Changes are needed to save the NHS from a perpetual crisis.
Dr Andy Stein, author of an upcoming book Understanding the NHS, believes the fortunes of the health care system could be reversed in five years if the political momentum is there. But that would mean governments of all parties look beyond their own mandate and for the greater good of the country, he said.
Dr Stein says measures such as the separation of elective and emergency care and the seven-day job would have a huge effect on the performance of the NHS and eliminate most waiting lists.
The welfare system needs to be integrated with the NHS and IT needs to be tackled, he says.
He also calls for a Minister of Public Health, who would oversee arrangements for any future pandemic.
Here, Dr Stein describes the moves he says demonstrates that repairing the NHS does not have to be “a pipe dream”.
He explained: “As we enter a post-Covid world and learn to live with the virus, we now have to deal with the nearly six million on waiting lists for operations.
“That’s almost 10 percent of the population. We have to realize that we have had an imbalance and an excessive focus on one disease.
Stein believes that focusing on five key areas would save the NHS.
“We cannot go back to what we were. The system has passed its tipping point. When a complex system breaks down, it is not repairable without a slow drastic change.
“People are already dying while waiting for hip surgeries and replacements. This is happening because the waiting list is so long.
“It takes five things to turn the tide, but it could take around five years and each one needs their own project. The tragedy of health care is that governments generally do not have enough time to address the stubborn problems of our time.
In addition, successive health ministers step into the role of the blind, without any health care experience. It takes them two years to figure out what to do, and then they move on.
“The interesting thing is that all of these things are fixable. It’s not a pipe dream of unrealistic things.”
1. Separate emergency and elective care
Elective surgeries are often canceled in an emergency.
Without it, you cannot manage the waiting lists. Complete stop. At the moment we are mixing hot and cold care, that is to say emergency surgery with surgery such as hip operations.
However, as there are not enough beds, we always favor the fragile and the most vulnerable as they are more likely to die. These emergencies happen and mean elective surgery is canceled.
But people can die while waiting for hip surgery, and the quality of life can be unbearable.
If cancer surgery is delayed for just a month, the patient can die much sooner than he or she would have.
In a large normal hospital, there are about 20 surgeries and 10 emergency orthopedic operations per day.
They may have 50 planned, with a heavy orthopedic component as well. And a lot of them are canceled.
Thanks to Covid, we learned that private operators can perform surgeries near acute hospitals and we can do it again, so that you do elective surgeries in a different building.
We could also build two different buildings side by side, separated by a hallway but not wide enough for a cart, so emergencies could not replace. Private operators are good at managing such surgical treatment centers (or “hubs”).
2. Seven-day work week
I would run this with point number one. I think 60% and maybe up to 80% of NHS problems could be solved by dividing emergency care and elective care, and working seven days a week would save tens of thousands of lives by year.
Due to the lack of separation between emergency care and elective care, and the lack of a seven day work week, when emergencies arise on weekends, we do not discharge patients, this which clogs the beds in the surgical departments.
The proposed private sector surgical treatment centers would never compromise their emergency beds.
3. Information technology
Regional surgical centers and computer systems could go a long way in resolving waiting lists.
Over the past 15 years successive governments have tried to create a national NHS electronic patient record and this has failed. At the local and sub-regional level, the data are not compatible.
GPs, hospitals, pharmacies, mental health services and ambulances don’t know what the other is doing. This leads to many errors, especially when it comes to prescribing medication.
Theoretically, it is very easy to do when you have numbers in the thousands and tens of thousands.
However, when you have millions of patients with millions of information, it becomes much more difficult. These things are surmountable with money, and of course Google, Tesco, and Amazon have.
However, the NHS has substandard systems. Many hospitals now rely on predominantly American computer systems, including Cerner and EPIC. These are very expensive.
For a large hospital group, even a cheaper system can cost £ 7million per year to maintain.
Once you start to ramp it up, the cost is significant (around £ 300million per year for England), even if it is minimal compared to the amount of money we spent on Covid.
Only the £ 16bn we spent on Covid in the first year on testing and traceability would have paid for surgical centers, regional IT systems and went a long way in resolving waiting lists.
4. Social assistance
Twenty percent of patients who leave the hospital have complex needs. They are generally fragile and elderly and need additional care, at home or in nursing homes.
The social protection system and the health system are not linked between councils and hospitals. For example, if you have a frail, elderly person in a nursing home who has a fractured neck or femur and is sent to the hospital, they have priority over planned operations first.
Four weeks later, when they are ready to return home, they are stuck in hospital at £ 400 a day. Why don’t retirement homes take them back? It’s because everyone gets paid.
The hospital is paid £ 400 per day to keep them there and the nursing home is paid for the bed even though no one is there. If everyone gets paid, there is no incentive to get people back.
Twenty percent of patients who leave the hospital have complex needs.
In addition, social services, such as health, largely operate five days a week. We cannot therefore unload these complex patients on weekends, which further clogs hospitals and lengthens waiting lists.
The fact that the Ministry of Health and Social Affairs is called that is a misnomer. Health does not run social services in the UK. This is the Department of Upgrading, Housing and Communities (i.e. local government, councils).
The healthcare budget is £ 139 billion a year, compared to £ 29 billion for local authorities. The solution is to put welfare in the NHS.
If health and social services really worked as one, tough decisions would have to be made about how to transfer money to social care.
5. Public health
Public health is also outside the NHS and that is wrong. We need to re-establish the Ministry of Public Health and a Minister of Public Health should share an office with Sajid Javid and have equal status in Cabinet. This is for disease prevention and mitigation. Their first task should be to organize a pandemic planning exercise week each year. We have to be ready for the next one which could be worse than Covid.