-year plan.


Darzi report In short, there are many factors cited by Lord Darzi, which we all know and regret. NHS spending has reduced over the last few years and is poorly distributed between acute care and the primary sector. In recent years, when there has been a crisis, more money has been sent to acute care and hospitals, leaving the community in difficulty. In addition, funding reductions in local authorities has meant the closure of a number of care homes and has further exacerbated the delayed discharges within hospitals with patients no longer needing hospital care. However, social care was not included in the remit for the Darzi report.


the


new Labour Health and Care Secretary of State, and also by the Prime Minister3


– all focused on


Long waiting lists are unsustainable and there


are many thousands of people waiting for care, surgery and mental health services. By April 2024, around one million people were waiting for mental health services and, by September 2024. the overall NHS waiting list stood at 7.57 million, which has now begun at last to reduce, but still represents much pain and suffering and a reduced ability for patients to live a quality life. The public health grant has been reduced in


real terms since 2015, which has exacerbated poor health in the population. The social determinants of health such as poor housing, low income and low and insecure employment have impacted the nation’s health over the last 10 years. The effect on the population of COVID-19 has been enormous and the continuing influence on the healthcare workforce has been significant. Staff morale is at an all-time low, while all around them are asking for greater productivity, making it unlikely that they will succeed. Maternity services have been subject to several independent reports and continuing


troubles. There are difficulties in staffing, skills, clinical models, leadership and culture. There are huge health inequalities within maternity services, which disenfranchise sectors of the public.


General practice has increasing issues with falling numbers of GPs and many more choosing to work part-time due to the pressures. A recent boost to the NHS in the October 2024 budget of £22.6 billion, which is the biggest increase since the 2010s, will help to fund 40,000 more elective appointments each week, as well as upgrades for GP facilities, new surgical hubs and more diagnostic scans. In the recent past, according to the Darzi


report, the NHS has been starved of capital spend and much has been shifted towards everyday revenue spending. This has left hospitals with crumbling buildings and a backlog of maintenance, outmoded digital technology and too many outdated scanners. This has been disruptive for patient services, not helping the waiting lists.


January 2025 I www.clinicalservicesjournal.com 15


t


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