We must help our NHS adapt in order to keep it healthy

Writing for a national newspaper, Professor Keith Willett, NHS England’s Medical Director for Acute Care said:

Up and down the country, our GPs, community services, NHS111, ambulances, A&E departments, and hospital services are under intense pressure. The problems are complex but must be – and are now being – addressed urgently.

The NHS of today is still based on its original 1940s design.  Every industry needs to adapt, and the NHS – at the forefront of innovation and technology – is no different.

As a population, we have changed considerably.  We are all living longer – over the next 15 years the population aged over 65 is projected to increase by 40 per cent, which is good news.

But our health and care needs are greatest in the later decades of life as we accumulate multiple ageing disorders that can affect our independence as much as our wellness.

Right now our health and social care system has an inbuilt default mechanism. When society cannot meet our personal care needs at home, we are moved, often distressingly for us, to a hospital medical setting, the only way to provide that care.

The NHS has around 100,000 beds, which is enough for the medical treatment of our patients.  But what we are increasingly facing is using a large proportion for ‘personal care’ – dormitories of older people.

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 per cent.

The opportunities for bringing about a shift in care from hospital to home, or close to home, are enormous.

Our frail and elder patients would be particularly advantaged – hospitalisation often disorientates them – physically, mentally and socially – and puts them at unnecessary risk.

To tackle these issues, NHS and local authority leaders have come together for the first time across England to plan future services with their communities, producing what we call sustainability and transformation plans (STPs). Such collaboration will give nurses, doctors and care staff a better chance of succeeding.

Finally we have 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.

Now what we need in every part of England is evidence-based debate about what our local authority, community and health and care leaders are suggesting.  I am sure those ideas can be improved but they deserve a fair hearing.

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.

These are societal issues and very personal to us.  In the past we have often been told what was right for us without reference to those of us in the NHS who live and breathe these issues on a daily basis, or those who experience services as patients or carers.

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.

Keith Willett

Professor Keith Willett is the Director for Acute Care to NHS England and is the Professor of Orthopaedic Trauma Surgery at the University of Oxford. An NHS consultant surgeon for 24 years he has extensive experience of trauma care, driving service transformation and healthcare management.  He has taught surgery and leadership extensively across the NHS and internationally.

In 2003 he founded the Kadoorie Centre for Critical Care Research and Education focusing on the treatment of critically ill and injured patients. This year IMPS, a children’s safety charity he launched, celebrated 20 years and over 250,000 children trained in risk awareness, first aid and life support.

He was the co-founder of the unique 24-hour consultant-resident Oxford Trauma Service at the John Radcliffe Hospital in Oxford in 1994. Building on that model, in 2009 he was appointed the first National Clinical Director for Trauma Care to the Department of Health and was charged with developing and implementing government policy across the NHS to radically improve the care of older people with fragility hip fractures and to establish Regional Trauma Networks and Major Trauma Centres. By 2012 both re-organisations and care pathways were successfully in place and are now credited with marked improvement in patient care and survival.

In his current role, he has the national medical oversight of acute NHS services ranging from pre-hospital and ambulance services, emergency departments, urgent surgery, acute medicine, children’s and maternity, armed forces, and health and justice services and national major incidents. He is now leading the transformation of the urgent and emergency care services across the NHS in England.

He was awarded a Commander of the Order of the British Empire (CBE) in the New Years Honour’s List in 2016 for services to the NHS.  On receiving this honour he said “I have been exceptionally privileged to build a career as part of the collective commitment of so many dedicated individuals and friends who are our NHS”.

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