Health service ‘at risk of sudden collapse’ – and the honest debate has yet to occur

Chris Smyth in The Times 2nd October 2015 reports: Health service ‘at risk of sudden collapse’ – and the honest debate has yet to occur…

Waiting times for NHS care are getting longer and patients will find it harder to get treated, experts warn.

A&E units, ambulances and GPs are all taking longer to see patients and a “sudden and catastrophic collapse” is possible as the NHS struggles to cope, think-tanks warn today.

Standards have been consistently declining and are likely to get even worse, say the Nuffield Trust and the Health Foundation in an annual report on the quality of care.

Ministers need to be realistic about what the NHS can do and come up with a proper plan for making efficiency savings beyond cutting staff, the report says.

Nigel Edwards, chief executive of the Nuffield Trust (Closer to Critical? QualityWatch annual statement 2015) and Richard Taunt, of the Health Foundation, write: “The warning lights on care quality that we observed last year now glow even more brightly. So far we have seen a gradual decline in some elements of quality. The problem with complex systems under high levels of stress is that they can suffer sudden and catastrophic collapse — often without a lot of warning.”

Big A&E units dealt with only 91.1 per cent of patients within four hours in the first quarter of this financial year, down from 95.6 per cent in the same period of 2011, while long “trolley waits” have jumped 45 per cent in a year.

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The Nuffield Trust report conclusion reads:

The start of the new Parliament provides the opportunity for political and health leaders to develop a long-term plan that puts the NHS and social care system on a sustainable footing. The Five Year Forward View provides the NHS leadership’s own plan and there is much to support in this vision. While it does not provide all the answers, we would urge politicians to work with the grain of the Forward View and support the local innovation and experimentation that will follow from the vanguards in particular.

The financial outlook for the NHS – not to mention for social care services – is a significant cause for concern and, as our QualityWatch programme has shown, we are now seeing worrying signs that historic gains in quality are going into reverse, particularly around waiting times, mental health services and staff wellbeing.

How politicians respond to this challenge will be critical. We have outlined some of the more immediate approaches that we would recommend. However, more generally, we would also encourage further thinking on the mechanisms for creating change that are deployed during this Parliament. The NHS has become fixated with the use of targets, micro-incentives and punitive approaches, which are an attempt to continue to try and manage care services in detail. Directives and requirements enforced by regulation have also been overused.

But the approach to change outlined in the Forward View requires more organic and locally tailored approaches. For these approaches to be successful, there will need to be experimentation, risk taking, and time and space for clinical and managerial leaders to do the work. It will require a shift in mind-set away from central control. It will also require an engaged and empowered NHS workforce. Politicians must therefore think carefully about how to reconcile the need to develop and encourage the workforce with the inevitable political desire to maintain ‘grip’ on the NHS when the financial situation continues to deteriorate.

We do not underestimate how difficult this will be for political and health system leaders – especially given the deteriorating financial outlook and the need to maintain standards of quality. However, it is essential that we move to a more empowering, bottom-up approach while at the same time holding health care leaders to account for the care their organisations deliver to patients and service users.

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This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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