Noble visions have been proposed for the NHS before. Will this time be different? | The Secret Consultant

The NHS is in serious trouble. This is the considered diagnosis of Lord Darzi’s report on the NHS.

It is an astonishing piece of work, delivered in just nine weeks, and the brief underlines the new government’s commitment to action on the NHS from the outset. It details the steady decline in the health service over the past 15 years and rejects the idea that this is purely a hangover from the pandemic.

But, my goodness, it’s bleak reading. Demand on the NHS has never been greater, and yet performance across the board is shockingly poor. Some highlights: 2 million people are waiting for community or mental health services, many of them children and almost 400,000 for over a year; more than 300,000 people have been waiting for over a year for outpatient treatment – ​​15 times the number in 2010; and almost 10% of patients have to wait more than 12 hours to be seen in A&E, causing an estimated 14,000 unnecessary deaths a year.

The state’s health care system is like a staircase with an emergency room at the bottom. For a patient with the vulnerability of chronic illness or old age to end up in the emergency room, they must skip countless safety steps along the way. The first, and perhaps most important, is good social services to improve overall health and reduce poverty. Next come public health measures for primary prevention of disease, and then reliable access to primary care physicians and community-based care with rapid response services to treat illness before it progresses to hospital care.

If specialist treatment or surgery is required, it should be done quickly enough to prevent further deterioration. Discussions about advanced care should occur early, before hospital admission, to identify those who are nearing the end of life and for whom home care may be more appropriate.

All of these steps fail. Patients end up in the emergency department, where they have to wait longer for treatment and are therefore more likely to die. Even once they are in a hospital bed, patients are often stuck for long periods due to inadequate social care services, meaning they cannot be discharged easily.

There are 28 hospitals full of patients in England just waiting for a safe place to be sent. This unbearable pressure on acute hospitals is the most visible and dramatic aspect of the struggling NHS care, but Darzi’s report rightly identifies that it has led to investment in hospitals at the expense of more important community care, to prevent the need for hospital admission in the first place. This balance urgently needs to be redressed.

And yet it is also clear that, even as investment in hospitals is relatively protected, productivity here is also falling. Blocked beds are one reason, but there are many others, including the chaotic state of our estates and our poor use of technology.

The NHS is indeed “broken”, and in response the Prime Minister this week set out his vision for fixing it. There are three “big shifts”: increased digitisation of our outdated paper and analogue systems; moving care from the hospital environment to the community; and moving from treating diagnosed disease to ensuring the primary prevention of disease.

A 10-year plan will be published to set out exactly how this will be done, due to be implemented next year. Impressive proposals include NHS health checks at work and advanced diagnostic testing offered on the local high street. Even at this stage, however, it is clear that it is unlikely to involve any additional funding and will be largely based on reform.

So far, so good. But the problem is that I have heard this before, and often. Even during the shameful degradation of the health service over the last 15 years, many similarly noble visions have been proposed for the NHS.

It’s long been standard advice for aspiring consultants preparing for their job interview: make sure you read the following information Five Year Outlook, Long term plan And NHS: from good to great.

Many of the themes in these old documents echo those of Kier Starmer.

Previous attempts to digitise the NHS have been nothing short of disastrous, and since 2012 I have seen many of the chaotic reorganisations that have only made things worse.

Darzi’s report is adamant that the current problems are not due to failing NHS management.

And unfortunately, while reform must of course accompany any investment, I cannot see how it can be achieved without more money. Despite being a huge and diverse organisation, the NHS is lean in management and we achieve a lot with a little compared to other health systems that pay much more per population than we do.

It is certainly impossible to launch all these new initiatives – and improve our digital and physical infrastructure – without paying for them or without diverting resources from current services that are already far beyond their capacity.

The Darzi report clearly highlights the desperate shortage of capital that has been going on for years, which has prevented our hospitals from functioning effectively. However, it seems that Starmer forgot to read that part.

Moreover, the demand for care will continue to increase if the overall health of the population does not improve.

I see the effects of poverty in my patients every day, for example unemployment, poor housing, obesity due to poor diet, inability to afford medication. I know for sure that the mental health of my patients has never been worse because of this. These problems cannot be solved by the NHS – what good is an inhaler for someone whose mouldy house and chronic stress are causing asthma?

We can’t expect the NHS to improve public health on its own. But that’s not even what worries me most. All organisations live or die by their staff and since the trauma of the pandemic our staff are tired, disinterested and fed up.

The decline in productivity is not due to staff working less hard, but our time is increasingly spent trying to make up for shortcomings elsewhere. Working in the NHS is a miserable experience at the moment and it is heartbreaking. I became a doctor expecting to work hard, and I certainly do, but the chronic inability to do my job well and the futility of not being able to help so many of my patients is destroying the satisfaction that used to make my hard work so rewarding.

I see the same thing in my colleagues every day. Worryingly, our junior doctors seem particularly affected. How can we hope to reform without a motivated and productive workforce?

I don’t want to sound too cynical here. Of course there are reasons to hope – the NHS and its staff are resilient and with the tools and resources we have, we can deliver the excellent care that we can. And I believe that we now have a government that has committed to the NHS on its founding principles, recognises the daunting scale of the problems it faces and is at least realistic about the effort and time required to fix it.

But words have been spoken before. The scale of the task is truly immense, perhaps more so than ever before.

Will it be different this time? God, I hope so.