Nothing less than a radical overhaul is needed to deliver an NHS fit for the future
4 min read
I am proud to be a practising NHS hospital doctor and work in a health service that delivers patient care which is free at the point of need, regardless of a patient’s wealth, background, sex, race or age.
As we celebrate 75 years of our NHS, the best birthday present we can give to patients and staff is to develop a credible plan for the wholesale transformation of how we deliver care.
While the NHS is world leading in the quality of its urgent and emergency care services, we must recognise that, if we were designing a health service from scratch today, it would need to look very different.
Many people are now living longer, but often this also means living with a long-term medical condition. In England alone, there are approximately three million people now living with three or more long-term conditions including hypertension, diabetes and COPD.
Our split commissioning model … leads to both financially inefficient and fragmented delivery of care for many patients
Our split commissioning model, where social care is commissioned by local authorities and healthcare by the NHS, leads to both financially inefficient and fragmented delivery of care for many patients with chronic health conditions. Even within the NHS there are silos – for example primary (GP-led) care and secondary (hospital-based) care – which each have their own ringfenced budgets.
Caring for people with chronic illnesses requires more effective community-based care and better integration of health and social care services.
Politicians rarely understand the importance of good commissioning but they need to learn to do so. The only way we can transform patient care is through pooled budgets and a single commissioning process. There are many vested interests who will resist change, but a radical overhaul is long overdue and essential if we are to transform services and deliver the integrated and community-focused model of care that is now required.
With a commissioning model that is fit for purpose, we will be able to make basic healthcare much easier for more people to access, for example through pharmacies and gyms. It would also allow us to properly join up the fragmented NHS IT infrastructure, perhaps through cloud-based solutions, in order to better integrate patient care.
The NHS also needs to focus more on preventative care. Medical genomics is the future. Better understanding how people are susceptible to certain illnesses and how they respond to different treatments will revolutionise care. To unlock the potential of medical genetics, we need to recognise that, in future, more effective public-private partnerships will need to be forged between the NHS, universities and the private sector.
A credible workforce plan that is regularly updated is essential when planning the care needs of patients. Government will also need to recognise that adequate pay, as well as having other appropriate recruitment and retention incentives, will be needed if we are to avoid having a health and care workplace that increasingly relies on temporary staff.
Finally, a word on NHS managers and boards: there are far too many weak managers who would not survive employment outside the public sector workplace. I have seen first-hand how, too often, underperforming chief executives surround themselves with weak boards. The result is hospitals in deficit, with poorly managed estates, with demotivated clinical staff, and (even allowing for Covid) with long waiting lists for care. The NHS must do something to address this.
NHS managers and executives need better training, experience of the private sector, and there must be consequences for poor performance, not simply a game of musical chairs into the next NHS management role.
The NHS has served this country well for 75 years. As it looks towards the future, it must transform. A focus on prevention and reform of commissioning is vital if the NHS is to continue to meet the needs of patients in the years ahead.
Dr Dan Poulter, Conservative MP for Central Suffolk and North Ipswich, former health minister and practising NHS psychiatrist
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