The NHS Consultation, part 1: Initial Questions

 The Labour Government has launched a consultation on the NHS. 

Undoubtedly, this is a way of deferring any action on it, but I feel it is an opportunity I should take up to document some of the concerns and observations that Viv and I have.

The consultation consists of a number of initial questions requiring fairly brief answers, and two later questions that, in my case, will require a significant number of words to articulate my views. My responses are therefore split across three blog entries, this one covering the initial questions. 

Best things about the NHS

The government has promised to put in place a 10 Year Health Plan to fix the NHS in England. In your opinion, what are the best things about the NHS?

Q1. Please tell us up to 3 of the best things about the NHS today.

A1. I cannot think of three, only one. The only good thing about the NHS today is that it is no worse than it actually is.

Challenges facing the NHS

In your opinion, what are the biggest challenges facing the NHS?

Q2. Please tell us up to 3 challenges facing the NHS.

A2. 1) It has to operate in a world where those that are ultimately responsible for it insist that it is the ‘envy of the world’ whereas those at the sharp end - patients and front line staff - know very well this is not the case; those ultimately responsible for it, in government, are in denial about the shambles that it really is.

2) The people who should benefit from it - the patients - are not seen as ‘customers’ in any way, therefore, to those who make decisions, the opinions of, and the health of, the patients at an individual level are of little importance;  also, those who benefit - the patients - do not (except in dentistry and ophthalmology) see themselves as customers or that there is a cost associated with meeting their demands, but as beneficiaries of a free service.

3) Political and fashion trends drive policy whereas what constitutes ‘health’ should not be open to such influence; what ‘good health’ meant to our grandparents should apply today, and in a century’s time. 

The Darzi Report

In July 2024, an independent investigation of the state of the NHS in England was carried out (the Darzi Report). The findings of the investigation identified several challenges facing the NHS which will need to be addressed to improve services over the next 10 years.

Q3. Which, if any, of the following have you personally experienced? Please select all the challenges you have personally experienced.

• Difficulties getting a GP appointment

• Waiting to access community services (for example, district nursing, community physiotherapy, community occupational therapy)

• Waiting to access mental health services

• Long wait times in A&E (Accident & Emergency)

• Long waiting lists for a hospital procedure

• Delays in being referred for treatment

• Poor co-ordination between different health and care services

• Poor communication from health services

• Poor quality care

• Treatments or services not available on the NHS

• Other – please specify

A3. All apart from the mental health one; also, specifically, poor audiology services, and poor support after something went wrong.

Q4. Which of these challenges do you think is most important for the 10 year health plan to address? Please select up to 3 options that you feel are most important to address.

A4. 1) Improving support when something goes wrong is most important. The NHS lives in a culture of denial; when a patient is harmed they, and their family, suffer, but the NHS does as little as it can to accept responsibility or put things right. THE CULTURE MUST CHANGE. Harmed patients require more NHS resources and are a further strain on the system, if the number of such incidents were reduced it would have a huge impact on the strains of the system as a whole. A number of the Darzi points potentially fall within this category. 

Q5. In what ways, if any, do you think that delivering more care in the community could improve health and care?

A5. Simply delivering ‘care’ in the community rather than in a hospital setting has the potential to be a waste of money. It is not WHERE the care is delivered that matters, it is HOW it is delivered: the processes followed, the attitude, competence and training taken by and availability of the staff concerned. Like other aspects of the NHS, there needs to be a standard solution that is delivered consistently, everywhere; hotch-potches of solutions, properly implemented in one county but shambolically elsewhere, are guaranteed to fail and waste money. 

Q6. What, if anything, concerns you about the idea of delivering more care in the community in the future?

A6. Like every other great idea that government has had about the NHS in the last 50 years it will be used as a means of spending vast amounts of money without better meeting the needs of any patients.

Q7. In what ways, if any, do you think that technology could be used to improve health and care?

A7. Not as many as government would like. (I write as someone who worked on the great missed opportunity, NPfIT, nearly twenty years ago.)  Artificial Intelligence is only as clever as the person that programmes it, and all technology is awfully dependent upon data and infrastructure quality; the NHS has a very poor record in terms of use of technology, and quality of data about patients.

An example at present is the seeming obsession with using text messaging for communication with patients; this does not work well. Sometimes such messages include hyperlinks and are sent, without any instructions or guidance, to patients who do not have smartphones; at other times, messages arrive late - I am aware of one lady receiving text messages two days after the appointment to which they referred (possibly due to inadequacies of the mobile phone network where she lived). 

Q8. What, if anything, concerns you about the idea of increased use of technology in the future? 

A8. That the current garbage in, garbage out model of the Summary Care Record will be extended and used to determine everything from how often you need to be checked for verrucas, to what your NHS assigned date of death will be. SCR suffers from a fundamental flaw - that it relies upon human activity to maintain patient data, and this human activity often fails to ensure that important details are saved on the SCR. (I am aware of one person who had head radiotherapy in 2017, but this fact was never recorded on their SCR; a few years later they developed throat issues, but doctors were not aware of the patient’s high risk of cancer and did not refer them as a priority, because one of their predecessors had failed to record the radiotherapy on the patient’s SCR.)

A consultant has told me, informally, that this sort of thing is far from unusual.

Use of more technology without getting patient data right will achieve little. 

Q9. In what ways, if any, could an increased focus on prevention help people stay healthy and independent for longer?

A9. The most important aspect of  ‘prevention’ is to prevent health issues being caused within the NHS, and, at this, the NHS is dreadful. Too often ‘prevention’ seems to involve blaming humans for being human - eating too much, not exercising enough, etc., but this should not be the focus while mistakes happen routinely in the NHS. Every time something isn’t done quite as well as it could be that causes more work to be required, and affects the health of patients and possibly their carers. What is needed is a focus on repeatable, high quality treatment and care, addressing everything from seemingly minor NHS-induced issues - such as timing errors in the provision of medication on wards - to major ones, affecting life and limb. 

Q10. What, if anything, concerns you about the idea of an increased focus on prevention in the future?

A10. It will be used as an opportunity to shift the focus from the NHS to the population as a whole, blaming them; the NHS will no longer serve the people (if it does anyway now), the people will have to serve it. 

Q11. All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?

A11. Very dissatisfied

Q12. In the last 12 months, which of the following NHS services have you personally engaged with, if any? Please select as many as you like.

A12. GPs

Hospitals

Dentists

Prescriptions & Pharmacies

Other NHS Services (please specify): Audiology