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 160.

    David Nicholson presided over a trust that unecessarily allowed up to 1200patients to die; now he is promoted to preside over all the NHS.God help you that live in UK.Cameron and Hunt are good judges of character.

  • rate this

    Comment number 159.

    As a front line NHS worker I find that there are 2 main problems: excessive paperwork (mainly introduced to provide "accountability" but actually hindering staff to spend time caring for their patients) and a completly insane pt to staff ratio. A trained nurse who is not answering a buzzer for a commode because she is dealing with 10 other pts at the same time is not un-caring, she is overworked.

  • rate this

    Comment number 158.


  • rate this

    Comment number 157.

    Any other 'industry' would have the HSE all over this.
    Senior people would be hauled up in Courts charged with Corporate Manslaughter .

  • rate this

    Comment number 156.

    The culture of fear is not only prevalent in the NHS but also in other organisations, public and private. Promotion is on the basis of toadying to ones bosses whilst bullying ones subordinates. Before trying to redeem the NHS culture the government has first to change the culture of politics.

  • rate this

    Comment number 155.

    The BBC should feel proud of themselves. This is the most biased reporting i have ever heard. Yes, there are problems with the NHS, bad things happen in what is the biggest employer in the UK. But it seems that when things go wrong, they forget the what good work is being done.

    Carry on whinging, let's destroy this institution. But be warned, you may like it's replacement even less.

  • rate this

    Comment number 154.

    148 It isn't just "staffing problems", the money wasted on the NHS is beyond belief, one of the biggestest employers globally. How many people do they need? There are definately lazy, incompetent staff members tenured away in cosy roles who to whom nothing will be done due to Union excuses, then people get bored and another round of public money is handed over to support awful standards. A mafia.

  • rate this

    Comment number 153.

    @129 alexicon "Government exists to organise society. Health care is a collective responsibility"

    What if they "organised" you into a concentration camp? I suppose you'd approve, right? The truth is that government's role is simply to protect the individual's rights. Nothing more, nothing less.

    There is no "collective responsibility" because there is no such thing as a "collective brain".

  • rate this

    Comment number 152.

    There are an incredible amount of "private sector is best" posters here, little realising that it's just as bad if not worse. I work in the private sector, it's just as wasteful, just as inefficient and just as incompetant as the public sector is made to be. Only difference here is, they'll charge ££££'s for the privilage. Keep the NHS public!

  • rate this

    Comment number 151.

    I'd have (relatively cheap) catastrophic healthcare insurance coverage, and I'd have it on the condition that I'd still be covered even after developing a catastrophic condition."

    You don't get to set the conditions nor the price. You labour under the delusion you can buy insurance for risks that are uninsureable. No-one's going to insure you for a lifetime of expensive treatment.

  • rate this

    Comment number 150.

    If the criteria comes from judging success by solely by cost then quality suffers

    If you approach a task by this is how much you can spend on it rather than this is how much it will cost to do it properly then you are bound to have problems

    Treatments should be costed (&staffed) by how to achieve them effectively.. not just some "suits" guess of cost for an ideal patient in perfect circumstances

  • rate this

    Comment number 149.

    134. Ramalamadingdong
    Staff should be accountable but government created targets that compromised patient care. Managers focused on those targets and ignored the deterioration of care - it didn't happen overnight. So they too are accountable. The Chief Executive was ultimately responsible at the Trust and should leave his current post without a golden goodbye. Won't hold my breath.

  • rate this

    Comment number 148.

    Comments like that of Ramalamadingdong are nothing but offensive and do nothing to intelligently solve these problems.I dont know what his problems are but i hope he finds some happiness soon.
    Meanwhile, as a caring and competent nurse of 28 years and one who has been bullied and intimidated for daring to say there are staffing problems etc,none of this surprises it just upsets

  • rate this

    Comment number 147.

    The highly paid NHS doctors, managers and board members all knew what was going on. They chose to ignore this unacceptable drop in care standards & must be held responsible.
    Let's roll the clock back so that nurses don't do 'degrees' of doubtful value and focus just on patient care. We now have an NHS where it's almost impossible to discipline or sack badly performing staff!

  • rate this

    Comment number 146.

    My daughter had extensive treatment on the NHS, around 18 months worth in fact. They were, quite simply, magnificent. Truly angels on our shoulders. In an organisation of around a million people, it's inevitable that there will be bad, but for all those preaching a private solution, your views couldn't be more misguided. For starters, the costs would be incredibly prohibitive.

  • rate this

    Comment number 145.

    @141.Trout Mask Replica

    Never have you made so many comments that I actually agree with.

  • rate this

    Comment number 144.

    I'd have (relatively cheap) catastrophic healthcare insurance coverage, and I'd have it on the condition that I'd still be covered even after developing a catastrophic condition.

    Ha Ha Ha Your comments gets sillier and sillier. Just what healthcare (or any other for that matter) insurance company lets you dictate exactly what or not you are covered for.

  • rate this

    Comment number 143.

    My husband has recently been diagnosed with a serious illness. Not all hospital staff are cut from the same cloth. I want to applaud the staff on A&E and CDU at the Northern General Hostpital and wards L1 and L2 at the Royal Hallamshire, both in Sheffield, all of whom have been absolutely amazing with nothing too much trouble for them. Go and observe; see how its done.

  • rate this

    Comment number 142.

    @134 Sorry but you are wrong.The big fat salaries are being paid to the swathes of so-called Managers who could not run a bath,let alone a hospital as Stafford Hospital exemplifies.The fuss will all fade away and it will be business as usual.

  • rate this

    Comment number 141.

    One root cause of these problems is from the cahnge in nursing training since the 1980s. It's taught as an academic, not vocational or practical, discipline and nurses no longer get the in depth ward experience until after they graduate. There's no disciplined leadership to show the standards required. As a result compassionate and care are deprioritised compared to management led targets.


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