20 YEARS IN PAT I ENT CAR E
failure to show patients how this is equal or better than a face-to-face appointment.
What has changed for the worse? Over the last decade, we have seen progress the NHS made from the turn of the century undermined by underfunding and a failure to plan for its workforce. This is why in 2022 we see public satisfaction with the NHS at its lowest levels since 1997, despite the fact that the public’s belief in the tenets of the NHS is as strong as ever.
A failure to plan for a future where our population is older and sicker, has been a major disappointment to us. The demographic changes in the UK were predicted and should have been planned for. But a lack of a strategic, cross-governmental approach to health and wellbeing – something we have raised nearly every year for the last ten – coupled with a decade of austerity has allowed health inequalities to grow. On its own, the NHS cannot make up for inadequacies in education, housing, entrenched deprivation in communities, and a decade of cuts to public services. A failure to fix social care undermines the NHS. From a patient’s perspective, inadequate social care means patients are frequently cared for by family members whose health deteriorates because of the responsibility; they often have to give up their jobs and are largely unsupported. This is an unacceptable situation and fuels inequalities. We would have liked to have seen the NHS’s safety record and its handling of complaints improve, but the publication of the Ockenden Report in 2022 into failings in maternity care at Shrewsbury and Telford Hospital NHS Trust finds many of the problems highlighted in earlier reports, still happening. This too, is unacceptable. We wish the health
service understood the overwhelming sense of powerlessness felt by patients and families when something goes wrong and they try but fail to get answers. Any patient hurt or damaged by the NHS deserves answers for why that happened, redress, and the service must be clear how it will avoid making the same mistake again. Layered on top of all these concerns, is the damage the pandemic has done to the NHS and to the relationship between patients and the NHS. In practical terms, it is clear to us that we will be living with a backlog of care and treatment needs for years to come: the NHS simply doesn’t have the resources to tackle the backlog caused
by the pandemic while handling newly presenting patients.
The rupture between patients and the NHS is a major concern to us. We see this clearly in all surveys of patients’ attitudes, not just our own research. Finally, funding for the NHS may have risen but it is still not adequate for the needs of the nation. Even before the pandemic, the NHS was experiencing a shortfall in funding. This was because of increasing demand for services and years of inadequate funding. It, and social care, now need an urgent uplift in resources.
How has the culture towards patient care changed?
The culture towards patient care has changed but independent review after review has continued to find uncaring dismissive cultures at the heart of problems experienced by patients and this is why errors are repeated. The Ockenden Report found regulators and others had failed to improve an uncaring culture, despite investigations into clinical incidents and recognition that the maternity care the Trust provided was substandard.
Nearly a decade
earlier, the Francis Inquiry into failings in care at Mid Staffordshire NHS Foundation Trust found
an appalling culture reigned. Changes have followed but as Ockenden shows, there are still real problems in NHS culture in some Trusts.
There is hope, however. Our research among health professionals earlier this year found the majority wanted to work in partnership with patients when delivering care. Several barriers need to be removed for professionals to be able to do this and
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it needs strong leadership from senior clinicians and managers to do achieve this patient partnership.
What have been the key developments during the past 20 years? The NHS Plan, launched in 2000, has had a significant impact on the services patients receive: it introduced performance targets, mechanisms for assuring the quality and safety of services, as well as the concept of patients having a choice. With the benefit of hindsight, the introduction of competition and the Private Finance Initiative have left mixed legacies.
The introduction of the Commission for Healthcare Improvement – the first organisation to assess the performance of NHS hospitals – does mean that there is outside scrutiny of hospital activity. But as inquiries like Mid Staffs and Ockenden show, even when external regulators have raised concerns about performance some hospitals continue to behave in ways that do not serve patients well.
The multiple reorganisations of the NHS have been significant and, from our perspective, a distraction from the business of improving patient partnership and reducing health inequalities. Foundation Trusts, fundholding general practices, practice-based commissioning – all have fallen by the wayside. The Lansley reforms have all been jettisoned.
Although funding for the NHS was increased before the big global crash in 2008, a decade of austerity has eroded those advances. This is partly the reason the NHS entered the pandemic under resourced in terms of funding and staff.
The introduction of the NHS Constitution was welcome; it’s just a pity that so few people on the frontline appear to have read it or act on the seven principles. It is now time it was reviewed, and we’d like to see patients involved in any revision, and for the
NOVEMBER 2022
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