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 340.

    Time was not so very long ago when you heard that a friend or relative were going into hospital you would say that "it was the best place for them".

    Now, who knows?

  • rate this

    Comment number 339.

    Tax is indeed theft -- faceless bullies demand some esoterically-determined sum with the threat of destroying you. The bullies then spend it on their schemes and their pals.

    The NHS is excellent though underfunded. Wouldn't you rather the money stolen from you were spent on hospitals and not, say, zillion-pound submarines? You weren't consulted. Therein lies the problem.

  • rate this

    Comment number 338.

    Zero tolerance for A & E departments with unsafe staffing levels? What happens to them all? Do any A & E departments enjoy staffing levels meeting the College of Emergency Medicine standards? Do all which don't, close? Then what? 'Zero tolerance' is a hackneyed phrase which must be accompanies by a description of the alternative to whatever is not tolerable.

  • rate this

    Comment number 337.

    What happened in Stafford Hospital was appalling, unforgivable and those at the very top should face the consequences.
    But the NHS is no longer National - and around the rest of the country are some superb Trusts, most NHS staff are very dedicated, and the vast majority of patients are both medically treated and treated well.
    Stop bashing the rest of the NHS over these dreadful events in Staffs.

  • rate this

    Comment number 336.

    A health service is not a business. 34 years of imposing business models on hospitals and primary care has led us here. 34 years of denigrating public services. 34 years of Austrian economists' nonsense setting govt. policy all over the western world. 34 years of demonising nurses, teachers, social workers, prion officers, police officers, 34 years of stagnant wages while the financiers laugh.


Comments 5 of 340


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