The NHS belongs to the people: a call to action

NHS England sets out call to action to staff, public and politicians to help NHS  meet future demand and tackle funding gap through ‘honest and realistic’ debate.

NHS England has today called on the public, NHS staff and politicians to have an open and honest debate about the future shape of the NHS in order to meet rising demand, introduce new technology and meet the expectations of its patients. This is set against a backdrop of flat funding which, if services continue to be delivered in the same way as now, will result in a funding gap which could grow to £30bn between 2013/14 to 2020/21.

A new publication, ‘The NHS belongs to the people: a call to action’ sets out these challenges facing the NHS, including more people living longer with more complex  conditions, increasing costs whilst funding remains flat and rising expectation of the quality of care.  The document says clearly that the NHS must change to meet these demands and make the most of new medicines and technology and that it will not contemplate reducing or charging for core services.

Speaking today, Sir David Nicholson, Chief Executive of NHS England said:

“The NHS was set up to provide high quality care for patients, free at the point of need. The NHS has stayed true to this aim and to do so in the future, we must embrace new ways of working. The NHS, like every other healthcare provider in the world, is facing these challenges. Too often, the answers are to reduce the offer to patients or charge for services. That is not the ethos of the NHS and I am clear that our future must be about changing, not charging. To do so we must make bold, clinically-led changes to how NHS services are delivered over the next couple of years.

“The focus needs to shift from buildings and onto patients and services. The  NHS was 65 years old last week and throughout its history our services, staff  and treatment has evolved as medicine, technology and evidence has changed.  Our success in extending life means people living longer, but with more conditions and illnesses such as dementia that were not common twenty years ago. New technology means earlier diagnosis and better treatment, but this costs more and we are not reaching everyone we need to.  The NHS can increasingly deliver care at home, yet too often patients have to travel are around buildings.

“We are facing demands, opportunities and investment unimaginable when the NHS was created in 1948. New data is available now to highlight where we get it right – and as importantly, where we get it wrong. We are setting all this out today – including the funding gap – to encourage the public and doctors and politicians to have an honest and realistic debate about how they want their local NHS to be shaped. With the new independence of NHS England and the establishment of  GP-led commissioners, we can find local answers to meet these challenges .”

Commenting on NHS funding, Sir David continued:

“Our analysis shows that if we continue with the current model of care and expected funding levels, we could have a funding gap of £30bn between 2013/14 and 2020/21,which will continue to grow and grow quickly if action isn’t taken.  This is on top of the £20bn of efficiency savings already being met.  This gap cannot be solved from the public purse but by freeing up NHS services and staff from old style practices and buildings. ”

The document sets out a number of latest facts on the NHS, including demand, the changing  demographics of the patients being treated and the growth in long term conditions.  These include:

  • The NHS treats around one million people every 36 hours
  • Between 1990 and 2010, life expectancy in England increased by 4.2 years
  • The difference in life expectancy between the richest and poorest parts of the country is now 17 years
  • Around 80 per cent of deaths from major diseases, such as cancer, are attributable to lifestyle risk factors such as smoking, excess alcohol and poor diet
  • One quarter of the population (just over 15 million people)  has a long term condition such as diabetes, depression, dementia and high blood pressure – and they account for fifty per cent of all GP appointments and seventy per cent of days in a hospital bed
  • Hospital treatment for over 75s has increased by 65 per cent over the past decade and someone over 85 is now 25 times for likely to spend a day in hospital that those under 65
  • The number of older people likely to require care is predicted to rise by over 60 per cent by 2030
  • Around 800,000 people are now living with dementia and this is expected to rise to one  million by 2021
  • Since it was formed in 1948, the NHS has received around four per cent of national income
  • Modelling shows that continuing with the current model of care will lead to a funding gap of around thirty billion between 2013/14 and 2020/21

NHS England along with other national partner organisations will be providing support to local GPs, charities and patient groups to hold meetings to discuss these issues. These meetings will provide the mechanism for patients and the public to have a genuine say in how the NHS of the future will look.

All feedback from these meetings, as well as national events and online contributions via NHS Choices, will be published and used to help shape a longer term strategy for the NHS.  This will need to be in place by early 2014 to feed into commissioning plans for GP-led Clinical Commissioning Groups in 2014/15 and 2015/16.


  1. Clive Spindley says:

    With the the level of integration which is currently underway, it might have been better to have a discussion on free healthcare in the UK rather than limit it just to the NHS.

  2. Duncan Rochester says:

    Need to look at non-medical staff levels especially in management. Start thinning it out a bit and plough the money into medical staff levels.

  3. MaryRuth says:

    GPs are loaded with work. The goods ones mainly. Many people go to such GPs for TLC because they are lonely or unhappy . It would be good to have a lounge at the GP practices with nurses to discuss what is upsetting these people. With a cup of tea. All some of them need is someone to talk to. Their baby may only have a sniffle but its a major thing for a new mother with her first baby. Bereaved people may need just a chat.This would help the GPs not have such a load of patients.

  4. Robin says:

    My wife has had bad treatment from NHS. She was given psychiatric drugs in 1976 that she didn’t need and they made her very ill and she cant get off them the withdrawal is so bad. She has been left all those years with no help from NHS to get off and she suffered dreadful withdrawal in front of her small children many times trying to get off and was just put back on the drug by NHS to stop the withdrawal symptoms .She divorced her husband and met me and I’ve been trying to get her well. She got off the drug eventually in 2012 by slow withdrawal and my wife was well and ok but a new psychiatrist put her back on it and didn’t allow my wife a voice.Its been dreadful for my wife.We have made complaints to NHS and ombudsman but we have had no reply. What shall we do please?

    • NHS England says:

      Hi Robin,

      Would you be able to give us the contact details of who you’ve been in touch with? is for the Ombudsman, it is very unlike them to not give you a response. We apologise for this and hopefully we can help this matter to be resolved.

      Please send your information through to

      thank you.

  5. Yvonne Griffiths says:

    I am very concerned by the impact the Health and Social Care bill recently passed by parliament will have on the provision of services by the NHS. Clearly the opening up of the health service to private providers and the consequent European competition law is already having a detrimental effect on the NHS.i would like to know what can be done to prevent the privatisation of the health service and to keep the pressure up on the Labour Party to stand by its promise to repeal the act.

  6. Jill Waterhouse says:

    I believe as others have said here, the threat of privatisation looms large. The ability to access 24/7 health care within the community, preventative, social and mental health care in all communities, not only economically efficient but will continue the most excellent model and principals of the NHS.

    Consolidation, efficiency savings can never be a savings when more people suffer ill health as a result, it stresses and taxes the system, as we have seen. Efficiency savings at the top within management teams, outsourcing and privatisation being handed wasteful monies at the expense of real patient care.

    The NHS is an exemplary model, the fact that like education and services it is the first to suffer cuts and ‘efficiency’ reorganisation shows how little respect we have for our society and the people that live within it. The most important aspect of any society is health care, education which is vital to all communities, with access and care and the ability to have a good quality of life.

  7. Jill Waterhouse says:

    I happen to have a very good surgery at the moment and I hope that doesn’t change, I’ve had far worse surgeries. What is done well at my current surgery and is an excellent example of what can be done, are the hours, open three days a week until 8pm and open surgeries one to two days a week.

    At my old surgery I was lucky if it was open on a Wednesday afternoon, things like this example should not happen.

    The ability to get an appointment on the day is of the utmost importance and I also believe the ability to be handled quickly when you call in the morning and not be treated as if you are not a concern, such as, the nurse will call you back. During this time period of wait, people can escalate their anxiety and make the problem much worse.

    There is a world of difference when a kind voice on the other end sets an appointment immediately for you and it also shows that a surgery is being managed quite well.

    The ability to access care on weekends is also very important. I happen to not drive and it makes it very difficult to travel over 20 miles to the nearest hospital. Cab fare alone is a week’s groceries, so we can see the hardships some families face in having access to hospitals that are further from where they live. Of course one can’t and may not feel well enough to take a bus or any form of public transport and then walk the distance. Again, not having the ability to access health care even for two days a week is stressful and of course can lead to a worsening situation.

    I believe that when health care is managed correctly, with preventative measures, then we cut down on emergency services. Preventative measures can only happen when communities have access to health care, even if that means a reassuring voice on the other end of the phone. Parents, to carers, to those with chronic health problems, every person worries and it makes quality of life difficult and can lead to further health problems. One of the things the NHS has always understood is that good care in the community is essential to well being.

    As an aside, the privatisation of services clearly threatens the above measures. People’s health should never be for profit and the NHS is a remarkable system, one of the world’s leading examples of exemplary care for all. I hope this does not change.

  8. Jackie says:

    At my local GP surgery every month more than 90 appointments are missed. I tried for 5 days to secure an appointment for my husband who had developed a serious eye problem, As a result of no appointments I used the out of hours service where we were directed straight to the out of hours eye clinic. The next day things were worse but when I called my GP to see if they could arrange an appointment to go back to the eye clinic we had to see them first and amazingly an appointment was available. However I cannot help but think this was more expensive than if we could have had access to our own GP and then been referred.

    There is also massive waste of drugs and other resources, hospitals have staff continually filling up blue latex gloves even if there are stacks of boxes. The NHS needs a ‘just in time’ review carried out by the private sector ( manufacturing) to reduce unnecessary costs, which would free money to fund other areas of work.

    Those missing GP and hospital appointments without good reason need to be charged as with dentists, opticians etc. This would reduce the issue massively.

    People need to be more responsible for their own health, particularly those who seem to ignore excessive weight as though it is someone else’s fault.

  9. Martin says:

    Looking around most towns there are a whole lot of people that are quite frankly ‘unhealthy’ in body or mind
    I propose the following:
    1. Ensure that foods that are on sale are as healthy as possibly can be (reduce / sugar / reduce fat and any other that aids ill health). Reform the food industry
    2. Vitamin D (for much of the year, populations in cloudy climates have a population that are deficient/severely deficient in this essential vitamin
    3. Alcohol is too cheap
    4. Virtual budget for all people within a certain financial bracket (eg. adults Under £20k per yr). This group will be given an incentive to keep healthy and reduce contact with medical services (contact me via email for a more detailed proposal). If their usage is low, they are given £500 at the start of December each year. (the timing of this means that this will be spent for Christmas preperations to give Q4 figures a boost
    5. Proportionate taxation in the UK. Ill health and early death is more prevalent within the poorer areas. Wealthy people need to look after their poor
    6. Fruit trees in parks (free food for local people)

  10. Elizabeth Potter says:

    Keep Our NHS Public. Pure and Simple.

    It is OUR NHS, a public service, not for profit, so private companies should not be providing its services because they have a duty to their shareholders and have to make a profit.

    The NHS should be the employer, and the provider. NHS staff should be employed by the NHS, not be forced to work for a company providing NHS services. They applied for a job IN the NHS and this is the contract they signed – to be employed BY the NHS. The patients should have proper NHS staff, employed on proper terms and conditions with an NHS pension. That is what I want as a cancer patient. I have high standards and I want to be looked after by NHS-employed staff.Nothing else is good enough for me.

    OUR NHS is fragmented now and full of privatisation.

    Marketisation should not be allowed into health care -pure and simple.

    Governments should be in charge of the NHS – pure and simple

  11. Rob says:

    I would like to see more early screening for diabeters. I was diagnosed as diabetic a few years ago in my mid mid 50s following sudden weight loss. I was advised that I had probably had the condition (developing) for some years. To my knowledge I am the first in my family to be diabetic and I was not obese prior to be diagnosed so a couple of the possible indicators were not obviously there. I’m on insulin now plus various medication and I’m aware from hospital/GP check ups plus medication that I am now costing the NHS a lot of money – whereas for most of my life I have not been a cost on the NHS. It seems we’re not exactly sure what causes diabetes though there are indicators which may suggest higher incidence/likelihood for some people. Surely we should be testing for this illness rather than waiting for the obviouis signs to develop.

  12. Shirley says:

    In terms of GPs using innovative approaches to patient appointments I totally agree. I rarely visit my GP, and as a health care professional if I do it is usually because I want a referral or know what prescription I need. So I don’t want to spend an hour out of work getting to the surgery, waiting, then simply getting a referral done or prescription. I would want a tele consultation, or even use Facetime or Skype. Why don’t more surgeries use technology – then I could be at work and use my Ipad or Iphone for the consultation.
    I realise this is not for everyone, but even one or two Skype clinic’s a week would be good for those of us who want this method.

  13. Ian says:

    Dear NHS, please think about wide range systemic review of mental health services. My personal experience is in Mental Health Services. Drs see the most well of service users in out patients appointments, every six months to ‘check’ the service user. However the most complex service users have little contact with the people who could help them the most, ie psychiatrists, psychologists and psychotherapists as they are busy in their ‘traditional services’ of seeing who they want, when they want. Very senior and extremely well paid professional people seeing the most well does not make sense to me. Get rid of Dr’s PA pay as well. All Dr’s that I know get paid a basic salary and then around 8PA’s a week in adition to their pay, all for the work that they should be doing in their normal day. I dont think that the ‘old schoolboys club’ will disapear altogether, however the most expensive pay group need to be challenged to change practices into a more modern and service user demand manner.

    To be a potential point of confrontation, NHS pay and conditions have been very generous in the past. AfC, Drs and other professions I feel could also be reviewed with a possible suggestion of payments by results on an individual basis? This may help move on some poor performing professionals that I know of.

  14. David Hutchinson says:

    Take the NHS completely away from use as a political tool to generate votes every 5 years.
    Stop continually (and at huge cost) asking the public what they want. knowing that Utopia is not on offer so why pretend!
    Take unpalatable decisions and implement them,.It is a job for experts and not lay people. Accept that public health education has a depressing record of failure unless backed up by legislation or financial pressure. The recent backing away from alcohol legislation is a clear example, where in the long term, there could be huge savings but in the short time it would be a vote looser.
    Unless the NHS is considered at this level, supply will always be behind demand..We will just go on with this endless debate about community, hospital, GP services , IVF, old age, NICE and all the rest. This is all “fiddling whilst Rome Burns>.
    An all Party Commission into the fundamentals of the NHS is urgently needed.

  15. Terence says:

    With 77% of back pain patients suffering depression, (USA stats) substantially from prolonged treatment patterns, is it not time that NICE took a more proactive role in the promotion of promising ideas at least with those granted a patent.

  16. richard says:

    Save costs – cut out all of the competition between Trusts, and encourage more collaboration and reduce duplication. Produce NHS central policies on key areas giving standards required in a policy format- Health and Safety, Equality and Diversity, Dignity at Work, Fraud, Medicines Magement and let Trust’s just add their own local protocols as appendices.
    Cut out cosmetic surgery and fertility treatments. Much of the latter is the result of lifestyle choices so why should I as a taxpayer pay for this?
    Stop thinking about life-saving and think more about quality of life. Actually it is about delaying death. Stop trying to do everything for everyone. And stop spending money on things that are not important. And cut out the bureacracy – just ran a report on 3 outcomes for CQC for one Trust – over 2000 pages – what a nonsense…

  17. Katherine King-Thomas says:

    I have been a nurse for over 36 years. In that time I have seen numerous remodelling and revisions of the delivery of care over that time and find myself reflecting on them as to the benefit to patients of having less Registered Nurse contact by the introduction of more Nursing Assistants, having fragmented care rather than the holistic approach which was in place when I began my career and the repeated attempts to reduce the need for patients to attend hospital. I admit that I have been an Acute Hospital nurse for the whole of my career, but have had periods of experience in the community in both adult and paediatric nursing.
    I now work in an area which allows me access to data on why patients attend hospital. For many it is an active choice based on a lack of confidence in community services to meet their needs in a comprehensive and timely manner. Repeatedly I hear stories of being unable to get an appointment with a GP, not having enough practical support to receive care without significant imput from family and friends. This in a society where families are less able to provide support owing to the need to work or move away from their elderly in order to find work. Our older population is increasing, people are living longer which means many of their support group are also older, or have died and are not available to be used as substitutes for professional care givers. Acute Trusts are being driven to reduce Emergency Access figures and turn patients around at the door, utilising the services in the community. This is fine where the social and emotional needs of the pateint are being considered rather than the cost of a hospital admission versus that of sending them home with at time inadequate support which results in them returning, having deteriorated and requiring a longer admission than might have been required in the first instance. David Nicholson’s intentions are I am sure well meant, but there is an old saying about intentions and where they lead and for many patients in the community, this is exactly how it feels. If we are to truly re-invent the NHS we have to increase the levels of input to individual patients in their homes and the range of services which can be accessed on their behalf, otherwise we will simply be reinventing the wheel, which has already fallen off the cart!

  18. Susan Acott says:

    I have spoken to enough patients to know that access is fundamental. Smaller hospitals should not be dismissed, but form part of networked approach to patients care, enabled by technology and telemedicine. Centralistaion is not the whole answer and nor is being naiive about how much can go into the patients own home.

  19. jeff says:

    It would make sense to redesignate Hospital Nursing Assistants as Ward Assistants and clarify their duties to support patients on the ward physically and emotionally rather than to imply that they have an exclusive clinical assistance role. The reason is the lack of care identified in Stafford and elsewhere when patients and family felt they were abandoned by staff. With someone looking out for them who can draw on experiences and concerns associated with patients on their ward the perceived lack of care should diminish.

  20. hank says:

    “”The NHS was set up to provide high quality care for patients, free at the point of need. The NHS has stayed true to this aim and to do so in the future””

    Not true, free teeth and glasses were part of the NHS in 1948, but were removed in 1954 when it became clear that this was unsustainable.

    We need an injection of honesty, the NHS constitution promises us a comprehensive service, free at the point of need. What we are receiving is a fragmented rudimentary service, delivered 6 months later than the point of need.

    The lists of low priority procedures / not routinely funded care / exclusions / rationing or whatever euphemism, that are circulating in the various health authorities go against the NHS constitutional rights and go unchallenged.

  21. Margit Physant, Malnutrition Task Force says:

    In view of the twin challenges of an ageing population and the need for efficiency saving, it is more important than ever for the NHS to take every step to optimise the health of older people to reduce their need for healthcare.
    Good nutrition is fundamental to good health. Reducing malnutrition could make a significant impact on healthcare usage and there is sound evidence to demonstrate that good nutritional care reduces mortality, hospital length of stay, the need for GP appointments and residential care whilst improving patient outcomes and saving money.
    Malnutrition is more common than generally believed with 1:10 of people over 65 at some degree of risk. The risk increases with age and is higher among older people with long-term conditions.
    The consequences of malnutrition are serious as malnourished people are more prone to illness such as pressure ulcers, infection and to harm from falls. They are therefore more likely to be admitted to hospital and one in three older patients are already malnourished or at high risk on admission. They take longer to recover and have therefore longer hospital stays. If malnutrition is not identified and treated (or worsens) while in hospital, people will return home in a poorer state of health than before and are at greater risk of re-admission.
    Malnourished people use health services more than well-nourished people. We have to challenge this status quo because much malnutrition in later life is preventable. We have effective treatment interventions as documented in NICE Clinical Guidance (32) ‘Nutrition Support in Adults’ . Organisations should be able to demonstrate their compliance to the NICE Quality Standards (24) for Nutrition. They are not only clinically effective, they are also cost-effective. NICE estimates that by implementing them, there is a potential saving of £72K per 100,000 population.

    Nutrition should be an integral part of basic care in a truly integrated health and social care provision. There is good practice in many places but there needs to be a systematic approach to ensure processes and reliable integrated nutrition care pathways e.g. Adult Malnutrition Pathway are implemented in all acute and primary care settings. Furthermore, here is a need to empower people and encourage self-care and safe care in the community.

  22. Jacqueline McMenamin says:

    I am an RMN who is the main carer for an adult son with ASC(autistic spectrum condition). Because of cuts to his support in 2011, he had to move in with me again . This has caused my own health to fail. I can no longer work and face losing my flat. I feel very alone and isolated. My son is agraphobic and anxious. I cannot see a way out of my situation. I tried to find a way to retrain in autism but found no pathway exists.

  23. Terry Davies says:

    The NHS is desperate to minimise wastage, one area that I am passionate about that could help to avoid a huge waste of money, resources and manpower is the problem of persistent DNA’s (did not attend). It is a radical idea which will no doubt upset many people but I feel that persistent DNA’s should be made to pay somehow, either by a fine or being charged in some other way such as the real cost for the service they would have had if they attended. Instead little or nothing is done to get these people to change their ways. I believe that it’s due to the misconception that the NHS is free and as such then it doesn’t matter if they don’t turn up. We need to educate every one of the consequences of failure to turn up for an appointment.

    • NHS England says:

      Thank you for your suggestion Terry. We are very interested to hear views on how the NHS can improve and it is important that people use NHS services responsibly, including keeping or cancelling appointments within a reasonable time. However, we set out in ‘The NHS belongs to the people – a Call to Action’ document that we will not be considering charges for NHS services as part of the Call to Action.

      • Susan Edwards says:

        If not charging for DNAs, the removal/push back of waits must be enforced where cancellations are not advised.

      • Susan Edwards says:

        If we aren’t going to charge for missed appointments an alternative such as being removed from waiting lists or pushed further down lists must be enforced where no cancellation has been made.

  24. Peter Holmes says:

    The NHS time bomb is dementia – and if we can create good pathways for dealing with dementia that encompass early diagnosis, early information and help systems in the community then good care planning in the later stages, we can create systems which are transferable to other LTC and palliative care situations . we need realistic strategies that keep people out of hospital whenever possible, and only admit when that is the undoubted best option.. We should consider hospital admission for elderly people, particularly those in care homes, to be a failure of the system in most cases, and most particularly for those wih dementia

    • NHS England says:

      Thank you for your comments Peter. We agree that there is more the NHS can do to support people with long term conditions, and to help people to be cared for in the community and closer to home – and people with conditions including dementia should receive the best possible care. This includes having much better preventative services and better early diagnosis, which will be one of the specific themes we will explore through the ‘Call to Action’.

  25. Clive says:

    NHS data belongs to the people, not the NHS (they should just be taking care of IT), ok?

  26. Bill Mackay says:

    Call for action! That is part of the problem with the NHS, it wan’t broken, so why all the action to mend what wasn’t broken. In 2010 the NHS required small improvements to the structure, but not action such as the Health and Social Care Bill 2012, a plan for privatisation.
    To deliver the NHS into a market might be fine for the private providers of health care, but the NHS was formed in the fashion of a public service and it is seen by the public as a treasure. We have sufficient resources to provide a free NHS. All that is required is the will to collect the taxes from those that avoid paying their tax by devious means. The rich didn’t like paying 50% tax so the refused to pay and the government lowered the tax to 45%. As a famous tennis player yelled, “You can’t be serious!”

  27. John Rice says:

    One of the main points raised is “meeting the expectations of patients”. This is one of the biggest reasons for increases in demand for services. Instead of simply pandering to peoples need for continuous contact with NHS services for every aspect of their life, START SAYING NO! Personal responsibility needs to be reinforced and people start taking care of themselves.

    Although “the NHS belongs to the people”, the people are stupid and will destroy it if they continue to expect so much and abuse the service.

  28. Teresa Whelan says:

    Two changes which will not involve charging:

    1. include a few more basic checks by the doctor when a blood pressure test is needed. To help earlier diagnosis of cancer,( in particular lung cancer which is most in need of earlier diagnosis in order to help outcome ) docotors could quickly check the lymph nodes around the neck. Few people reaslise that a lentil size lump there could well be cancer in the lymph system.

    2. The diets provided by hospitals should be changed to help treat and train patients on what they should be eating. This does not have to cost. A recent experience at chest hospital where many patients have cancer. Coffee and sugar are both known to feed tumours. These and other similar products should not be on offer. Pineapple and Green Tea are known to shrink tumours. These and other products should be included in the diet. This hospital was offering snack packs which contained chocolate bars, crisps and burgers – all very tasty but not what these patients should be eating. Why are we treating patients medically and ignoring teaching petients to eat better by example. Why are some of the medical profession so reluctant to embrace the value of correct diet in treatment and training of patients? My brother had a heart attack and was told to lose weight and change his diet. His hospital diet should have been appropriate to that. If doctors want patients to take on board the need to eat differently then this different diet is what should be provided. the patients then may be more likely to do what their doctor tells them, especially if they are given written examples of appropriate cookbooks.

    I could be persuaded to volunteer to help a group with this.

  29. Ned Donovan says:

    After a procedure, a patient should be sent a receipt saying how much the procedure cost the NHS just so they’re aware of how much is done for them, and how much the taxpayers spend on it.

  30. Kevin says:

    I’t’s about time that some Proactive thinking is being done for a change.To bring change to a system instead of complaining about it.I would also like the option somewhere where I can give Compliments I was in hospital recently and was being push in a wheelchair to the X-Ray department for a brain scan.He pushed me all the way there I had the Scan came out and the next one was there,it was only 10 in the morning and I could see the pressure he was under.You know what he said to me.He said I worried about our youth in this country.I said yes I am very worried about them too.But first I worried about you. This is happening everwhere.I just book a appointment for a blood with the Systemonline,you know what it said at duration.I have 7min 50 sec….7min 50 is that caculated.The last time I was there someone had smacked her in the face and gave her a black eye.I want to take a few minutes to talk to her about that.But I can’t because the next one is at the door for his 7min.50sec.I can continue with a lot of other thing’s I have seen but I am not sure if this where I should voice them all.But if you continue to squeeze the bubble it will burst.Thank’s for taking action at last.

  31. M. Castleton, Admin. says:

    I would support a token charge made to people not turning up for their N.H.S. appointment, so that clients get an idea of the cost they have incurred to the Service.

    • NHS England says:

      Thank you for your suggestion. We are very interested to hear views on how the NHS can improve and it is important that people use NHS services responsibly, including keeping or cancelling appointments within a reasonable time. However, we set out in ‘The NHS belongs to the people – a Call to Action’ document that we will not be considering charges for NHS services as part of the Call to Action.

  32. Mike Allen says:

    The problem basically is doctors’ working hours changing and the 111 system having teething troubles. Has any consideration been given to Practice Nurses running evening and weekend surgeries ? It would cost but I expect there are many retired nurses who could cope with many evening and weekend patients. Nurses would be more personal than 111, have access to patient records, sign sick notes and minor prescriptions. For urgent cases they could send patients to A & E or make an appointment to see GP in the morning. I think nurses have the nous to do the right thing. You might have to change a few NHS bureaucratic rules (written for the guidance of the wise and the blind obedience of fools ).

    • NHS England says:

      Thank you for your comments Mike. We are looking for all input and ideas as to how we can improve services and outcomes for patients within the financial budget we have been allocated. These ideas will be shared within the NHS and with local clinical commissioning groups to support future plan development at national and local level.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  33. Frank Duffin says:

    This debate on NHS governance cannot be held in isolation from the changes to GP clinic practices. I have been in and out of A&E this last year and have nothing but admiration for their professionalism. Most of my problems were orthopediac, shoulder problems, clavicle/sternum damage, broken ankle, achillies heel, knee and last but by no means least whooping cough. It became clear to me during this year that GP’s and GP clinics were abdicating their own responsibilities by immediately dumping anything not requiring a treatment of tablets onto A&E. When I called my local practice ( with whooping cough) I was on my hands and knees outside my house trying to get air into my lungs! The receptionist told me (between my choking) to get myself along to A&E. During my many visits to A&E inthis last year I have heard registrars complain about patients who have been sent to their A&E department when their condition should have been treated by their own clinic.

    • NHS England says:

      We are sorry to hear of your experiences. We encourage you to contact your local clinical commissioning group and GP clinic as this will help them to make improvements to the services available. The ‘Call to Action’ is intended to look at the whole NHS, including primary care services such as those available from GPs, and we know there are areas where both primary care and hospital services can improve.

      We encourage you to look out for the local engagement activity that will be run by your clinical commissioning group as part of the ‘Call to Action’, as this will give you an opportunity to feedback your views to the people who arrange local health services on behalf of your community.

      In the meantime, please visit our dedicated Call to Action web page on our NHS Choices website to continue the debate.

  34. L Common says:

    I am a midwife who is aware of excellent evidence collected by Birthplace England that demonstrates out of hospital birth is both safe and cost effective, particularly for women who have had babies before. It concerns me deeply when Sir David Nicholson talks about centralising services into larger units as they endanger women by employing a production line mentality that does not suit the natural pace of normal labour and birth. Hurrying women up with drugs or surgery is not the way to go. The closure of smaller or stand alone birthing units is short-sighted in the context of a plurality of provision that can deliver safe care to a quality standard. Birth needs patience, not efficiency.

    I am sure the concept of centralising care may be music to the ears of those obstetricians who seek to pathologise all pregnant women and ignore or minimise the massive body of evidence that demonstrates the iatrogenic effects of hospital based maternity care (e.g. higher caesarean section rates, higher intervention rates for forceps, episiotomies, lower breastfeeding rates, higher levels of parental depression etc). We must not allow those who commission services to believe that the hospital is the safest place for all women and must make sure they know that it is safer and cheaper for many women to give birth away from these institutions.

    There are a large number of pregnant women in the UK who are healthy, both physically and psychologically before entering a hospital, lets keep them that way by ensuring they have a real choice of where they feel is most suitable for them to give birth – be that at home, in a freestanding birth centre or in a hospital setting. One size does not fit all women and we will do immeasurable damage for generations to come if those who argue that large baby factories are all we can afford to provide on the NHS, are able to dominate this debate. This is a key human rights issue for women and families.

    • NHS England says:

      Thank you for your comments. The ‘Call to Action’ supports, and is underpinned by, the principles of patient choice set out in the NHS Constitution. The aim of the ‘Call to Action’ is for NHS England and clinical commissioning groups (CCGs) to engage and hear people’s views on how they would like the NHS to improve and meet current and future challenges.

      This will help inform and shape the future commissioning plans of both NHS England and CCGs, and we would expect any decisions about the future commissioning of services to be based on evidence, and patient insight and engagement.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  35. Steve Turner says:

    Form my perspective I’d say there are 3 priorities:

    1. Change the culture of fear so that people are really engaged and encouraged to speak out, and their views robustly debated with all options covered. No more tokenism.

    2. Do more to foster talent and root out those who are not up to the job, wherever that may be from the cleaner, to health professionals to to the CEO and above. To help promote this we need to break down the old style restrictive practices and culture of secrecy caused by the old NHS hierarchy.

    3. I also reject the argument that there is not enough money, but agree that the whole system needs to be focused around the patient’s journey not individual providers. I believe there is still a huge amount to be saved through this, as the NHS constantly re-invents the wheel and duplicates effort. This needs to be cut out.

    • NHS England says:

      NHS England is working with Health Education England and the providers of health care throughout England in changing the culture of the NHS; empowering and encouraging staff to speak out through the enforcement of the NHS Constitution and the values and behaviours that it promotes.

      We encourage any further comments or suggestions that you may have via our dedicated Call to Action page on NHS Choices which will be seen directly by our Strategy team, collated and shared with national and local clinical commissioning groups to inform national and local future plans.

  36. Jody Aberdein says:

    We are the 7th richest country, we have perhaps the most efficient health service amongst rich nations. The ‘fact’ of a funding gap to which you refer is presumably an extension of the £20bn ‘Nicholson Challenge’ number, itself dreamt up by McKinsey. Perhaps the NHS could start by resisting and in fact reversing the wasteful internal market and covert privatisation. Otherwise the NHS will very soon no longer belong to the people at all.

    • NHS England says:

      Thank you for your comments. We are looking for all input and ideas as to how we can improve services and outcomes for patients within the financial budget we have been allocated. These ideas will be shared within the NHS and with local clinical commissioning groups to support future plan development at national and local level.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  37. Michael Vidal says:

    The problem why most reconfigurations attract opposition is that patients are not involved at an early enough stage. In all the reconfigurations and mergers I have been involved in patients and the public have been presented with a case of change which includes a solution to the percived problem. They are then asked do you agree. If patients were presented with a problem and asked how they thought the problem could be solved then they would have more confidence that the solution is to their benefit.

    Far too often changes have been proposed which only tinker with a part of the problem. For instance when we had the Health for North East London proposals they in the main dealt with reconfigurating the secondary care sctor not as the name would suggest all of the Health Service in the North East London area. But then I suspect that the proposals had more to do wiht bailing out BHRT than improving health outcomes.

    This call for action is therefore long overdue but we need to start from a blank sheet wiht no preconceived solutions.

    Michael Vidal

    • NHS England says:

      Thank you for your comments Michael. We agree that it is important the ‘Call to Action’ looks across the whole health system and we specifically want to hear the views and ideas of patients, staff and the public about how the NHS can improve. We hope that the ‘Call to Action’ will be different to previous public engagement exercises.

      NHS England and clinical commissioning groups are working closely to identify ways we can reach out to communities, so we can hear people’s views on the issues that matter to them, within the context outlined in the document ‘The NHS belongs to the people – a Call to Action’.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  38. Paul Munim says:

    I would urge the NHS to promote the preventative services available in the community sector. From our own experiences we know that people do not know what is available in their area and as a result do not access their local services. For example, they could have accessed a befriending service from their local organisation and talked with the volunteers about their health issues at an early stage or taken part in a local community activity like gardening and stayed healthy. But instead people stay at home, get unwell and develop chronic conditions which requires expensive NHS intervention. We have created a website where we have listed the free local services that people can access. Perhaps if there was more publicity about the local services that are available, there might be less demand for NHS services.

    • NHS England says:

      Thank you for your comments Paul. We agree that it is important patients and the public have information on how they can access different services available in their communities. Clinical commissioning groups are working closely with local authorities and the voluntary sector in publicising the services that are available in their area.

      We welcome responses and suggestions through the ‘Call to Action’ that can further improve the information available to patients and the public.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  39. Ron Singer says:

    Use all your energy to slow up privatisation of NHS. Then pursued HMG to invest more in NHS and social care (not raid NHS to pay for social care).

    I reject the argument that there is no money in such a rich country.

    • NHS England says:

      Thank you for your comments Ron. The ‘Call to Action’ is an opportunity for everyone to have a say about how the NHS can improve. We believe that it is important that the public can discuss, debate and influence how they would like to see the NHS of the future, and that this debate should be informed by the current challenges facing the NHS. This does though not change the core principles of the NHS Constitution, which are that the NHS provides a comprehensive service, funded through taxation, available to all, with access based on clinical need and not a person’s ability to pay.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

  40. Harry Longman says:

    Fine words indeed and much to agree with on the nature of the challenge and the vision to meet it.

    What doesn’t convince me is the gap between what this says and what happens on the ground.

    The body which scares hospital managers is Monitor. I haven’t read every word of its report out last week, but a few word counts illustrate the thinking. “Compliance” occurs 53 times, but “innovation” only once. While you call for bold changes, the people who can sack you and calling for boldly sticking to the status quo.

    Do you talk amongst yourselves? This document says “patient” 78 times, not one doctor or nurse, but while Monitor has 103 mentions of “patient” it has 164 of “financial”, 45 of “target” and 128 of “breach”.

    So what is really driving behaviour in the NHS?

    • NHS England says:

      Thank you for your comments Harry. We are working very closely with our partners, including Monitor and other national NHS arms-length bodies on the ‘Call to Action. All the organisations that are signatories to ‘The NHS belongs to the people – A Call to Action’ are committed to working together in supporting the NHS to deliver long term improvements in health outcomes and quality, and to live within its resources. Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

    • NHS England says:

      Thank you for your comments Harry. We are working very closely with our partners, including Monitor and other national NHS arms-length bodies on the ‘Call to Action. All the organisations that are signatories to ‘The NHS belongs to the people – A Call to Action’ are committed to working together in supporting the NHS to deliver long term improvements in health outcomes and quality, and to live within its resources.

      Your points have been noted and we would encourage further debate and opinion to be shared on our NHS Choices website

      • Margaret Williamson says:

        The decision to close down NHS Direct is not the best outcome for patients says the RCN, and to replace with call centre handlers is not satisfactory . It has been shown that privatations within the NHS have often cost more for an inferior service, so why do they proceed?
        Also , cuttting nursing staff on wards has contributed to the current problems in caring for patients.

      • Sue Davison says:

        Put patient care at the centre of the NHS.
        Individual care instead of targets
        Set minimum ratio of qualified staff to patients
        Really listen to what patients want/ need instead of what professionals feel is best
        Listen to staff at ground level about how to provide quality care
        If patients receive quality care they get better quicker and do not need readmission to hospital after discharge.
        Provide care where the patient needs it.
        Invest In hospitals and hospital sites as this is where people feel they should receive care. No matter what alternatives have been put in place people still go to hospitals. So think how to provide services on hospital sites