Healthcare delivery
Solutions heralded The definitive solutions are not yet detailed; we await the ten-year plan to emerge. However, there are some strategic developments identified by the Secretary of State for Health and Social Care in his speech to the NHS Provider Conference in November 2024. These are moving from: l Hospital to community. l From analogue to digital. l From sickness to prevention.
The ambition for fundamental change is breathtaking, signalling a huge transformation in the function and delivery of the NHS, as the Prime Minister has said, the NHS needs ‘major surgery not just sticking plaster solutions’. In the changing terminology required by the new administration, these are known as ‘shifts’. It remains to be seen how this extraordinary amount of change is achieved and in the timeframes envisaged by Government. Together with these changes, there are
shadows of previous management solutions by measuring every Trust and creating League Tables. There are promises of greater freedoms for those Trusts that achieve top status and those that suffer at the bottom of the league will face targeted interventions using turnaround teams and their leaders may well face the sack. This will change the metrics by which NHS
organisations are measured and ranked: the quality of services to patients, financial management and senior leadership. Wes Streeting has promised that there will be no more reward for failure, with the potential of senior leaders denied pay uplifts if major improvements are not made. It should be remembered that data in many of the league tables will be identified within a context of local health deprivation and will be beyond the control of hospital leaders. Having experienced many years of pollical
changes imposed on the NHS over forty years, I feel strongly that targets and league tables will not enable quality improvement. In a system populated by staff of all types who are exhausted, demoralised, and struggling with transformative change and patients who have waited long periods for attention, league tables may be a final straw for some. The pressure to respond
when it is a political necessity (which will have an undeniable effect on the Boardroom pay scales), will not achieve the outcomes desired. The government needs to be careful here, as this author recalls that the scandal at Mid- Staffordshire was caused in some part by the leadership counting on tightening the belts of all spending, in order to achieve an outcome – in that case, Foundation Trust status.
Hospital to community There will need to be a huge change to budgets in order to emphasise the move to better access to community and primary care. However, there are insufficient GPs currently, as defined by Lord Darzi. While there have been schemes to enhance the numbers of doctors choosing general practice for their specialism, it is not known how successful that move has been recently. Solutions will need to be found to support GPs – who are, at present, saying they will not employ Physician Associates in their practices – the very people who could help them
One glaring gap in all of this is the lack of attention to social care, which has such a cumulative effect on health and health services in the last few years. It must be subject to a strategic plan and enacted very soon.
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www.clinicalservicesjournal.com I January 2025
to manage in the new era. There is a desire to deliver plans for new neighbourhood health hubs where people can see GPs, district nurses, care workers, physios, health visitors or mental health professionals all under one roof. In my local area, this is already the reality, so it is difficult to see how different this might be going forward. It is clear that the demographics experienced
now and the increased volume of patients with chronic conditions will need primary and community care priority – taking money away from acute care for the next few years. However, workforce issues must be addressed immediately with Royal Colleges and union acceptance.
Analogue to digital The investment in digital services in healthcare has been very slow to be realised, and with it the culture towards a more digital world. There are still services dependent on faxes. In some ward areas, the hardware is so old, it takes ten minutes at the beginning of the day to warm up to functional level. Departments have often determined their own digital answers, so the result is that nothing is connected to anything else, all of which takes time and effort by clinical staff to resolve. If even some of these problems can be resolved, many human hours of frustration will be saved. Primary care also needs to focus on being a bit more tech
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