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 60.

    54 "I think we need Freedom From Endless Attacks On The NHS by privatisers like Jeremy Hunt" - yes, all suggested reform is an "attack", we don't need change, it's clearly working so well! Rather than cowering behind mawkish language why don't you face up to the truth? Yet again Socialism has created a money skin run solely to employ huge numbers in jobs for life without accountability.

  • rate this

    Comment number 59.

    I want to be able to opt-out of the NHS / national insurance. If I get injured or ill, then I'll get privately treated instead. I want freedom from your thieving socialist healthcare system, and I think a lot of other people also want that freedom; a freedom that all you socialists out there want to deny to people, because you know it would end if you couldn't force everyone at the point of a gun.

  • rate this

    Comment number 58.

    So the cover up begins, senior managers and politicians trotted out yesterday evening and today saying that there should not be a blame culture for systemic failings
    Who created the service as it stands today, why should they not be blamed and in fact much worse..

  • rate this

    Comment number 57.

    A nurse on the school run yesterday related their dread of "gardening leave". Every shift starts with checking their in-tray for the "little brown envelope" which tells them they're suspended pending complaint investigation. It seems incompetent to expect expert front line staff to perform their best under high stress and on low wages when admin staff enjoy predictable high wages.

  • rate this

    Comment number 56.

    Population is increasing every day, we are getting more and more tourist patients every year, yet, the powers that be, in their infinite wisdom have decided that it now needs less money to function.
    The gov,t don't care because there are no cutbacks in Harley street where they go, paid for by taxpayers.

  • rate this

    Comment number 55.

    39/52 You only have to look at the ridiculous, frothing cap locks posts like these to see how we are dealing with 70s class war failures clinging on by their finger nails, desperate to cling to the last vestiges of the power they used to bankrupty and bully the country. Disgusting self interested dressed up as morality, we need to smash the last few unions and all will be well.

  • rate this

    Comment number 54.

    @49 - I think we need Freedom From Endless Attacks On The NHS by privatisers like Jeremy Hunt.

  • rate this

    Comment number 53.

    Just look at the comments on this forum

    The genuine public saying the NHS fails in patient care and the NHS union members saying it is all about cuts, plus marking down the opinions of the public.

    This is exactly why the NHS is failing. Head in the sand mentality.

  • rate this

    Comment number 52.

    One day you might crash in your car, or get cancer, or have a baby and have your life saved by the NHS - NO NHS = NO HEALTHCARE

  • rate this

    Comment number 51.

    Nothing will change until you cut the head off the snake. Then revoke all those whistleblower gagging clauses that were imposed over the last ten years. Let's get it all out there. To cope with those telling statistics concerning elderly care bring back geriatric wards where specialist care can be provided on site. No-one will be starved to death in their own home or in a hospital bed.

  • rate this

    Comment number 50.

    In my area we have lost our A&E dept and many other wards and services have been moved to other hospitals both over 25 miles away, just as in London. The result being that the other hospitals are struggling to cope, people are having to travel unnecessary distances for outpatient care and visiting relatives and we have a hospital standing half empty in a busy town. How is that right?

  • rate this

    Comment number 49.

    Lots of handwringing, to be expected on the BBC, but you can see people know the real problem: a unionised mafia that exists merely to suck down taxpayers' money and defend mediocrity or worse. It doesn't matter whether they change or not, eventually, as with all Socialism it crumbles away as the vested interested bankrupt that they claim to love by refusing to listen to fiscal sense.

  • rate this

    Comment number 48.

    The failings in the NHS arise from an excess of "management", an obsession with targets, the pointless "internal market" and the belief of successive governments that the UK should provide free healthcare for the universe.

    All these things can be easily rectified, given the will. Sadly, the present lot of politicians of all colours don't have the will, just the ludicrous belief in private sector.

  • rate this

    Comment number 47.

    Recently, i was at our local hospital and while waiting for my appointment i watched a contract cleaner mop a 70m (paced out) corridor and only dipped his mop twice , and didn't even get within 0.5 of meter to the edges.
    When i confronted the cleaner, he said '' we have a limited amount of time to do the work, and the hospital would not pay for enough people to do the job in the time allotted.

  • rate this

    Comment number 46.


    And has your ideology done any better? Get ideology out of healthcare. What is best for the patients is what is important. This constant swinging from Right to Left and back again destroys care and efficiency. No one knows whether they are on their a.ses or their elbows. For God's sake and all of us, sort it out.

  • rate this

    Comment number 45.

    I think everyone agrees the NHS could use reform. However nobody apart from rich fat cats want the free market involved. Such reform should only be done by politicans people trust and promise to do so without any support from the free market. Unfortunately there aren't many of those.

  • rate this

    Comment number 44.

    Sack and /or imprison those who were responsible. They shouild never be allowed in a public service position again.

    Disband the medical & dental council, it is just a whitewash centre for doctors.

    The NHS is not the envy of the world, it is now a laughing stock with a licence to kill.

  • rate this

    Comment number 43.

    Is it not right to apply criminal law against those who kill people in hospitals?

  • rate this

    Comment number 42.

    The NHS needs proper funding and no more privatisation. If you go to the US model which Cameron and his chum want you may as well sell it all off there and then. Basically you need to have a ring fenced funding and a nationalised model ala 1948. We will ALL have to pay more to achieve this as eventually we will ALL need the NHS.

  • rate this

    Comment number 41.

    Far too many administrators, reducing the economy of scale that could and should be used to ensure efficient use of funds. Only then will we get the NHS that we deserve.


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