THE FIVE STEPS TO LIFE SUPPORT AND
RADICAL changes are needed to save the NHS from a perpetual crisis, but a focus on five key areas would make it achievable, a consultant and adviser to NHS England says. Dr Andy Stein, author of a forthcoming book, Understanding the NHS, believes the fortunes of the health system could be turned around in five years if the political impetus is there.
But it would mean governments from all parties looking beyond their own term in office and at the greater good of the country, he said.
Dr Stein says measures like splitting elective and emergency care and seven-day working would have a huge effect on NHS performance and get rid of most waiting lists.
The social care system needs to be integrated with the NHS and the IT needs to be resolved, he says.
He also calls for a minister of public health, who would oversee provisions for any future pandemic.
Here Dr Stein outlines the moves he believes demonstrate that fixing the NHS needn’t be “a pipe dream”.
He explained: “As we move into a post-covid world and learn to live with the virus, we now have to deal with the almost six million on the waiting lists for operations.
“That is nearly 10 per cent of the population. We have to realise that we’ve had an imbalance and an over focus on one disease.
“We cannot go back to how we were. The system has passed its tipping point. When a complex system breaks down it is not fixable without slow radical change.
“People are already dying waiting for operations and hip replacements. This is happening because the waiting list is so massive.
“There are five things needed to flip it round but this could take around five years and each needs its own project. The tragedy of healthcare is that governments are generally not in long enough to fix recalcitrant problems of our time.
Also, successive ministers of health come into the role blind, with no experience of healthcare. It takes two years for them to know what to do, then they move on.
“The interesting thing is that all these things are fixable. This is not a pipe dream of unrealistic stuff.”
SPLIT EMERGENCY AND ELECTIVE CARE
Without doing this you cannot deal with waiting lists. Full stop. At the moment we mix hot and cold care, which is to say emergency surgery with surgery such as hip operations.
However, because there are not enough beds, we always prioritise the frail and most vulnerable as they are more likely to die. These emergencies come in and mean that elective surgery is cancelled.
But people can die waiting for hip operations and quality of life can be insufferable.
If a cancer operation is delayed for just one month, the patient may die much earlier than they would have done.
In a normal large hospital there are about 20 surgical and 10 orthopaedic emergency operations a day.
They may have 50 planned, with a heavy orthopaedic component as well. And many of these get cancelled.
Through Covid we learnt that private operators could carry out surgery near acute hospitals and we could do this again, so that you have elective surgery carried out in a different building.
We could also build two different buildings side-by-side, separated by a corridor but not wide enough for a trolley, so that emergencies could not supersede. Private operators are good at running such surgical treatment centres (or “hubs”).
SEVEN-DAY WORKING WEEK
I would run this together with point number one. I believe that 60 per cent and perhaps up to 80 per cent of NHS problems could be fixed by splitting emergency and elective care, and working seven days a week would save tens of thousands of lives per year.
Because of the lack of a split between emergency and elective care, and the lack of a seven-day working week, when emergencies come at the weekend we don’t discharge patients which clogs up beds in the surgical wards.
The proposed private sector’s surgical treatment centres would never compromise their beds for emergencies.