In the last couple of days I have attended two events where smart people have discussed the future of the NHS - and come away worried about the scale of the challenges it faces. Rory’s Always On Newsletter is a reader-supported publication.
Any mention of prevention or funding for public health would be a start.
Bringing back SureStart centres - everywhere not just in areas of high deprivation - in Oxford there are few of any ante-natal classes and new mums are getting advice from Instagram, Peanut and Mumsnet. Number of health visitors have plummeted.
Huge new housing estates being built with no public space - I live on an estate of 500 homes. We have one room of space for meetings, enough for 10 people. Nowhere for exercise classes, coffee mornings, mums and toddlers.
I'll stop there but we do need the bigger picture.
I'm reading you stacks with much interest & agree with the points made. My mum 93 has just come out of hospital after a fall resulting in a broken shoulder - very debilitating. A number of issues strike me; poor repetitive fragmented communication, non existent communication with outside agencies such as care providers leading to bed blocking, the amount of admin nurses are expected to do with many hours spent on computers/databases, the poor use of tech for communication with the patient/carers/family.
My wife ex nurse vol for age uk in large city hosp. Nurses have to walk to her to ask for any help services age uk can provide for patients in hosp. And only few nurses even know or bother. Drs dont bother at all. So older folks often dont get help which is literally down the stairs. And apparently the nhs is wonderful.
I focused on changing organisations behaviour during my consultancy career, working with household name private and public organisations, including leading hospitals. All nhs organisations I saw demonstrated the same basic flaws with excellent committed people at the very top and bottom of the ladder, but with many middle management blockers nursing their over inflated egos not patients; Too many overpaid admin managers who measured themselves by the number of meetings they attended, and the number of meaningless awards and accreditations they gathered rather than the overall number of patients that were treated. This problem isn’t going to be solved by throwing ever increasing sums of money about, but more by changing attitudes and service delivery approaches at all levels. Technology has a huge part to play here but Let’s start by depoliticising the NHS; improving community based healthcare services to avoid hospital visits, and encouraging and educating the public to better take care of themselves. Early Prevention not last minute cures.
Nhs canx consultant appt yesterday as his speciality didnt meet my need. Wtf didbt that happen when i booked the appt in sept? After waiting the entire previous month to speak to my GP to arrange the appt. Now Ive got to go back to Gp. Wait another month no doubt to start again.
Now if i had £13k spare another surgeon i saw, before the nhs fiasco, who was happy to do op privately, but not on nhs, would do op in 2 weeks.
Thank you again Rory for a very informative summary of the discussions. One aspect that seems to be consistently missing from the table is the role of the DoHSC in how the NHS manages itself and how day to day funding and capital investment is managed, for the most part it seems, very poorly.
Funding for GP services is based on a business model which would ensure bankruptcy in any commercial line of business and like NHS dentistry doesn't follow a logic of payment for actual work done. Most capital funding is based on two factors, current political whim & the ability of NHS organisations to bid successfully when a pot of money, tagged for some specific purpose, becomes available. The capital investment processes ensure fragmentation of services and an inability to benefit from economies of scale or negotiate better terms of engagement with suppliers. Frequently NHS organisations will be required to employ external consultancies to bid for capital funding and bizarrely, the cost of these services will be taken from the NHS project budget.
Without question the way the NHS manages itself requires radical reform as Mr Irving above suggests & one of the first changes to be made should be the culture of secrecy and the corrosive practice of management by witch hunt. However without a fundamental root and branch reform of the DoHSC in parallel, the effect of the changes will be very limited.
Thanks again. Peter
PS I hope Professor Coyle arrived home reasonably refreshed following her run-in with Air Canada; a customer service situation familiar to many such travellers.
Any mention of prevention or funding for public health would be a start.
Bringing back SureStart centres - everywhere not just in areas of high deprivation - in Oxford there are few of any ante-natal classes and new mums are getting advice from Instagram, Peanut and Mumsnet. Number of health visitors have plummeted.
Huge new housing estates being built with no public space - I live on an estate of 500 homes. We have one room of space for meetings, enough for 10 people. Nowhere for exercise classes, coffee mornings, mums and toddlers.
I'll stop there but we do need the bigger picture.
I'm reading you stacks with much interest & agree with the points made. My mum 93 has just come out of hospital after a fall resulting in a broken shoulder - very debilitating. A number of issues strike me; poor repetitive fragmented communication, non existent communication with outside agencies such as care providers leading to bed blocking, the amount of admin nurses are expected to do with many hours spent on computers/databases, the poor use of tech for communication with the patient/carers/family.
There are glaring issues & it is unsustainable.
My wife ex nurse vol for age uk in large city hosp. Nurses have to walk to her to ask for any help services age uk can provide for patients in hosp. And only few nurses even know or bother. Drs dont bother at all. So older folks often dont get help which is literally down the stairs. And apparently the nhs is wonderful.
I focused on changing organisations behaviour during my consultancy career, working with household name private and public organisations, including leading hospitals. All nhs organisations I saw demonstrated the same basic flaws with excellent committed people at the very top and bottom of the ladder, but with many middle management blockers nursing their over inflated egos not patients; Too many overpaid admin managers who measured themselves by the number of meetings they attended, and the number of meaningless awards and accreditations they gathered rather than the overall number of patients that were treated. This problem isn’t going to be solved by throwing ever increasing sums of money about, but more by changing attitudes and service delivery approaches at all levels. Technology has a huge part to play here but Let’s start by depoliticising the NHS; improving community based healthcare services to avoid hospital visits, and encouraging and educating the public to better take care of themselves. Early Prevention not last minute cures.
Nhs canx consultant appt yesterday as his speciality didnt meet my need. Wtf didbt that happen when i booked the appt in sept? After waiting the entire previous month to speak to my GP to arrange the appt. Now Ive got to go back to Gp. Wait another month no doubt to start again.
Now if i had £13k spare another surgeon i saw, before the nhs fiasco, who was happy to do op privately, but not on nhs, would do op in 2 weeks.
The nhs is shambolic disaster.
Thank you again Rory for a very informative summary of the discussions. One aspect that seems to be consistently missing from the table is the role of the DoHSC in how the NHS manages itself and how day to day funding and capital investment is managed, for the most part it seems, very poorly.
Funding for GP services is based on a business model which would ensure bankruptcy in any commercial line of business and like NHS dentistry doesn't follow a logic of payment for actual work done. Most capital funding is based on two factors, current political whim & the ability of NHS organisations to bid successfully when a pot of money, tagged for some specific purpose, becomes available. The capital investment processes ensure fragmentation of services and an inability to benefit from economies of scale or negotiate better terms of engagement with suppliers. Frequently NHS organisations will be required to employ external consultancies to bid for capital funding and bizarrely, the cost of these services will be taken from the NHS project budget.
Without question the way the NHS manages itself requires radical reform as Mr Irving above suggests & one of the first changes to be made should be the culture of secrecy and the corrosive practice of management by witch hunt. However without a fundamental root and branch reform of the DoHSC in parallel, the effect of the changes will be very limited.
Thanks again. Peter
PS I hope Professor Coyle arrived home reasonably refreshed following her run-in with Air Canada; a customer service situation familiar to many such travellers.