Health and social care: three priorities for the new government

Mounting deficits, worsening performance and declining staff morale mean that the NHS is facing its biggest challenges for many years, while pressures on social care are escalating. The challenge for the government will be to strike a balance between addressing unprecedented short-term pressures and initiating the long-term changes needed to place the NHS and social care on a sustainable footing. The stakes could not be higher.


#543790 Harry Longman
Chief Executive
GP Access Ltd

"Better outcomes can be delivered at lower cost" - yes, agree with that comment. But unfortunately what follows does not amount to a method for getting there. You resort to the tired platitudes of leadership, culture, "putting patients first". All these are undeniable, but they don't tell you what to do, they are not a method. Agree, too, that the inspection and target regimes are counterproductive, and there is no sign of them even being questioned in government. But you need a method to make change, not just exhortations. Start here: understand demand. This seems obvious yet is utterly radical in the NHS built on supply, from GP slots to UCC white elephants through to acute hospitals pulling in as much tariff work as they can to stay afloat. Ruinous.

#543793 Karen
Adult sevices
Local Authority

I agree with the previous comment. I would also add that these are in some respects symptoms of a broken system observed through the same lens that has not hitherto been able to alter the course. If health and social care are created in the same medical model as ever demanding health services incentives and levers operate then however they are combined or aligned will only serve to have more of the same. What about thinking radically differently about the dialogue with the public about what our taxes can afford, rethinking risk , helping people really take their own health and well being into their own hands, investing in the wider determinants to prevent deterioration or escalation that helps people to become more resilient and use their own assets and strengths?

#543797 Brenda Riley

Systems within NHS need radical overhaul we have to rethink it all, a serious amount of communication is missing in terms of joining up sectors especially in the community, preventing admission into hospital can work but financial investment needs to come too to enable a better service
We see miss management of money every day top heavy management in terms of commissioning it needs change now and needs accountability.

#543799 Michael Osborne
Director (Unpaid)
Integritas Advocacy Registered Charity.

It is clear that some financial input needs to be put into the NHS. I am afraid that it can only be done by tax increases. I believe that a separate tax to pay for the NHS would be acceptable to a large majority of the population. I think it is generally recognised that if we want a first class NHS then we will have to pay for it. I would also like some business leaders put into hospitals for a year to try and sort them out in finance, working methods and economics.
Regarding the merge with social services, currently it looks like turning into a vast complex piece of work. I prefer small nibbles at the easier parts first.

#543802 Patrick Gardner

I agree with the comments about the platitudes of leadership, culture etc. The Canterbury District Health Board in New Zealand faced in microcosm seven years ago what the NHS faces today - in simple terms, low morale, parlous finances and increasing demand. They turned it all around by a reformulating all their health pathways - they must now have about 500 new health pathways that integrate care in a highly successful total reform of their operations. It is true and simple to understand that reform manifests itself in new health pathways. So why is this not the core of all the reform activity?

#543803 Mark Rickenbach
GP and Visiting Professor of Healthcare and Education Quality
Park Surgery

The NHS needs more funding but it needs to go on pilot projects that coalface healthcare workers see working or likely to work. Emerging integrated care models seem likely to help. 7 day a week GP access should focus on information sharing across GPs to provide continuity, rather than moving around the same doctors to more unsocial hours and less work in office hours.
NHS reform does need to be bottom up, promoting those successful initiatives. Helping the overaching organisations, especially CCGs, to effectively build links rather than breaking and reforming new organisations.
Health and Social care should work more closely with shared budgets where there is overlap ie at discharge funding. However healthcare should not be drained of funds to support underfunded social care. The administration of continuing healthcare funding currently seems to slow the discharges from hospital and as GPs were are becoming a referee between two opposing teams protecting their limited funds.

#543807 Jacqueline Moun...

The comments above start a good discussion that has to be had nationally. The present retirees are our fittest cohort ever. We have benefited, throughout all aspects of life, from the post war baby boom; rationing, free health and education, accessible housing, clean air, equality. However the next generation are less fit so if we don't get health and social care right within the next ten years, I fear we never will.

#543960 D Harries
Local Age Cymru

Long term goal needs to be a new Public Health initiative. We've had clean water & sewerage systems in the 18century; seat belts and smoking in the 20th. We now need diet and exercise big time, to include sugsr and fat peak time advertising ban.If nanny is good enough for Cameron then nanny state is good enough for us.

#544162 Alice Hodkinson

I would like to suggest that demand has been increased by the tendency in recent years for the hospitals to increase vastly how much they are able to do for each patient in terms of investigations. Now everyone with a headache, confusion or just a sprained ankle seems to get an MRI, CT or an X-RAY.
As a GP who spends a lot of time trying to educate patients to care for themselves instead of coming to see me with a sore throat, perhaps there is value in returning to a more risky, GP-like management of patients in hospitals? Perhaps the increase in available investigations and technology has meant that hospitals are dragging people in. It cascades the problems throughout the service and may be partly why hospitals in my area are constantly on black alert and cannot keep up with 2ww or 18w targets.
Payment by results has encouraged the increase of "doing things" in hospitals, and the passing of unfounded work to GPs. We must avoid these unintended consequences and work together!

#544200 Umesh Prabhu
Medical Director
Wrightington, Wigan and Leigh FT

The only way to transform NHS is proper patient and family engagement and to use GPs skill in educating families and avoid hospital admissions. Sadly payment by results, consultants training, fear of being criticised and referred to GMC and defensive medicine means once the patient comes to hospital he/she will get many unnecessary investigations, many heroic surgery, many medications and many stay in hospital for a long time. Where as GPs are well trained to take risk and manage patients at home or nursing homes or community.

It is equally important to transform funding system and for all NHS leaders (acute, community, CCGs, GPs, mental health, social services) to work together with more collaboration and to have common IT. We must get elderly care pathways right and there has to be more and more family and patient engagement and staff engagement. Many GP work can be done by Physicians Associates (PAs). We must also have well trained PAs in nursing homes to look after elderly patients and to keep patients comfortable with kindness, caring and compassion and support nursing home staff.

#545034 Paul Bennett
Social Worker
English Local Authority

As an adult care social worker, one of the biggest obstacles to integrating health and social care is outmoded inefficient I.T. software. Systems are not designed to share information on a "need to know basis". They are clunky, bureaucratic, heavily weighted towards collating quantitative data. The speed of working can be painfully slow. In 2015 I can contact a colleague in Sydney with a click on Facebook Messenger, but I can't alert an occupational therapist 2 miles down the road to a need for a bathing assessment. I find it hard to fathom how we can have got to such a ludicrous state of affairs. Investment in intelligent systems that understand our roles and are informed by health and social care professionals is such an obvious way forward, yet it is not implemeted.

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