Naomi Chambers and Ann Mahon discuss the challenges facing the NHS.
Healthcare is a labour-intensive enterprise requiring consistent development and, at times, transformation. Beyond any moral imperative, healthcare systems are essential to the effective functioning of society.
Health is wealth. If we were in any doubt before COVID-19 this is now an established truism. Across the globe, healthcare systems are facing many challenges and opportunities, many of which have been revealed, highlighted or amplified by the pandemic.
Some are depressingly familiar such as the challenges of working across boundaries and responding compassionately and in a timely manner to mental health problems. Others are exciting and full of hope such as the intelligent use of data to address inequalities, and promises associated with digital healthcare. And some are new such as how to manage the fallout from the pandemic, not least in terms of its impact on the workforce to deliver care.
Such global challenges apply more locally too, as reflected in the ten priorities for the English NHS in 2022/2023 which was recently published. These included:
- Workforce investment and strengthening the compassionate organisation culture needed to deliver outstanding care
- Responding to COVID-19
- Delivering significantly more planned investigations and operations to tackle the elective backlog
- Improving the responsiveness of urgent and emergency care and community care capacity
- Increasing timely access to primary care (including GP services)
- Maintaining continued growth in mental health investment to transform and expand community health services and improve access
- Using data and analytics to redesign care pathways and measure outcomes with a focus on improving access and health equity for underserved communities
- Achieving a core level of digitisation in every service across systems
- Returning to and improving on pre-pandemic levels of productivity
- Establishing integrated care boards with local authorities
Across the globe healthcare systems are facing many challenges and opportunities, many of which have been amplified by the pandemic.
What is the likelihood that any of these priorities will be met? What is the evidence from before the pandemic that any of these are realistic or that there is the political will to support implementation?
All these priorities are contingent on tackling the NHS workforce challenges. Namely, tackling staff shortages, burnout, low morale, defensive routines, the variable quality of leadership and management, and competition for workers between other service sectors and healthcare systems.
There were ominous signs well before COVID-19 struck of the pressures on the NHS. Targets for increasing the GP workforce weren’t being met (with actually fewer GPs in 2020 than there were in 2015), waiting times in A&E were growing, and social care was struggling to fill vacancies, exacerbated by Brexit.
Hospital bed occupancy was also too high with winter pressures becoming not just routine but all year round pressures. Behind all this were disappointing figures in comparison with our European neighbours in relation to hospital bed capacity and in terms of numbers of nurses and doctors in proportion to the population.
Many of these themes were explored in a book that I (Professor Chambers) co-authored last year. Organising care around patients: stories from the frontline of the NHS features true accounts of experiences of the NHS as narrated by carers, people with mental health difficulties, those suffering debilitating long-term conditions, and those difficulties associated with older age.
The book is a call to action for healthcare professionals, managers and politicians to reframe services to provide more patient-centred care, whilst also setting out a vision of a kinder and better organised post COVID-19 NHS.