Chart - Number of accident and emergency (A&E) attendences in NHS by A&E type in England (UK) 2010/11 to 2025/26

Source NAO report on Managing the flow of patients through hospital from A&E

What needs fixing with the NHS - Lord Dharzi's report summarised into 27 points

In a letter to the UK's Health Secretary of State, Lord Darzi summarises his conclusions from his rapid investigation of the state of the NHS, assessing patient access, quality of care and the overall performance of the health system.  (The Secretary of State for Health - Wes Streeting - had asked Lord Darzi to undertake such a review).

I think the report is clear in its analysis and recommendations.  Perhaps due to the brief Lord Darzi was given, his report does not address the question of how such a culture change in such a large organsation can be managed over the many years it will take. In researching such I fell upon this NHS document.

Lord Darzi's conclusions are summarised below.

1) The Health Service is in serious trouble, public satisfaction with it is at its lowest ever.

2) He's worked in the NHS for over 30 years & was shocked by what his investigation found.

3) Causes? Whats happened within the NHS plus a deterioration in the nations's health.

4) The report sets out where the NHS stands now, how we got here and some key remedies.

5) The NHS hasn't met its promises made to people since 2015 on waiting times & treatment.

6) People are struggling to see their GP, shortages are acute in deprived communities.

7) More than 1m people have long waits for community services & mental health.

8). A&E is in an awful state with longer waiting times likely causing 14k more deaths p.a.

9) Waiting times for hospital procedures have ballooned (2010 20k over a year, 2024 300k)

10) The UK has appreciably higher cancer mortality rates than other countries.

11) Care for cardiovascular conditions are going in the wrong direction.

12) Once people are in the system, they get high quality care but maternity care is a concern.

13) Productivity is low, with too much of NHS £ spent on hospitals, too little in the community.

14) NHS isn't contributing to national prosperity as it could by reducing long term sickness.

(Four heavily inter-related factors have contributed to the current dire state of the NHS. They are austerity in funding and capital starvation; the impact of the Covid-19 pandemic and its aftermath; lack of patient voice and staff engagement; and management structures and systems)

15) Spending is below the 2018 funding promise and the historic rate its based on.

16) The NHS has been starved of capital resulting in crumbling buildings that hit productivity.

17) On top of 16) there is a £38b shortfall of capital investment in buildings & equipment.

18) Capital starvation & COVID means the NHS backlog is bigger than other health systems.

19) A familiar theme in care failings is patients’ concerns not being heard or acted upon. 

20) Post pandemic too many staff are disengaged with high levels of sickness absence.

21) The 2012 changes to the NHS structures were a calamity without international precedent.

22) The 2012 changes meant  constant reorganisation of NHS HQ & regulatory functions.

(NHS organisations should focus on the patients and communities they serve, but the sheer number of national organisations that can ‘instruct’ the NHS encourages too many to look upwards rather than to those they are there to serve. The Care Quality Commission – which inspects the NHS – is not fit for purpose, as the recent independent review made clear. Its focus on inputs rather than outcomes has played a major role in driving up the numbers of clinicians in hospitals to unprecedented levels.)

23) The NHS is in critical condition

(It continues to struggle with the aftershocks of the pandemic. Its managerial capacity and capability have been degraded, and the trust and goodwill of many frontline staff has been lost. The service has been chronically weakened by a lack of capital investment which has lagged other similar countries by tens of billions of pounds. All of this has occurred while the demands placed upon the health service have grown as the nation’s health has deteriorated).

24) This isn't primarily due to a failure of NHS management. 

(The NHS is the essential public service and so managers have focused on “keeping the show on the road”. Some fantasise about an imaginary alternative world where heroic NHS managers were able to defy the odds and deliver great performance in a system that had been broken. Better management decisions might have been taken along the way, but I am convinced that they would have only made a marginal difference to the state that the NHS is in today.)

25) But the NHS’s vital signs remain strong - clinical talent, staff's belief in NHS values.

26) NHS Vision OK - Taxpayer funded, free at point of use, based on need not ablility to pay.

(With the exception of the United States, every advanced country has universal health coverage – and the rest of the world are striving towards it. But other health system models – those where user charges, social or private insurance play a bigger role – are more expensive, even if their funding tends to be more stable. It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around)

27) Over 10 years the NHS has fallen into disrepair, improving it will take more than 5 years.

28) Major themes for the forthcoming 10-year health plan - should be ........

a) Re-engage staff and re-empower patients. 

b) Lock in the shift of care closer to home by hardwiring financial flows that encourage such. 

c) Simplify and innovate care delivery for a team work multidisciplinary neighbourhood NHS.

d) Acute care providers should bring down waiting lists by radical productivity improvement. 

e) Tilt towards technology/digital systems/AI to unlock productivity. 

f) Spending £165b the NHS's productivity is vital for national prosperity. 

g) Clarify roles, strengthen capital approval processes & balance management resources.

h)  Change will only be successful if the NHS recovers its capacity to deliver plans.

Photo by nicolasjleclercq via unsplash

  

Covid-19 inquiry UK - predictions on the answers it will find to 14 of its likely questions

 

The UK Covid-19 Inquiry started in earnest June 2023, and is due to conclude in 2026 at a possible cost of over £200 million

The inquiry chair, Lady Heather Hallett, has already shown her independence by letting government know she, not they, will be the one deciding whether evidence is relevant to the inquiry.  The overall theme of the inquiry could be described as learning lessons by examining documents and calling witnesses to give evidence under oath.  So we'll all be waiting for the evidence based answer to the question of what lessons can be learnt.  

I couldn't resist coming up with my predictions on the answers to the questions the inquiry is likely to be asking (More info on the inquiry is below that if you're interested).

Q1) Was the pandemic properly planned for? A1) No

Q2) Was the UK adequately ready for that eventuality?  A2) No

Q3) What lessons are there to learn on the whole system of civil emergencies including resourcing, risk management, pandemic readiness and government decision-making?  

A3) a) A decade of NHS under-funding didn't help us be ready for a pandemic, b) mutiple pandemic options should be planned for rather than whatever the last one was, c) the economic and educational and mental health impacts of lock downs should be better quantified, d) decision making didn't join up impacts on the NHS and on social care.

Q4) Was the core political, civil service and central government governance and decision-making in the UK fit for purpose?  A4) No

Q5) How effective where relationships with governments in the devolved administrations and local and voluntary sectors?  .A5) Not much

Q6) How well did government and society respond to Covid-19? 

A6) Initially the reaction was panic and fear

Q7) What impact did the pandemic have on healthcare systems, patients, health care workers? 

A7) Burn out of staff and mounting backlogs of other medical procedures.

Q8) What effect did healthcare governance, primary care, NHS backlogs, vaccination programmes and long covid diagnosis and support have?

A8) a) The success with a vaccine was inspite of, not due to, our healthcare governance.  b) Long covid impacts were unexpected and will continue to demand NHS and social care resources for some time.  c) NHS backlogs were already mounting pre-pandemic, d) the NHS showed great flexibility in re-assigning staff and facilities to focus on hospitalised covid-19 patients, and in quickly sharing medical insights on how to treat covid-19 patient's symptoms.

Q9) What lessons have we learnt from from the development of Covid-19 vaccines, the implementation of the vaccine rollout programme, the treatment of Covid-19 through both existing and new medications?  

A9) See answer 8) above

Q10) How prepared are we for the next pandemic?  A10) We are not well prepared.

Q11) How unequal was vaccine uptake, what caused this, how did Government respond? 

A11) Vaccine uptake was uneven, driven in part by cultural issues and, as always, by those who are poorer, less educated and less priveleged having poorer health.

Q12) What are the facts concerning public concern relating to vaccine safety and the current system for financial redress under the UK Vaccine Damage Payment Scheme?

A12) a) AI and social media will continue to spread dis-information on vaccines, b) as of May 2023, 72 people have received a payment from the government for being severely disabled by a Covid-19 vaccine, or on behalf of someone who died from the vaccine.  In total, 96 people have been told that they are entitled to receive money via the UK’s Vaccine Damage Payment Scheme, run by the NHS authority, which means 24 are still waiting on the cash. Source

Q13) How well was government procurement handled?  

A13) Not at all well, with basic procurement disciplines being ignored and associates of those in power securing contracts that yielded them obscene profits.

Q14) How well did the Care sector respond to Covis-19?

A14) Infected older people were forced onto care homes leading to further unnecessary deaths.  The Care sector was, and still is, underfunded and faces significant resourcing issues.  

MORE INFO ON THE INQUIRY'S MODULES

The various modules are described below using information form the inquiry website.

Active modules

1. Resilience and preparedness   Was the pandemic properly planned for? Was the UK adequately ready for that eventuality?  What lessons are there to learn on the whole system of civil emergencies including resourcing, risk management, pandemic readiness and  government decision-making?  
2. Core UK decision-making and political governance Was the core political, civil service and central government governance and decision-making in the UK fit for purpose?  How effective where relationships with governments in the devolved administrations and local and voluntary sectors?  .
3. Impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK  How well did government and society respond to Covid-19?  What impact did the pandemic have on healthcare systems, patients, health care workers. What effect did healthcare governance, primary care, NHS backlogs, vaccination programmes and long covid diagnosis and support have?
4. Vaccines and therapeutics  What lessons have we learnt from from the development of Covid-19 vaccines, the implementation of the vaccine rollout programme, the treatment of Covid-19 through both existing and new medications?  How prepared are we for the next pandemic?  How unequal was vaccine uptake, what caused this, how did Government respond?  What are the facts concerning public concern relating to vaccine safety and the current system for financial redress under the UK Vaccine Damage Payment Scheme?
5. 
   

Future modules

5. Government procurement  Module 5 will examine Government Procurement across the UK. 
6. Care sector  Module 6, examining the care sector across the UK, will open in December.

Further modules will be announced in the coming months (says the Inquiry website as at 6/7/23) covering both ‘system’ and ‘impact’ issues across the UK including:

• Testing and tracing
• The Government’s business and financial responses
• Health inequalities and the impact of Covid-19
• Education, children and young persons
• Other public services, including frontline delivery by key workers

The NHS at 75 years - 15 points

1) Celebrate the NHS has got to 75 and we don't live in fear of pain from illness we can't afford to treat

2) Recognise that free health care is less personal, has longer waits and is in less nice crowded premises

3) Acknowledge that private health care tends to focus on easier medical procedures

4) Have a long term plan for resourced social care joined up with local services & primary health care

5) Regulate those parts of the food industry that profit from selling unhealthy food

6) Address the creaking NHS bureucracy and IT systems that make patients lives complicated

7) Insist politicians work on cross party solutions to the poors' worsening health and life expectancy

8) Educate people so they know how to cook using healthy foods

9) Create a plan to address the post pandemic 5 million people out of work with long-term sickness

10) Sort out the problem of getting appointments at GP Surgeries by employing more Doctors

11) Admit that historically health care has grown by some 4% p.a. (in low inflation times)

12) Admit that from 2008 and for about a decade health spending only increased by some 1.5% p.a.

13) Celebrate that on efficency the NHS comes 4th out of 11 health systems

14) Keep revenue spend on private sector services at around 7% (largely unchanged since 2012)

15) Acknowledge that our taxpayer funded health service needs urgent cross party attention

Boris - look her in the eyes and tell her you never bend the rules

 

change when public servants get paid to save the nhs money

this freakonomics article reports on some 2010 research which apparently shows a link between mortality rates and when people get paid (the 30 years worth of data used is from the usa)






one explanation offered for the link is that when we get paid we go out shopping (which increases the risk of all kinds of things like car accidents or heart attacks) 


in summary it’s not the receipt of income  - it’s the activity generated by the receipt  - that’s the killer


so here's an idea


if the government paid different groups of it's employees at different times of the month


then presumably that would smooth the accident/health effects described above


and so spread the load of such on the nhs across the month more evenly


photo by leo reynolds