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.

To comment on this further please post a comment here or on www.thefutureofthenhs.com

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.

To comment further on this chapter, please leave a post or log onto www.thefutureofthenhs.com

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’.

To comment further on this chapter - please post a comment here or on the debate forum www.thefutureofthenhs.com

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.

To comment further on this chapter, please feel free to leave a comment or log onto www.thefutureofthenhs.com

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.

To comment further on this article - please leave a comment and/or comment on www.thefutureofthenhs.com

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.

To comment further on this chapter, please leave a comment or join the debate on the forum on www.thefutureofthenhs.com

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.

To comment on this chapter further, please either post a comment or e mail directly mail@drmichelletempest.com

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.