Chapter 12 - The Future of the NHS

This is a summary of chapter 12 - the future of anaesthetics. It was written by Dr Peter Simpson, President of the Royal College of Anaesthetists with special interests in training, examinations, assessment and accreditation of doctors and anaesthetists. He is President of the European Society of Anaesthesiology

In this chapter he discusses the importance of anaesthetics, highlighting that with this speciality is involved in 65% of all hospital admissions!

He focuses on how to plan ahead for the future and the requirement of having enough trained staff. He discusses the difficulties in projecting workforce requirements, in terms of gender, nationality or indeed the way in which they wish to work is challenging. Despite the increased intake into UK medical schools, which will take time to percolate through the system, the 70+% female intake will undoubtedly influence things. Also, the 50% overseas graduates currently in anaesthetic training are extremely welcome, but this needs to be considered in the diversity of workforce planning.

To comment further on this chapter - please feel free to post a comment.

Chapter 11 - The Future of the NHS

This is a summary of chapter 11, the Organisation of NHS maternity care, by Professor Jim Thornton. He is a Professor at the Academic Division of Obstetrics & Gynaecology and Child Health, City Hospital, Nottingham.

He descibes three organisational features which distinguish NHS maternity care from that of most other West European countries.
1. Britain has the most centralised system. Not only do we have a low rate of home births, typical of most other countries, but we also have the lowest proportion of small delivery units <1000,>5,000 deliveries.
2. Doctors, and in particular senior doctors, are relatively uninvolved in labour and delivery. It is difficult to overemphasise the importance of close consultant involvement in labour. Although maternal and perinatal deaths are now both uncommon, the day of delivery remains the most dangerous in most individuals’ entire lifespan. Yet normal deliveries are left largely to midwives and senior doctors leave complicated deliveries, forceps and caesareans, to doctors in training.
3. Probably as a consequence, Britain is unique in having the majority of normal births conducted by midwives. However, midwives are expanding their role outside labour and the required number of midwifes has not kept pace with these new developments leading to a possible overall shortage of midwifes.
4. The potential medico-legal claims arising from alleged negligent care in labour causing brain damage, now dwarf all other medical claims from any other NHS specialty. The chapter reviews evidence of the NHS having the highest rate of sub-optimal care in Europe and suggests ways to improve the service.

To dicuss further about some of his more chilling insights, then please e mail me direct or post a comment.

Chapter 10 - The Future of the NHS

This is a summary of chapter 10 on the future of health services for children. It was written by Professor Alan Craft, a Professor of Child Health and a Consultant Paediatrician. He is National President of Royal College of Paediatrics and Child Health and Chairman of Academy of Medical Royal Colleges and Dr Simon Lenton, Vice President at the Royal College of Paediatrics and Child Health. He works in Bath as a consultant paediatrician with a special interest in community child health.

They describe how superficially children themselves have never appeared to be healthier, but what about the health systems to support children and families, do we really have a first-class service or can we do better? It suggests some key ways of progressing child health services:

1) Increasing training for GPs to develop specialist skills in community child health.
2) They suggeat that it is no longer possible to continue to provide inpatient care on every hospital sites. Therefore, services will have to be redesigning. However, they warn against advancement attempts being thwarted at the last moment by politicians, concerned about losing votes.
3) Encourage “pathway thinking” as a logical way of providing information and lists the many good reasons for developing care pathways. They warn that the big challenge in developing better services for children, through managed networks, is difficult due to the fragmentation of commissioning. They site the example that for any child’s NHS “journey” there could be up to 7 different commissioning bodies (across health education social care and the community/voluntary sector) responsible for purchasing “bits” of a journey. The principles of commissioning have great potential for improving services if a way can be found to commission whole pathways across organisations, rather than contracts with individual organisations. Children’s health and well-being is dependent on multi-agency services, the outcome of which is only as good as the weakest link in the child’s journey.

Everyone has thoughts on the health and well-being of children in need and to comment further, post a comment here or log on to: www.thefutureofthenhs.com

Chapter 9 - The Future of the NHS

This chapter is a summary of Chapter 9 - The future of geriatric medicine. It was written by ,Professor Peter Crome, Professor of Geriatric Medicine and Deputy Head of Keele University Medical School as well as President-Elect, British Geriatrics Society. He is a Consultant Geriatrician with a special interest in the evaluation of health services for older people and the treatment of common disorders of later life, including stroke and dementia

In this chapter Professor Crome discusses the impact of the increase in life expectancy that has been a triumph for humankind, but brings with it great challenges for the NHS.

He explains the benefits of the key standards in the National Service Framework for Older People (NSFOP) but warns against a “tick-box” approach to the improvement of services. He tackles the difficult questions such as, residential and nursing homes, rehabilitation and chronic disease management and warns of the paucity of information about the effectiveness of medications for common conditions in those aged 80 and over.

Optimising the health of older people is no small task and requires investment and co-ordination at all levels. He suggests requirements over the next decade:
· greater emphasis on health promotion by education
· greater involvement of older people themselves in health decisions
· suggests developing tailored therapeutic elderly services to tackle the growing problems of the misuse of drugs and alcohol within this age group
· proposes developing GPs with a Specialist Interest in elderly care
· highlights the need to treat older patients as individual people, to respect their rights, opinions and feelings and to treat them with dignity and humanity however ill and seemingly incapacitated.

To comment on this chapter, please post a comment here and/or on the discussion forum at www.thefutureofthenhs.com

Chapter 8 - The Future of the NHS

This is a summary of Chapter 8 by Mr Jim Wardrope, President of the College of Emergency Medicine and a consultant at the Northern General Hospital, Sheffield and Dr Alastair McGowan, Immediate Past President of the Faculty of Accident and Emergency Medicine and consultant at St James's University Hospital, Yorkshire.

This chapter deals with Emergency Medicine - the sharp end of NHS care. In England, a staggering 13 million patients will visit an Emergency Department this year, equivalent to almost one quarter of the total population. They highlight that major changes in the delivery of primary care has had a knock-on effect, to increase the number of patients attending the Emergency Department.

Over the past 4 years the NHS has seen real growth in resources and successes in reducing Emergency Department waiting times. But they warn that the outlook for the next 5 years is less certain. Already there is evidence that demands are outstripping capacity and resources. The current level of success in emergency care is fragile and hospitals are operating at or near maximum capacity. They discuss that there will have to be greater availability of experienced doctors, and that other professional staff will have to expand their training and expertise to asses and treat patients who would have traditionally been seen by doctors.

To discuss this chapter further, please feel free to post a comment or go to the discussion forum at www.thefutureofthenhs.com

Chapter 7 - The Future of NHS

This is a summary of chapter 7, written by Dr Mayur Lakani, Chairman of the Royal College of General Practitioners, Visiting Professor in the Department of Health Sciences, University of Leicester School of Medicine.

In this chapter he discusses primary care, and mainly concentrates on the role of GPs. He explains how primary care is expanding and is imperative to the running of the NHS. He tackles some common concerns, such as the inability to book GP appointments in advance, not being able to access GPs out of hours, and the new GP contract.

He also explains the significance of the Government White Paper on 'Care in the Community', which is aimed at reshaping the NHS, by transferring services from hospitals, into the community. He sums up by considering some suggestions for the future development of primary care:
· Longer and flexible consultation times with patients (say 15 minutes)
· Focusing more on prevention and well being, including mental health
· Focusing on earlier diagnosis
· Making patients the key holders for deciding on their treatment
· Integrating primary health care teams
· Improving communication between hospitals and GP practices
· Providing more tests and procedures, and services in primary care
· Improving primary care access, particularly for urgent problems
· Developing stronger GP services in deprived areas
· Increase the sexual health services in primary care settings
· Offer patients a choice of seeing a named GP and the choice to register with their preferred practice.
· Let the GP be the navigator rather than the gatekeeper

· Improve management of co-morbidity which is found more in deprived communities.

To offer comments on his chapter please feel free to comment on this blog, or add to the forum debate on www.thefutureofthenhs.com/forum

Chapter 6 - The Future of the NHS

This is a summary of chapter 6 - The Future of Surgery. It was written by Professor Peter J Friend, Professor of Transplantation at the University of Oxford, Director of the Oxford Transplant Centre and a Consultant Surgeon specialising in Transplant and Hepatobiliary surgery at the Oxford Radcliffe NHS Trust.

Professor Peter Friend describes that the medical world is on the cusp of radical change and if properly implemented, will provide a better, safer service for patients and a more cost-effective service for the provider. He considers several possible areas of change for the surgical specialties, and a few of those are mentioned below.

1) The changing face of surgery
The surgeon, used to direct the progress of a patient often single-handedly, but notes the surgeon is now part of a ‘committee’ that determines how the patient should be treated. However, the multi-disciplinary team will now be the key to the way the health service of tomorrow will look.

2) Surgery as a technology-driven specialty
He believes the future of minimally invasive surgery will involve robotic procedures under video-imaging, carrying out the entire operation using robotic arms controlled remotely by the surgeon. He notes that this technology is hugely expensive to buy and operate. Therefore, it will be a challenge to deliver new technology and cost-effectiveness.

3) Surgery and training
He explains how the traditional system of apprenticeship surgical training is becoming replaced with a more active training process to enable a surgeon to achieve competence with less than half the clinical contact time of his/her predecessor. [There is nothing more important than investing in the future of training.]

4) Surgery and regulation
He describes how a surgeon's future will include a closely scrutinised performance record. In fact hospitals are subjected to ‘league table’ comparisons. He argues that although transparency is clearly a good principle, the use of such simplistic measure of outcome, such as crude death rates, could be extremely misleading. One surgeon may be the best in the country but if the most difficult and highest risk cases are referred, then the mortality may still be high. If crude mortality becomes the marker by which surgeons are judged, then there will be a natural tendency to refuse to take on high-risk or complex cases and warns this would be very much to the disadvantage of patients. He highlights the need for this to be considered.

To comment on this please post a comment, e mail me direct at mail@drmichelletempest.com or join in the discussion forum on www.thefutureofthenhs.com

Chapter 5 - The Future of the NHS

This is a summary of Chapter 5 - The Future of Medicine. It was written by Dr Robert Winter, a consultant physician and Medical Director, Cambridge University Hospitals NHS Foundation Trust.

He explains the Paradox that although the scope of modern medicine is immeasurably greater than it was, the optimism generated by its advances seems to have evaporated. In short, ‘medicine is doing better, but feeling worse’. The future of the NHS is a scenario where the elderly are living longer yet in less good health towards the end of life, the young with more ill-health related to lifestyle all demand access to high cost, high technology drugs and resources. This scenario is undesirable and unsustainable.

Perhaps the challenge for the future NHS will be to develop a more holistic, integrated approach with an emphasis on keeping people well and a service that better reflects high, but reframed, consumer expectations. He believes this will provide a more balanced and therefore a more hopeful future – the basis of a new kind of modern NHS. If this can be achieved then he thinks this would be the cusp of a new enlightenment.

To comment on this chapter please feel free to leave a comment here, or on the discussion forum www.thefutureofthenhs.com

Chapter 4 - The Future of the NHS

This is a summary of chapter 4, written by Professor Steve Webb MP, Shadow Secretary of State for Health (Lib Dem)

Professor Webb argues that the debate surrounding the NHS is unhelpfully polarised, and that an observer would be forgiven for concluding that there are only two possible positions.

Pole One: The market-driven approach:
This has merit of simplicity and argues that competitive markets usually deliver lower prices, higher quality and greater. If this works for supermarkets, the argument runs, it should also work in public services. [But is the NHS like a supermarket?]

Pole Two: The “do nothing” approach:

This is believing there is nothing much wrong with the NHS that can’t be solved by pouring in yet more money.

He believes the reality is that neither of these extreme positions stand up to rigorous scrutiny.
He discusses there must a third way. He goes onto discuss accountability, decentralisation, creating a pattern of local health services, determined locally and accountable locally. Finally, he suggests that prevention is better than cure and we need more emphasis on public health and encourages people to live healthier lives.

He also offers the metaphor that watching the current state of the NHS is like watching the NHS is being subjected to amputation with a rusty hacksaw.

To comment on this chapter please don't hesitate to contact me direct, or post comments on the discussion forum www.thefutureofthenhs.com

Chapter 3 - The Future of the NHS

This is a summary of chapter 3 written by Andrew Lansley CBE MP, Shadow Secretary of State for Health (Conservative)

In this chapter Andrew Lansley raises the concerns that the NHS has all the complexities and bureaucracy of a huge organisation, yet lacks any of benefits of scale and consistency being delivered in practice. He discusses :

1) Public Health

He believes there is a distinction between the NHS and the health of the public at large; the NHS should treat the patient, whilst the government should treat society. Therefore, the first element in his future NHS, is to deliver improved public health.

2) Return the NHS service to its staff
He believes that in an NHS which is professionally-led and patient-centred. The professionals (doctors, nurses and managers) should be trusted to deliver the NHS service, free from day-to-day political interference.

3) Increase plurality – using competition to increase efficiency.
He believes that by using a plurality of providers, this would increase competition (a tide that can lift every boat) and in turn greater efficiency would ensue.

4) Finite resources versus insatiable demand
He believes that commissioning bodies will have to reconcile the tough decisions involved in finite resources with insatiable demand.

He believes the future of the NHS must be secured by a clear consistent strategic approach. This can not be achieved without the skill, care and leadership given by the staff of the NHS- managers free to manage; doctors able to offer clinical and professional leadership; nurses able to focus on the needs and care of patients; and all the staff of the NHS able to realise the potential of their service. He looks forward to an NHS in which patients put themselves in the hands of empowered professionals.

To read this chapter in full, please buy the book 'The Future of the NHS' - which is available from amazon, good bookshops or buy on-line www.thefutureofthenhs.com

Chapter 2 - The Future of the NHS

This is a summary of Chapter 2, written by the Rt. Hon. Patricia Hewitt MP, Secretary of State for Health.

Ask people what makes them proud to be British and most will name the NHS. In this chapter Patricia Hewitt explains the nature of necessary change and describes what a reformed NHS will look like. She first tackles why we need more change and then explains the four strands of reform:

1) More choice and a stronger voice for patients
She wanta to create a self-improving health service that designs its services around patients, rather than making patients fit in around the service.

2) Money following patient.
She beleives as patients exercise more choice, as different hospitals challenge each other to provide the best quality, as payment by results exposes differences in practice and therefore in cost, every clinician, every manager and every organisation will have an inbuilt incentive to compare themselves with the best, to innovate and improve, to give patients the best possible care – and taxpayers the best possible value for money.

3) Create more diverse providers
In her new NHS, there will be an element of competition. As that drives the less good hospitals to improve – or sees their services replaced by better providers.

4) A new framework of regulation and decision-making that guarantees quality, fairness, equity and value for money
She believes this will ensure proper stewardship of public funds.

She concludes that now is the only opportunity we will have in our lifetime to secure a health service that is true to its founding values, but fit for modern demands.

If people want to comment on this chapter, then please log onto www.thefutureofthenhs.com or send me a comment direct.

The Start of the Book Summary

Introduction - Chapter 1 The Future of the NHS, written by Dr Michelle Tempest.

The book aims to assist the reader, to penetrate the fog of confusion, about how to make future plans for the NHS. It brings eminent experts together from centrally relevant disciplines with a wide range of perspectives, to set out views clearly and readably; to enable the general reader (whether professional or lay person) to better understand the cardinal questions involved in this NHS debate. Early chapters express views from main political parties, Labour, Conservative and Liberal Democrats. Then chapters continue from top NHS professionals, experts at the forefront of their specialty, who collectively bring Centuries of experience. Their wealth of knowledge is unrivalled, admired and invaluable; they are the leading authorities across a broad range of specialties. The discussion continues about how the NHS is managed, trained, regulated and funded, and considers alternative and innovative methods of tackling complex financial issues.

It is imperative for every person to be involved in the debate, as it is not just for the ‘experts’ in the disciplines concerned, but for everyone - doctors, nurses and patients, lawyers and clients, legislators and voters, young and old, - because the debate crosses every age group and every social divide. Each one of us has a right to contribute to the debate, not least because, how we as a society answer the questions raised about the NHS, will ineluctably have a profound effect on the very nature of society as we know it. This book allows views regarding the NHS debate, to be informed rather than ignorant, rational rather than emotional, and to evaluate competing arguments and various ideas. ‘The Future of the NHS’ book enables the reader to take the first step into the most exciting debate of our times.

2006 is an important year for the NHS marking 60 years since the implementation of the National Health Service Act 1946. Therefore, it is an ideal time to start planning for the future of the service and to ensure '60th birthday celebrations' are not a sign of retirement. It is hoped that by gathering together some of the most eminent and respected health care professionals, policy makers and opinion formers, this book could go some way to pooling their collective wisdom into one volume and help start what might be the great health debate in this country.

So, where do we start with this process, to acquire long-term strategies for successful rehabilitation? In medicine, when a patient presents, the doctor starts by taking a history and then examining the systems. This book also takes this approach by asking the most involved and knowledgeable people from many walks of the NHS for their thoughts and ideas.

Each day for the next 34 days will include a very brief chapter summary of all the 35 book chapters.