15.02.17
Overly-political NHS debate that turns plans into cuts ‘paralyses progress’
We cannot have an overly-politicised conversation about the NHS that “seeks to damn every proposal as a ‘cut’ and paralyses process”, especially since none of that is going to help the staff who are actively committed to caring for patients, NHS England’s medical director for acute care has warned.
In his first blog for the organisation, Professor Keith Willett aired his concerns about the need to adapt the health service to the way medicine and all our health and care needs are changing, particularly with regards to the country’s ageing population.
He outlined what is already being done to tackle these changes, including the integration of health and social care under STPs to “give nurses, doctors and care staff a better chance of succeeding”.
There is also an opportunity to “deliver long-promised expansions in general practice and truly responsive and hooked-up community care services”.
“Through extra investment, we also now have the opportunity to make common sense improvements to the way services work such as making it easier to see a GP, speeding up cancer diagnosis and offering faster help to people with mental ill health,” added Prof Willett.
“Medical care is also advancing dramatically. Today, a paramedic or GP can undertake tests and treatments in our homes or their surgery that 10 years ago, we could only do in a hospital. Likewise there are treatments now available in specialist centres that change patients’ lives and survival that are impossible in local hospitals.
“As a doctor, I cannot deny that offer to patients who suffer a stroke, heart attack or major injury. In London this has saved the lives of 100 stroke sufferers a year and across the country the odds of surviving a major trauma have risen up to 50%. The opportunities for bringing about a shift in care from hospital to home, or close to home, are enormous.”
With these changes already in motion, we now need to have an evidence-based debate across every part of England about what councils, community and health and care leaders are suggesting.
“I am sure those ideas can be improved but they deserve a fair hearing,” said Prof Willett. “We cannot just ignore what we now know, or how needs are changing. When it comes to healthcare, inertia can be truly harmful. It is no longer realistic to say ‘if it’s not broke don’t fix it’ – believe me it is breaking.
“What I most fear is an overly-politicised conversation that seeks to damn every proposal as a ‘cut’ and paralyses progress. None of that is going to help the staff who are committed to caring within the NHS, nor their patients – that’s you and your family.”
Rather than politicised, these are societal issues, he argued – and very personal ones to everyone who accesses the health system. In the past, people have been told what was right for them without reference to “those of us in the NHS who live and breathe these issues on a daily basis”, or those who experience it as patients or carers – and this outlook needs to change.
“Everyone in the NHS wants to ensure that every person in this country can access high-quality care whenever it is needed. But to keep our NHS healthy, we have to help it to adapt to the way medicine and all our health and care needs are changing,” he concluded.
Prof Willett, who has been an NHS consultant surgeon for 24 years and has extensive experience of trauma care, is now responsible for leading the transformation of the urgent and emergency care services across England.
But despite his request that the public treat change as a societal matter, the debate around STPs has so far been anything but. Just yesterday, the BMA published an investigation which found that almost £10bn of fresh money will be needed upfront to finance the projects put forward in 36 of the 44 draft plans, and its council chair, Dr Mark Porter, argued the programme was “doomed to failure all along owing to inadequate funding and a lack of political will to transform services properly”.
This built on previous remarks from the union that STPs will put the NHS at risk of drastic service closures, with Dr Porter again warning that the NHS needed an urgent cash injection to continue operating in the meantime.
Even across Prof Willett’s own remit of A&E transformation, there has been much criticism: earlier this month, the Royal College of Emergency Medicine criticised proposals within STPs of reconfiguring emergency departments as an option for long-term change, calling the approach “alarming”.
In national media, the draft plans, which have now been finalised across the board, have been treated largely as a covert, back-door attempt to squeeze the NHS purse only to then privatise its services. While much of it may owe to the fact that the plans can contain a lot of jargon, some healthcare leaders have argued that the public and stakeholders have so far been largely locked out of honest and meaningful conversations about what the STPs truly represent and intend to do.
Last year, STPs came under fire after campaign group 38 Degrees, alongside National Voices, warned that the plans could lead to service closures and were being implemented with limited, if any, public engagement.
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