Derek Bell: Attempting short-term crisis management will not solve NHS problems

Medical staff are experiencing increased pressure and workloads, says Derek Bell. Picture: Chris Furlong.

Medical staff are experiencing increased pressure and workloads, says Derek Bell. Picture: Chris Furlong.

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Headlines talking of an ‘NHS in crisis’ and patients ‘at risk’ are appearing with a worrying frequency as numerous reports outline the challenges and pressures faced by the NHS.

As a College with members working tirelessly in Scotland and throughout the UK, the Royal College of Physicians of Edinburgh knows that these headlines resonate with them, but do little to address the challenges they face on a daily basis. In reality we perform better in these areas than many other countries but that does not mean we can be complacent.

Recent reports [from Audit Scotland, the General Medical Council, King’s Fund, UK Parliament Health Select Committee], all looking at different aspects of the NHS in different parts of the UK, have a common vein running through them: the NHS is under pressure from our ageing population, financial constraints, and significant workforce challenges, all of which combine to exacerbate pressures on the NHS as a whole as well as the workforce that holds the system together.

However, these – and many other reports – cannot be looked at in isolation and meaningful action must be taken if we are to secure the long-term future of our NHS.

Morale is a significant cause for concern. The recent junior doctors’ contract dispute in England brought many issues to the fore, not only for trainees but for all doctors. Trainees are our future workforce, and their well-being and morale are important, not just individually but as a reflection of a functioning and valued workforce. Many of the difficulties identified by trainees can also be found across the NHS workforce, and require collective ongoing discussion to find solutions.

Medical staff, treating patients and providing training for the next generation of doctors, are experiencing increased pressure and workloads, as they work to deliver high quality patient care throughout the week.

When services are under pressure, time and resources for training can the first to be sacrificed; and we must ensure the values of time to care, time to train and time for research become an intrinsic part of the culture of the NHS in the interests of longer-term sustainability.

The issue of improving the emergency care experience and outcomes for patients is also of paramount importance but data over the last few years has shown a steady decline in system performance. It should also be recognised that emergency pressures have become an all year round problem throughout the UK.

Over the last 12 months while pressures in Scotland continue, overall performance has been consistently better than in the other three nations. As such, the 6 Essential Actions to Improving Unscheduled Care programme, which shares best practice across Scotland and the UK, appears to be showing patient benefit.

However, a whole system approach and additional investment should be targeted as it is unlikely that performance this winter – irrespective of illness severity or weather – will be good.

Focus should be on improving care to allow flow through the emergency department – either back into the community, or to the correct inpatient service – at the right time, cared for by the right person.

As we move towards the vital yet ambitious integration of health and social care, long-term and detailed workforce planning is vital to ensure we have a world-class clinical workforce to provide the new models of care necessary for integration to succeed. Doctors and other healthcare staff need to be able to play a role in – and take responsibility for – making decisions about clinical services, whether this is in relation to integration with social care, or to the way acute hospital treatment will be provided in future.

We also need to ensure that pursuing a career in medicine in the NHS is an attractive choice so that we attract – and retain – the best possible talent. By doing so, we will not only be nurturing our trainees but safe-guarding future patient care.

In the new era of integrated health and social care systems around the UK, we need to ensure that investment in services is targeted at the areas for which it was intended. Long-term sustainability in the NHS must be given precedence over short-term crisis management to ensure we make the best use our resources and continue to value our workforce.

Professor Derek Bell is President of the Royal College of Physicians of Edinburgh

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