Where next for the NHS?

Generic image of a pensioner The ageing population is creating challenges for the NHS

Across 1,781 pages, the public inquiry into the Stafford Hospital scandal has forensically set out what is wrong with the NHS system.

The report detailed a culture whereby the needs of patients were too often sidelined for the self-interest of the system.

Inquiry chairman Robert Francis was at pains to point out that change did not need major reform and reorganisation.

Instead, he said it was up to people to make a difference from the "cleaners and porters to the secretary of state".

But the question that has not been asked is: will they have the time?

Pressure on the NHS - and hospitals in particular - is growing all the time.

The ageing population and growth in chronic conditions, things like heart disease and dementia, means the health service has found itself having to manage patients rather than cure them.

That requires time. But that is the very thing staff all too often say they don't have.

Budget squeezes

The result is that many people find themselves having an emergency episode and end up in hospital.

Nearly two thirds of patients admitted to hospital are over the age of 65.

By far the most problematic for the health service is the very elderly - those over 85.

Once admitted they spend 11 days on average in hospital - nearly four times longer than working-age adults. Once discharged they have the highest chance of readmission.

Evidence suggests they would be better cared for at home, but that requires investment in NHS community services, such as district nursing, and social care support from councils.

Both are facing squeezes on their budgets in the current climate.

Towards the end of last year the Royal College of Physicians published a report called Hospitals on the edge?

It argued cultural change needed to be accompanied by a whole new approach to care whereby hospitals were seen as specialist centres.

But when the NHS tries to do that it faces problems as the furore over the reorganisation of hospitals in south London showed last week when thousands took to the streets to oppose changes.

It means the health service is caught between a rock and a hard place. Expectations are rising and care is getting more complex. Change is needed, but difficult to implement.

One thing is for sure, the Francis inquiry has ensured there will be no hiding place for the NHS as it battles to rise to the challenge.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 340.

    Time was not so very long ago when you heard that a friend or relative were going into hospital you would say that "it was the best place for them".

    Now, who knows?

  • rate this

    Comment number 339.

    Tax is indeed theft -- faceless bullies demand some esoterically-determined sum with the threat of destroying you. The bullies then spend it on their schemes and their pals.

    The NHS is excellent though underfunded. Wouldn't you rather the money stolen from you were spent on hospitals and not, say, zillion-pound submarines? You weren't consulted. Therein lies the problem.

  • rate this

    Comment number 338.

    Zero tolerance for A & E departments with unsafe staffing levels? What happens to them all? Do any A & E departments enjoy staffing levels meeting the College of Emergency Medicine standards? Do all which don't, close? Then what? 'Zero tolerance' is a hackneyed phrase which must be accompanies by a description of the alternative to whatever is not tolerable.

  • rate this

    Comment number 337.

    What happened in Stafford Hospital was appalling, unforgivable and those at the very top should face the consequences.
    But the NHS is no longer National - and around the rest of the country are some superb Trusts, most NHS staff are very dedicated, and the vast majority of patients are both medically treated and treated well.
    Stop bashing the rest of the NHS over these dreadful events in Staffs.

  • rate this

    Comment number 336.

    A health service is not a business. 34 years of imposing business models on hospitals and primary care has led us here. 34 years of denigrating public services. 34 years of Austrian economists' nonsense setting govt. policy all over the western world. 34 years of demonising nurses, teachers, social workers, prion officers, police officers, 34 years of stagnant wages while the financiers laugh.

  • rate this

    Comment number 335.

    How to put kindly?

    Patients, relatives, staff, managers, politicians, all have suffered in their own ways, while some Alien Force persuaded Healthy Earning Majority to demand Political Parties compete to cut Nation's Health-Bill Taxes

    Science rising, Access falling, So-Far Healthy Majority goes private, too late the Healthy think of family, friends & future, secure only for richest

    Alien Mammon

  • rate this

    Comment number 334.

    I worked in one hospital that has just been on ITN news,... back in 2005, I left as,quote "I am not nursing, I am doing damage limitation",.... I was running from one emergency to another,1 staff nurse and one hca to 18 totally dependent patients, several with cancer, in pain (priority),several with alcohol detox causing chaos, others with severe medical conditions, I went home every night crying!

  • rate this

    Comment number 333.


    degrees may not mean a difference in pay but it does restrict the jobs I can apply for (lack of one) despite my 16 yrs of paed A&E experience, I work in Canada and am thinking of returning to the UK but would likely only get a band 5 post. I don't want to be management but would like to be paid for the experience I have and the positive difference that would make for my patients.

  • rate this

    Comment number 332.

    pay is no different for degree nurses and they still start at the bottom and work their way up, what has changed is patient nurse ratios. what did make the biggest difference is when we were made to take on junior Drs jobs to reduce their working hours, ward clerks jobs, phlebotomists jobs (taking bloods) and not replacing staff when they leave, less time for patients, etc etc.

  • rate this

    Comment number 331.

    Management has killed the system and it will NEVER recover! The days when REAL nurses ran the hospitals is long gone! Today it's ALL about making money! The patience are just a pain in their rears! I have seen the state of some of the UK hospitals...DIRTY and the couldn't care less attitude from 90% of ALL that work there!
    N Not
    H Healthy
    S Service

  • rate this

    Comment number 330.

    Nursing started going downhill at the time that a "degree" seemed to become a neccesity. In the "olden days" when prospective nurses started off at the bottom as student nurses and slowly worked their way up through the system becoming SEN or SRN there appeared to be more caring more compassion. Are todays nurses just too clever and not willing to do basic tasks. We need willing caring people.

  • rate this

    Comment number 329.

    Everyone please stop being diverted by this issue. The problem is that of resource management at many levels- the NHS is just one part of it.

    Succesive govts have chosen to put resources into their choices of priority -say e.g. trident over health. Nothing could work properly unless the correct resources are put in place to deliver. Eg The Olympics.

    We must change our priorities.

  • rate this

    Comment number 328.

    "If I owned a garage, employing mechanics who failed time and again to replace wheel nuts leading the the deaths of hundreds of customers I would be imprisoned and my life would be ruined"

    What about if you owned an automobile factory where people make the cars that kill 2000 people a year in the UK. That's even worse, right?

  • rate this

    Comment number 327.

    The Medical Director was in an important meeting with the Manager. The Consultant was unobtainable at the private hospital. The Junior Doctor had clocked off none the wiser. The Midwife was handing over. The Nurse couldn't cope. The Health Care Assistant was having a fag. The GP was ticking boxes. The PCT were implementing a Government Directive about "Choice". As opposed to "Quality".

  • rate this

    Comment number 326.

    Nursing needs to go back to basics, but the constant cuts by the current government who pretty much picked up where they left off when they were ousted from power it is hard.

    What happened in Stafford is unforgivable, fewer bureaucrats/managers /less waste and more nurses, more beds in hospital/community are needed, 1 nurse can't provide a decent care for 20 patients, it isn't physically possible

  • rate this

    Comment number 325.

    Everyone who walks through the doors of an Nhs hospital as an employee should be employed by that hospital, not third party profit hunters.

    Return the pride to the health service.

  • rate this

    Comment number 324.

    Perhaps if there were fewer accountants in senior clinical and non-clinical management positions things might be different.Clinical staff are invariably forced into making service changes, for that read budget cuts, by accountants who are completely unaware of the clinical consequences of those actions. And don't think staff aren't threatened: the bullying of managers is endemic.

  • rate this

    Comment number 323.

    If I owned a garage, employing mechanics who failed time and again to replace wheel nuts leading the the deaths of hundreds of customers I would be imprisoned and my life would be ruined. If I work for the NHS, shut my eyes, keep my mouth shut - nothing happens except some 'recommendations' - not demands or orders but 'recommendations'. This situation has the foul stench of corruption.

  • rate this

    Comment number 322.

    Up to 75 square miles of district to cover. One Trained Nurse and 1 HCA dealing with mostly end stage palliative patients in pain nausea & restlessness, requiring personal care. Over 20+ Patients on a typical 12 hours shift the drive time between calls the maths is simple. Dealing with relatives that are drunk at times violent & abusive Not even a break at times. Two nervous break downs later!!

  • rate this

    Comment number 321.

    patient in pain, patient thirsty, patient crying, relative distressed, patient vomiting, patient needs comfort told they have cancer,patient confused and wandering, patient wet and dirty, who do I choose? I do my best, the patient I get to last will judge me to have no morals, that I dont care & my behaviour is indefensible, that is why I hug my children and try to do my best again the next day.


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