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 280.

    Having recently been an inmate of the NHS, I was impressed by the level of care given by the majority of staff... however a minority give the rest a bad name.
    The level of staffing was enough for the job too, except one thing
    It was usually 1 patient being difficult that would take all the time of the staff up, sometimes a patient who should not have been there at all

  • rate this

    Comment number 279.

    Has anyone thought of discussing ethics? It was once resisted by the medical profession, then they embraced it, but then came the bioethicists and health economists and issues were reduced to cost benefit assessments, and they tell us that it is ethics. Meanwhile, ethical arguments are dismissed as faith based dogma, whereas ethics - secular or faith based- ought to be at the centre of healthcare

  • rate this

    Comment number 278.

    The difference between private and public sectors is that private companies can hide their disasters from the public eye more easily for longer and then most go out of business eventually, so they rarely have to face the music. Just look at the banks, Railtrack, the energy companies, privatised water, G4S, A4E, to name but a few -
    shining examples of how to do it properly!

  • rate this

    Comment number 277.

    Got to laugh at the amount of nonsense being written about how nobody owes it to the rest of society to pay into the public sector. Without the public sector, there is nothing. No education, no healthcare, no bin-men, no police, no fire brigade, nothing. I'm no socialist but this ridiculous idea that anyone could ever get anywhere without the help of anyone else is a cancerous denial of logic.

  • rate this

    Comment number 276.

    Regarding the comment made by someone about nurses' 'pay rises' - our pay has been frozen for years. I saw a comment elsewhere about nurses 'constantly striking for pay increases'. UK nurses have never been out on strike. We actually voted not to as it's not possible without endangering patients' lives. Very few nurses go into it for the money - believe it or not most of us genuinely want to care!

  • rate this

    Comment number 275.

    I read saw and heard with sadness the videos, articles and reports that came out yesterday regarding the crisis in the health system.
    I have worked closely with adults over 65 in hospital, as a social worker, and for as long as I can remember, the biggest problem (for at least the last 7 years), has been and continues to be - 'a lack of nurses' on the wards. Employ more nurses!

  • rate this

    Comment number 274.

    Whitefall and all barking free marketeers.
    "I want to be able to opt-out of the NHS...There's nothing compassionate about stealing from people to fund a socialist program that a lot of people don't even want."

    God forbid you ever get caught in a car crash and an NHS paramedic walks up to save your life. I'm sure you'd happily refuse their help and wait for G4S to turn up instead.

  • rate this

    Comment number 273.

    TroutMaskReplica - do you want to return to the days of nurses simply following orders? We can now advocate effectively for our patients; modern nurses have saved lives by picking up on medical and other errors thanks to the academic part of our training. Give us enough staff to do so and we will gladly give compassionate care instead of rushing from one patient to the next like a production line.

  • rate this

    Comment number 272.

    @216 "Inflation busting pay rises" where can I have one please, "triple time holidays" I think not! You Sir are a troll.

  • rate this

    Comment number 271.

    Let's lay this rubbish about 'degree nurses' to rest. Degrees and 'caring' are NOT mutually exclusive. However, you can be the most caring nurse in the world and it still won't give you two pairs of hands and three more hours in a day when there just aren't enough staff. This anti-degree rhetoric is exactly that, a bandwagon jumped on by ignorant people who don't have a clue what they're on about.

  • rate this

    Comment number 270.

    This is just the tip of the iceberg. There are good and bad hospitals and I have been on both sides as a patient. As an allied health professional I also see some terrible instances of how the NHS helps people in the community. If I felt that by reporting these malpractices someone would take it seriously, I would. But unless you can complain to a truly independent authority, what is the point?

  • rate this

    Comment number 269.

    The NHS in the UK is Third World!!!

    Loads of the nurses barely speak English......a lot of them are lazy and don't do the tasks they dislike.....the consultants are as greedy as the bankers IMO.....half a million pounds a year salary??? Who are they trying to kid?

    It is disgusting. Greed is rife in the boardroom, care is poor, and value for money is NIL!!!

  • rate this

    Comment number 268.

    There are so many well thought through comments here but far too many stupid comments to respond to. However, "JPublic 38 Minutes ago" - It's not about money it's about COMPASSION - you can't pay for compassion or caring or commitment. Nurses don't become nurses just for money, they surely do so to help and to NURSE sick people.

  • rate this

    Comment number 267.

    Don't know enough, do we?
    Patients left untended while staff gossip - that's unacceptable and culpable.
    Patients left untended while staff run themselves ragged - that's unacceptable but understandable.
    Patients left untended because targets have have become a priority - that's unacceptable but a national responsibility.

  • rate this

    Comment number 266.

    I do wish that people would stop repeating the "big lie" of us having a "free market", when the truth is that we actually have a "mixed economy".

    If you're ignorant and don't know what the term is, then I suggest you go look it up, rather than continue to slander the free market for the crimes of the mixed economy.

  • rate this

    Comment number 265.

    Spent a lot of time over recent years at local nhs hospitals with my late wife, and the odd day procedure myself.
    There are some very dedicated and caring staff.
    Unfortunately there is also an apparent culture of processing self moving meat.
    It isn't a money issue, and targets are not the same thing as standards. It's not organisation.
    It's a people thing. The culture is wrong.

  • rate this

    Comment number 264.

    Yet again the slimy Teflon politicians wriggle out of responsibility. They invented the target-based system and put pressure on targets being met at all costs. Effective nursing is not measured in minutes per patient. Then when it hits the fan, it’s the management’s responsibility for “failure” when what they did was what they were told to do. Slow. Hand. Clap. Westminster

  • rate this

    Comment number 263.

    Whitefall: suppose you were knocked down by a hit and run driver, made quadraplegic, could not work and could not fund the healthcare costs of keeping you alive how would you survive in your "laissez faire" free market nirvana?

    You get something back for this "tyranny": it's there for you should you ever need it. Few of us have the sustainable resources to fund everything bad that might happen.

  • rate this

    Comment number 262.

    All services need to be updated, in order to survive. It's remarkable that the NHS still relies on paper files, in the age of computers.

  • rate this

    Comment number 261.


    The vast majority want things to change in the NHS. I am one of its supporters, I owe my life to it. But when you get comments about privatizing the NHS and the good doctors and nurses being called unionized scroungers who don't do a proper job. Then I feel it is my responsibility to fight your corner from which ever direction such scurrilous attacks may come from. I'm on your side.


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