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 220.

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

    Get it right:-

    The pressure is NOT on the FAT CATS at the top.... ALL of the pressue is on the poor nurses who are being told that they may face court of they don't admit mistakes... and who are being subjected to a massive rise in complaints against them from compensation-culture parasites jumping on this bad-press bandwagon

  • rate this

    Comment number 219.

    I wouldn't try to reason with Whitefall,Bastiat,Endless(is he Divil) as it seems their me/mine attitudes are immune to it.
    Just think of it that they are here for our amusement.

  • rate this

    Comment number 218.

    My son is an A & E CT4 for a London NHS Trust. There are some poor nurses and doctors however there are also those who try and have tried to whistleblow on poor practice, for their pains they no longer have jobs because managements sack them, so that managements keep theirpay cheques. The USA system works for those who can pay.

  • rate this

    Comment number 217.

    Successive governments have reduced caring nurses to box-ticking droids. The solution is 'simples'; 1) Bring back proper matrons, 2) bring back proper on-the-job training - getting rid of nursing degrees and 3) get the govt off health carers' backs. Job done! I claim my peerage.

  • rate this

    Comment number 216.

    194 "I am also a union member, if it wasn't for my union I would now be working harder for longer with less pay. How is paying me less supposed to incentivise my actions" - Why should you be allowed to bully the State into unfair inflation busting pay hikes and ridiculous triple time holidays for doing what anyone in the private sector does naturally? If you don't like your pay get another job.

  • rate this

    Comment number 215.

    Not if you negotiate a fixed contract, so that it cannot change in price, even if you develop a condition"

    And in which parallel universe do insurers offer such a policy for life? Name any in the USA (for example). If you asked an insurer to write a policy at a fixed priced for life you've basically asked them to take on an unquantifiable risk which means a very high price.

  • rate this

    Comment number 214.


    A huge proportion of the complete service is already provided by the profitable private sector - drugs, gases, equipment of all kinds, beds, bed linen, power, food, etc., etc. Even the clinical staff, doctors and nurses, make profit (called salaries).

    The only aspects in the public sector are management and ownership.

  • rate this

    Comment number 213.

    Profit is the root of all good.

    Rubbish. The purest example of an organisantion dominated by the profit motive is a bank. Remember payment protection insurance miss selling. pension miss selling, endowment mortgage miss selling, LIBOR rate fixing etc. etc. Do we really want our hospitals run like banks? Not likely. The only people who will benefit will be the managers who will get even more pay.

  • rate this

    Comment number 212.

    Why dont polititions listen to the people working on the frontline, our job is being made more difficult because of cuts. Morale is at rock bottom a three year pay freeze.

    -- Join the club I work for the council and with the same problems but if I done a crap job.. I WOULDN'T HAVE ONE!

  • rate this

    Comment number 211.

    @197 Trout Mask Replica: "The other key difference is that the criminal provides you nothing"

    Ok, let's say a thief steals a bunch of money from you, but then decides to spend some of it back on you - Would the justice system still call that man a thief, and still imprison them? - The answer is yes.

    My property is mine. I earned it. Nobody has a right to steal it, no matter what they do with it.

  • rate this

    Comment number 210.

    For those espousing the US healthcare system, the amount of GDP spent on healthcare in the US is nearly twice that of the UK, yet 40 million Americans only have access to the most basic of healthcare, due to inability to afford private insurance. Overall US healthcare is ranked far lower than here.
    Only those investing in the private sector are likely to gain. Many are Tory MPs or ministers

  • rate this

    Comment number 209.


    Sadly, its not a question if the UK public want an NHS - the Politicians, who incidently mostly pay for private medical because they can afford to, are deciding for us. Privatising the NHS is creeping in slowly over time...much to my increasing anger.

  • rate this

    Comment number 208.

    The one thing coming out of this affair is the lack of action at the time where the media asleep on the job they are quick to boast they are the guardians of the nation when things are in the publics interest they must have thought this was not and what about UNISON how many members worked at this hospital did they put members before the patients we have had a deafening silence from them

  • rate this

    Comment number 207.

    All goods and services are offered for profit"

    A private business can choose its customers and the markets it serves to ensure it is profitable, setting price and product accordingly. A universal healthcare requirement means the market and pricing cannot be segmented in such a way as many/most people cannot afford some or all of the products and services that must be provided.

  • rate this

    Comment number 206.

    The only way to improve care in the NHS is to sack a third of its employees (the ones holding the clipboards) There doesn't have to be an NHS manager for every hospital bed, but there is.

  • rate this

    Comment number 205.

    @185 Trout Mask Replica: "Once you contract something the risk profile changes at the point of next renewal and so price goes up"

    Not if you negotiate a fixed contract, so that it cannot change in price, even if you develop a condition. Sure, this would mean slightly higher prices, but it would cover the problem of insurers cancelling or massively increasing the price because of a new condition.

  • rate this

    Comment number 204.

    I believe that people now must realise that the NHS is a capable emergency (Life saving) service but lacks the resources to be much else.
    Demography has dictated that the resources available to the NHS provided through taxation will never be enough and eventually, some charging for non life threatening conditions will be necessary. I take no pleasure in saying this.

  • rate this

    Comment number 203.

    This should be the end of the idea that the best way to run a hospital is as a foundation trust. Stafford.s top priority was to become a trust and its managers forgot about patients. Trusts mean lots of jobs for managers, lots of duplication in administration, and they are the first step to privatisation. This scandal happened under Labour, shame on them for destroying the service they created.

  • rate this

    Comment number 202.

    I am a medical secretary - what I do not understand is: I open a letter of referral, I pass it to my consultant, he tells me what he needs for the clinic visit, and when to make the appointment. It is as simple as that. But.... it is not. There are targets, pressure from managers regarding costs, and adequate staff. How can something so simple be so

  • rate this

    Comment number 201.

    The public need to make it clear that they expect compassion and care and dignity as well as the clinical things - medications, observations etc. - that this is as important to them as everything else and they expect there to be staff who will care for them this way - and they expect there to be ENOUGH staff to enable these things to happen. Our taxes pay for the NHS - let's take ownership of it!


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