The Future of the NHS book 2007

I very much hope that the summary of all the book chapters has sparked interest in the NHS debate and perhaps inspired people to read some chapters in more detail. I am always pleased to hear from anyone who has feedback or just wants to comment about the NHS, please feel free to post a comment or contact me directly on mail@drmichelletempest.com

I wish you all a very successful and happy 2007.

Chapter 35 - The Future of the NHS (The final chapter)

This is a summary of chapter 35 - Funding Expectations. It was written by Jennifer Rankin and Jessica Allen. Dr Jessica Allen is Senior Research Fellow and Head of Health and Social Care at the Institute for Public Policy Research. At IPPR, she is currently working on a project exploring public expectations and a sustainable health system. Prior to joining IPPR, she worked at the Kings Fund and at Unicef. She holds a PhD from the University of London and has lectured at the University of Greenwich and LSE. Ms Jennifer Rankin is a Research Fellow in Health and Social Care at the Institute for Public Policy Research. At IPPR, she is currently working on a project exploring public expectations and a sustainable health system.

They explain in this chapter that rising public expectations are one of the main cost pressures on the NHS.

Since the NHS was founded people’s expectations have risen dramatically. They explain that the political process must bear considerable responsibility for creating excessive expectations and disillusionment. They cites the example that in 1997, Tony Blair came to power with the heady phrase that “we have twenty four hours to save the NHS”. The Government they suggest have subsequently adopted some more realistic language, talking about a process that would take years rather than months. Opposition parties are also guilty of using loose language around the NHS, citing how David Cameron said that the “NHS could no longer ration treatments”. They maintain that in a system where resources are limited and demands are infinite, rationing will remain a necessity - clearly, the NHS has to ration treatments according to need. It has always done and will continue to do so.

They continue with examples of the media fuelling unrealistic expectations. They suggest that politicians and the media are locked in a dialogue of mutual distrust and suggest the need to fashion a new political dialogue about how we value the NHS. Policymakers need to communicate what people are entitled to and how these entitlements can be fairly distributed among the population. The public should have high expectations, but they should also be fair and realistic expectations. Ultimately, a better understanding of health and health services will enable the NHS to pull off the difficult balancing act of maintaining public support, doing more for health and remaining affordable.

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Chapter 34 - The Future of the NHS

This is a summary of chapter 34 - The Case for Pluralism. It was written by Professor Nick Bosanquet and Andrew Haldenby. Professor Nick Bosanquet is a Professor of Health Policy at Imperial College, London and a health economist who first carried out research on NHS funding in the 1980’s for the York Reports sponsored by the British Medical Association, the Royal College of Nursing and the Institute for Health Services Management. He has been Special Adviser on public expenditure to the Commons Health Committee since 2000. He is a non-Executive Director of a Primary Care Trust in London. Mr Andrew Haldenby is the Director of Reform, an independent, non-party think tank whose mission is to set out a better way to deliver public services and economic prosperity.

In this chapter they put the case for a full move towards pluralism. They explain that if the private sector are rewarded for using capacity; markets grow and market expansion raises productivity and prices fall. The public sector currently lacks this dynamic.

They highlight that in the NHS, capacity is used to limit demand, rather than ‘excess’ capacity being used to meet demand and provide more. They believe waiting lists are the consequence. They think that liberalising the supply side will both cause more capacity and improve efficiency. Also effective use of the private sector can be made when it is free to supply in a competitive environment, so that it invests, innovates and responds to consumers. It discusses the need for greater competition to make pluralism work and they list four key elements for effective pluralism:

1) Increasing information about choice.
2) Developing the market for alternative supply.
3) Recognising that reform through supply pluralism will take substantial launch costs.
4) Supply pluralism would be greatly assisted by a wider use of advertising.

They explain that real reform must also extend to demand as well as supply and suggest the NHS requires an environment where there are independent sources of funding. They summarise with the thought that without change in funding of the NHS, any ‘supply side only’ reform is likely to run into new problems of rationing as improvements increase the demand for services.

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Chapter 33 - The Future of the NHS

This is the summary of chapter 33. Localism in the NHS: Reducing the Demographic Deficit. It was written by Mr Tim Kevan, a Barrister at 1 Temple Gardens, with expertise in personal injury (including clinical negligence), sports, consumer and general common law. He is the author of nine legal textbooks and edits three legal newsletters. The other author was Mr Daniel Hannan MEP, a leader writer for The Daily Telegraph, author of 6 books and MEP for South East England.

They suggest that guiding principles for reform should be - decisions made as closely as possible to the people they affect; and those people should have as much say in those decisions as possible. They suggested the following:
1) Patient choice should be encouraged.
2) That all structures need to be democtratised. The most significant body within the present structure is the primary care trust (PCT) which commissions the majority of NHS services. They suggested that this should consist of directly elected representatives accountable directly to the people.
3) That structures should be simplified and made more transparent. They suggest that PCTs and other health organisations should be given boundaries that coincide not only with each other, but also with local authorities.
4) They advocated that the powers of 'local bodies' such as PCTs should be increased with greater decision-making discretion.
5) They suggested that doctors and other health care professionals should be brought back into the decision-making process.

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Chapter 32 - The Future of the NHS

This is a summary of chapter 32 - Alternative Funding Models. It was written by Dr Eamonn Butler, Director of the Adam Smith Institute, an influential think-tank which for more than twenty years has designed and promoted practical policies to promote choice and competition in the delivery of essential services. He frequently contributes articles to national magazines and newspapers on subjects such as health policy, economic management, taxation and public spending, transport, pensions, and e-government.

In this chapter he discusses the alternative methods of funding the NHS. Explaining that even after record big budget, the finances remain in a rough state, with many trusts reporting deficits and some being plainly unable to bring their budgets under control. The chapter argues a strong case for looking at alternatives for how the UK healthcare system should be funded. It offers an instructive overview with 16 other alternatives. To learn more about these 16 alternatives I would encourage you to buy the book, it can be bought from most good bookshops or on line at www.thefutureofthenhs.com

Chapter 31 - The Future of the NHS

This is a summary of chapter 31 - Taxation and Insurance. It was written by Professor Alan Maynard, Professor of Health Economics and Director of York Health Policy Group at York University. He has worked as a consultant for the WHO, the World Bank, the European Union and the UK’s Government Department for International Development. He is widely published in many books, specialist journals and the mainstream media. Since 1997 he has been Chairman of the York NHS Trust.

In this chapter he focuses on the debate about financing health care, remembering the objective of the NHS: to improve population health for the least cost. However, instead of focusing on the clinical and cost effectiveness of competing interventions and measuring clinical outcomes, the media and competing politicians propagate the illusion that more and/or different funding will “cure” the system’s often ill-defined problems.

The principle conclusions to be derived from his discussion of funding health care are that reasons for advocating change may be disguised by ideological and political agenda, but proponents of change have to be challenged. All health care systems, public and private, exhibit gross inefficiencies in terms of variations in practice and failure to deliver, but what the evidence base shows to cost effectiveness? The challenge for all who enter the debate about funding is to be transparent about their ideological concerns. Also, they must recognise that pouring more money into a health care system may not improve the level nor the distribution of population health.

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Chapter 30 - The Future of the NHS

This is a summary of chapter 30 - Financing the NHS: The Current System. It was written by Mr Tony Harrison, a Fellow in Health Policy at the King’s Fund. He has published extensively on the future of hospital care, the private finance initiative, health research policy and waiting list management.

In this chapter he gives an overview of the ways in which the NHS is financed and the historical loop funding seemed to have followed. He believes the decision to finance services almost entirely out of taxation, still leaves a large number of issues to be resolved. The question remains to be considered, is it appropriate to continue to rely upon tax finance? The Government is committed to it: so is the Conservative Opposition. Nevertheless, it may come into question in the very near future.

The Government’s response was to argue that tax finance remained the best option, but that substantially more resources would be needed to provide high standards of health care. The result was the largest sustained increase in NHS spending ever experienced. This rate of increased spending will continue until 2007, but what will happen after that?

He believes, as yet, there is no reason to believe that the level achieved will be regarded as ‘good enough’: the pressure to spend more will continue, due to new technology, the need to continue to raise clinical quality, and from the Government’s own desire to respond to what it perceives as rising public expectations.

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Chapter 29 - The Future of the NHS

This is a summary of chapter 29 - Redressing the compensation culture. It was written by Mr Tim Kevan, a Barrister at 1 Temple Gardens with expertise in personal injury (including clinical negligence), sports, consumer and general common law. He is the author of nine legal textbooks and edits three legal newsletters.

He Suggests that a culture of risk aversion and fear of litigation has gone too far. In order to re-set the balance, he suggests the following:
1) The law of liability for clinical negligence to be reviewed and that certain medical specialties should be immune from litigation.
2) Alternative forms of non-fault compensation to possibly apply.
3) Medical practitioners should generally be immune from discipline subject to certain basic exceptions on condition that they provide full and frank disclosure of their mistakes which would not be able to be used in litigation.
4) Suggestions for spending on legal costs to be reduced.

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Chapter 28 - The Future of the NHS

This is a summary of chapter 28 - Medical Negligence Claims. It was written by Dr Gerard Panting, Director of Policy, Medical Protection Society.

In this chapter he provides a guide to the NHS Redress Bill which is aimed at improving procedures for dealing with clinical negligence claims, both in terms of helping victims and in reducing costs. Ultimately, he believes the success of the Redress Scheme will depend on how individual trusts manage the process at local level, and whether there is counter shift away from attributing blame, towards preventing harm reducing risks and learning from mistakes.

The scheme is to be overseen by the National Health Service Litigation Authority (NHSLA) and he raises questions as to its impartiality, and also whether it will have the resources properly to investigate what the acceptable range of practice was and whether the work came within it.

Ultimately his belief is that the scheme is likely to result in more patients with low value claims coming forward to use the scheme.

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Chapter 27 - The Future of the NHS

This is a summary of chapter 27 - From self-regulation to professionally-led Regulation in Partnership with the Public.

It was written by Dr Joan Trowell a University Lecturer in Medicine and a Consultant Physician at the Oxford Radcliffe Trust. She is a member of the General Medical Council and until recently she was chairman of the GMC’s Fitness to Practise Committee. It was also written by Mr Paul Buckley, the Director of Strategy and Planning at the General Medical Council (GMC).

This chapter examines the changing face of professional regulation. While the focus is largely on the GMC, the trends identify conclusions, intended to apply to the regulation of healthcare professionals more broadly. Many changes have already occurred, but some would advocate yet further change. Given the clear willingness of regulatory bodies to reform radically, further imposed structural change for its own sake, or for the sake of continuing the momentum of change, cannot be the answer. The effect of the recent reforms requires adequate evaluation.
They suggest that the new model of regulation, which is emerging, retains the strengths of professional ownership, but balanced by full public involvement. This is the true meaning of professionally led regulation in partnership with the public.

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Chapter 26 - The Future of the NHS

This is a chapter summary of chapter 26 - The Future for Health Care Management: an Analysis and Some Proposals. It was written by Professor Ewan Ferlie, Director of the Centre for Public Services Organisations and Head of the School of Management, Royal Holloway University of London

In this chapter he argues that 'better management can lead to better health services', via the slogan ‘better management; better health’. He sees a core management task involving active leadership from both general managers alongside clinicians, to inspire and sustain collective service improvement activity rather than ‘form filling’ management, for proliferating audit systems. He suggests the need for more local and long term strategies and fewer top down quick fixes. He believes health care management should be based on a secure evidence base as well as clinical practice. He offers analysis and a 4 point agenda for management in the medium to long term.

1) Stabilising The System: Less haste; More speed.
2) Getting Doctors into Management and Developing Medical Leadership
3) Strategies with Private Sector Providers
4) Developing an evidence based method for NHS management.

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Chapter 25 - The Future of the NHS

This is a summary of chapter 25 - NHS staff. It was written by Dr Chess Denman a Consultant Psychiatrist in psychotherapy at Addenbrookes hospital where she runs the Complex Cases service which specialises in the treatment of personality disordered patients. Dr Denman is the secretary of the Royal College Faculty of Psychotherapy, a member of the Society of Analytical Psychology and a founder member of the Association of Cognitive Analytic Therapists.
Mr Daniel Barnett a leading Barrister in employment law and author of three employment law textbooks, including co-author of the Law Society Handbook on Employment Law. He has advised and defended a number of NHS trusts in unfair dismissal and discrimination claims. He frequently comments in national and specialist press on employment law matters. Also Dr Colin Payton a Consultant Occupational Physician and Clinical Director of Occupational Health and Safety at the Royal United Hospital, Bath.


This chapter describes how the NHS (the fifth largest employer in the world) has reported 36% of their staff have suffered work-related stress. Psychological ill health remains potentially the most serious problem for the health and well-being of NHS staff. What does not emerge from the statistical and survey data are the human stories which surround psychological ill health in hospital staff, many of whom are there caring for others. Doctors take the fewest days off sick but have high rates of suicide. It also seems unfortunate that there are increasing numbers of health care workers with alcohol misuse problems and more recently with other substance misuse problems.

With this in mind this chapter provides some positive suggestions for change in relation to improving the care of the nation’s carers. They fall into two categories. First, improved access to psychological care and second, more employee focused employment procedures.

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Chapter 24 - The Future of the NHS

This is a summary of chapter 24 - proposals to improve clinical academic training. It was written by Professor David E Neal and Professor Mark Walport. Professor David E Neal is Professor of Surgical Oncology at the University of Cambridge & Member of PMETB. He is an elected member of the Council of the Royal College of Surgeons of England and a past Chairman of the SAC in Urology. Professor Mark Walport FMedSci, FRCP He is the Director of the Wellcome Trust and Chair of UKCRC & MMC Academic Careers Sub-committee.

In this chapter they address the importance of an academic career including researchers and educators by considering the following issues:
1) Academic medicine as a career had been under threat with warning bells ringing for some time over the perilous state. Several reports highlighted difficulties facing clinical academics, as they attempted to negotiate the hurdles of dual training in clinical and academic skills. Fortunately, an increase to NHS Research and Development funding and the promotion of a partnership approach to strengthen clinical research.
2) The increasing the strength of academic medicine to improve expertise in clinical research and education is of great benefit to the NHS and the wider academic and business community in the UK.
3) Overall, the prospects for academic medicine are improving, and depend upon working with the Colleges, Faculties and Specialties to ensure that new academic programmes are coherent with changes in training. If there continues to be real commitment to improve careers in Clinical Academic Medicine, then they expect prospects to be good and the declining number of academics to be reversed.

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Chapter 23 - The Future of the NHS

This is a summary of chapter 23 - training for a new NHS. It was written by Professor Shelley Heard and Professor Elisabeth Paice. Professor Shelley Heard trained as a medical microbiologist. She has been a chief executive of an acute trust and for the last 10 years has been a postgraduate dean for medicine in London. She is also currently the National Clinical Advisor for the Modernising Medical Careers (MMC) programme. Professor Elisabeth Paice MA FRCP She is Director of Postgraduate Medical and Dental Education for London. She developed the Hospital at Night concept and has published on stress in doctors; doctors in difficulty; workplace bullying; flexible training; and other aspects of medical careers.

They describe how medical education in the UK has an international reputation for excellence, and our own graduates are eagerly sought after by other countries. Nonetheless, there is plenty to improve about the way we train doctors, and there are powerful drivers to do things differently. Whatever else is needed to support the vision of a future better NHS, education must be right up there. It explains the recent changes in medical school training, and the new terminology, such as Modernising Medical Careers (MMC), and the new standards set by the Postgraduate Medical Education and Training Board (PMETB).

They discuss the issue of healthcare being a twenty-four hour business, but that the move to a twenty-four hour society has not produced twenty-four hour people. Night working is intrinsically stressful, error-prone and socially undesirable, and no vision of the future NHS can ignore the damaging effects of night work on its staff. The European Working Time Directive has proved a powerful driver for change to long hours, but in some cases, shortening the hours has simply resulted in excessive work intensity.

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Chapter 22 - The Future of the NHS

This is a summary of chapter 22 - what do patients want? It was written by Claire Rayner, president of The Patients Association and is the UK’s best known agony aunt. She has a long and successful career as a journalist, broadcaster and writer, but began her working life as a nurse at the Royal Northern Hospital in London.

Claire Rayner makes several strong points in this chapter, which include:

1) We Want to Know the People Who Treat Us:
Patients understandably want to get to know the professionals who are treating them, yet she has found the number of strange faces bewildering. Strangers who know little about you or even why you are there, make patients feel not only lonely but alienated.

2) We Want to Feel Safe
Hospitals now seem a byword for dirt, disorder and hospital acquired infections with horrid accounts of MRSA. Thatcherite thinking to save money was to employ contract cleaning firms; but it seems to have left hospitals disgustingly dirty. The contract company’s employees tend to lack any real incentive to do a good job and they are rarely paid enough for the effort demanded of them.

3) We Want Reliable Day and Home Care
Whatever happened to the idea of convalescence? Now the aim seems to be to get patients out of hospital as quickly as possible, else fear being a ‘Bed Blockers’ - an unpleasant, indeed insultingly, label given by management. To be able to afford care home placements many elderly people have to sell the home, to provide what NHS gurus call Social Care yet many others regard as basic nursing care.

4) We Want the NHS to Continue to Exist
For all its current problems and occasional disasters there is no doubt in my mind that the majority of the people in this country value the NHS highly, and would be deeply dismayed if the current obsession to reduce its costs, takes us back to the bad old days pre 1948.

5) Will the NHS collapse in the future?
I have to say that I very much fear it will. We now have not a National Health Service but a series of Local Health Services, a net that has many large holes through which patients fall with distressing frequency. Add to that the cost debts and the future of the NHS is very bleak indeed. Hence, my fears our descendants be pushed back into the past, to die not only unhonoured and unsung, but uncared for.

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Chapter 21 - The Future of the NHS

This is a summary of chapter 21 - integrating alternative health. It was written by Dr Mosaraf Ali, who after qualifying as a doctor continued his studies into complementary medicine. With continuous help and encouragement from Prince Charles he established a clinic where both complementary and conventional treatments are integrated. He opened the Integrated Medical Centre in London with a team of fifteen doctors and therapists.

In this chapter he focuses on ‘Integrated Medicine’ – a combination of conventional, complementary and traditional medicines. He sets the basis of integrated medicine as the patients’ participation in creating their own health. He argues that integrated medicine should be incorporated into the NHS and that primary healthcare physicians should be trained in its principles.

He suggests that the NHS should cast aside reservations about integrated health and should embrace it. He also adds that as many diseases could be arrested at the grassroots level this would have the knock on effect of reducing the burdens on the more expensive hospital and specialised treatment.

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Chapter 20 - The Future of the NHS

This is a summary of chapter 20 - the future of nursing. This chapter was written by Jane Naish (a policy adviser at the RCN with a background in nursing, sociology and health policy) and Ms Sylvia Denton, President of the Royal College of Nursing who has recently retired from her post as lead nurse/Senior Clinical Nurse Specialist in breast care. Sylvia was awarded the CBE in the New Years Honours List in 2006 for services to health care.

In this chapter they examine the future for nursing and review the key principles for the development of nursing. They highlight the serious shortages in almost all categories of health care workers and recognise that the low numbers of registered nurses is becoming a significant problem, because of:

· Difficulties regarding nursing recruitment and retention.
· Overall nurse shortages, critically compounded by an ageing nurse population.
· Predictions that more nurses will leave the nursing register than will join in the future.

They warn that any future nursing strategy needs to recognise that registered nurses will not be able to personally deliver all the nursing care needed and will have to rely on teamwork, and to extend their expertise to others in the caring profession. They discuss that nursing and nursing teams will have to become far more integrated across the different care settings span both community and hospital settings.

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Chapter 19 - The Future of the NHS

This is a summary of chapter 19 - the future of mental health provision. It was written by Mr Derek Draper, a former political adviser and author of “Blair’s 100 Days” (Faber). He is a psychotherapist in private practice in Marylebone, London and during his training worked as the development director of a community counselling centre in northern California. He is a member of the British Association for Counselling and Psychotherapy (MBACP). He writes monthly columns in the magazines “Psychologies” and “Therapy Today”.

This chapter Derek concentrates on “sub-clinical” problems; conditions that don’t quite meet the diagnostic criteria for any particular mental disorder, but that nonetheless involve a great deal of psychological or emotional unease. He explores:
1) The changes that would be necessary to make the current system deliver on its existing standards.
2) Reviews the recent proposals for expansion of therapy services, arguing that whilst such changes are welcome, they remain fundamentally inadequate to deal with the scale and depth of the problem.
3) Proposes a new and radical solution of therapeutic volunteers – coining the term “para-counsellors”.

He concludes that current demand is so great that without the new voluntary “para-counsellors”, millions of Britons in need of mental health treatment, will sadly never receive it.

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Chapter 18 - The Future of the NHS

This is a summary of chapter 18 - the future of psychiatric services in the NHS. It was written by Professor Peter Tyrer, Professor of Community Psychiatry, Imperial College, London in the Department of Neurosciences and Mental Health Medicine.

In this chapter he considers how mental health services have been regarded as a 'Cinderella service' scrabbling for resources; yet mental illness incurs a heavy burden on populations and it is very unwise to ignore this burden.

He discusses the attempts to integrate mental health and social services, yet warns of the remaining yawning gap. He suggests that these systems should integrate and work together to allocate patients to appropriate care.

He warns that although there are increasing services for care in the community there is still a long way to go. Currently there are too few outlets for patients to be discharged from hospital into community settings, meaning they remain in hospital. This has the knock on net effect of there being a shortage of acute psychiatric beds.

The chapter adds a plea ‘please, oh please, do not introduce changes in policy until they have been shown to be evidence-based’.

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Chapter 17 - The Future of the NHS

This is a summary if chapter 17, Plastic, Reconstructive and Aesthetic Surgery by Mr Peter Butler. He is a Consultant Plastic Surgeon and Honorary Senior Lecturer at the Royal Free and University College Hospitals, London and a Consultant in Plastic Surgery at the Massachusetts General Hospital, Boston, USA. He is a council member of the British Association of Plastic Surgeons (BAPS). He is also frequently seen on television discussing face transplants.

In this chapter he explains that plastic surgery specialty is adapting to the ever-changing healthcare environment. However, he discusses the concern over the lack of provision of adequate manpower. This has caused other surgical specialities to have to pick up this capacity shortfall, adopting plastic surgery techniques with variable standards and achieving mixed results. The inadequate numbers of plastic surgeons is in the face of an increasing demand for plastic surgery provision. This is in part related to medical advancements making plastic surgery possible, that previously would have been deemed untreatable. Demand is also compounded by an ageing population and increasing numbers needing plastic. Added to this is the demand for surgery for normalisation and improvement of appearance, partly related to increased patient demand and increased awareness due to television programmes such as ‘Extreme Makeover’. Increasingly, GPs refer patients to plastic surgery units for this type of surgery.

He believes that currently the provision of cosmetic surgery is not driven by evidence-based medicine but by subjective opinion.

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Chapter 16 - The Future of the NHS

This is a summary of chapter 16 - The Future of Public Health, written by Professor Griffiths. He was the regional director of public health for the West Midlands Regional Health Authority until his retirement in May 2004 and is currently the President of the Faculty of Public Health. He was awarded the CBE in 2000.

In this chapter he discusses the three aspects of public health.
1) Health promotion.
He Comments on the recent parliamentary vote in England to ban smoking in all enclosed public places as a landmark decision. He hails it as a success for public health but warns that there is still more work to be done towards health promotion.
2) Health protection
He explains that health protection involves surveillance of infectious disease, environmental hazards and interventions intended to control outbreaks and incidents. Controlling an outbreak of infectious disease requires public health workers to be part of multidisciplinary teams, understanding ststatistics, epidemiology, social sciences and the arts. The diversity of workers from a variety of backgrounds in public health has enriched the specialty enormously. It is also necessary to remember the importance of international collaboration. This has been highlighted recently by avian influenza (bird flu), where WHO collaboration around the world identifing new infectious agents in a matter of weeks and greatly continues to assist in controlling measures.
3) Service improvement
He warns that the required close relationship with statutory organisations makes public health vulnerable to politicians reorganising the system. He highlights that NHS reorganisation can disrupt the important work of public health leading to a net loss of capacity.

He hopes that in the future there will be a more stable pattern of authorities retained for a longer period, to let the public health workers get on with their jobs.

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Chapter 15 - The Future of the NHS

This is a summary of chapter 15 - the crystal ball of cancer care, written by Professor Karol Sikora. He is Dean of Britain’s first independent Medical School at the Universities of Brunel and Buckingham. He is an editor of the standard UK postgraduate textbook Treatment of Cancer which this year goes to its 5th edition. He was Professor of Cancer Medicine and honorary Consultant Oncologist at Imperial College School of Medicine, Hammersmith Hospital, London where he was Clinical Director of Cancer Services for 12 years. He was seconded as Chief of the WHO Cancer Programme in 1997.

In this chapter he worryingly highlights that the global incidence of cancer will increase by 100% over the next twenty years. The public, understandably, is more frightened of cancer than any other illness, but warns that it is difficult to present balanced views, as everyone has a vested interest and calm analysis is not front-page stuff.

He believes that the NHS has unfortunately not anticipated the dramatically increasing costs associated with high quality cancer care. Even though politicians are keen to improve cancer care, the existing system just can’t cope, despite the massive amounts of taxpayers’ money thrown at it. He warns that the NHS in its current format will simply not be able to meet the surge in demand for innovative cancer care.

He proposes that it is time to get the independent sector to drive the cancer delivery agenda. Moving the NHS away from the Stalinist era, towards the consumer age, where people can vote with their feet. He explains how the delivery of care could be done in the future, giving a template to rollout a network of outpatient ‘cancer hotels’. He believes that the NHS needs a revolution, demolishing the icons of the past – waiting times, targets, restrictions to access, propaganda and mindless bureaucracy - cracking them apart like the statues of Lenin around Eastern Europe. When they fall, the new Phoenix of a consumer led healthcare system will emerge. Britain could then lead the world in cancer care.

I would encourage you to comment on this chapter further after reading his hard hitting view about the future of cancer care. Please feel free to comment here or log onto www.thefutureofthenhs.com

Chapter 14 - The Future of the NHS

This is a summary of chapter 14 - the future of cardiology within the NHS by Dr David Stone, a consultant Cardiologist and Director of Education at Papworth and Associate Dean at the Faculty of Clinical Medicine.

In this chapter he warns that cardiological development is fraught with uncertainty, because the discipline crosses many borders and is associated with technological development in very rapidly changing fields. He addresses the question: what will we be doing and where will we be doing it?

He strongly warns against the short term-ism in working within a system, at least somewhat dependent on an electoral system, with a (maximum of) 5-year cycle. The consequences are then imposed upon a financially based health service that is also undergoing major changes in training and reimbursement. He believs it is little wonder that the future is uncertain and that there is a retreat into a defensive position. He sums up by warning against letting the future of the NHS be sacrificed for our present.

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Chapter 13 - The Future of the NHS

This is a summary of chapter 13 - the future of ophthalmology (eye specialty). It was written by Dr Nick Astbury, President of the Royal College of Ophthalmologists and is a Consultant Ophthalmic Surgeon at the Norfolk and Norwich University Hospital NHS Trust.

He belives that the debate about plurality of providers is particularly relevant in ophthalmology, as cataract surgery is the most commonly performed elective procedure in the UK. The specialty has been a leading innovation with a highly successful initiative conceived by the College in partnership with the government. NHS staff, by embracing new technology have dramatically reduced waiting times. But he warns that the future does not lie with commercially driven independent sector treatment centres staffed by overseas doctors on working vacation, who to date, have carried out just 2.5% of the cataract throughput, at considerably greater cost. Experience has revealed that we should be investing in our own hospital departments that are more than capable of delivering an excellent, innovative and local service.

He believes that the future rests in all of our hands, to a greater or lesser extent. What we do today directly affects our patients and those around us; we can set a good example to others or lead them astray. But there will always be events over which we have no control and governments that impose change for changes’ sake rather than building on existing good practice.

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