Our Future Health: the future of healthcare

In the year that sees the 500th anniversary of the RCP and 70 years of the NHS, the college is launching a new programme of work. Our Future Health is designed to explore the challenges and dilemmas frequently faced by physicians in clinical practice, and how these are affected by the system we work in. Clinical fellow Dr Sarah-Jane Bailey explains.

It seems timely not only to celebrate the great achievements of the NHS, but to face up to these challenges, and have some difficult conversations about the underperformance of many systems we have in place. Underfunded, underdoctored and overstretched1, is the NHS still workable – and how can we get the best from it?

The NHS was originally underpinned by three core principles: to meet the needs of everyone, be free at the point of delivery and to be based on clinical need, not ability to pay. In 2012 the NHS Constitution for England set out seven key principles to guide the NHS in everything it does:

  1. The NHS provides a comprehensive service, available to all.
  2. Access to NHS services is based on clinical need, not an individual’s ability to pay.
  3. The NHS aspires to the highest standards of excellence and professionalism.
  4. The patient will be at the heart of everything the NHS does.
  5. The NHS works across organizational boundaries.
  6. The NHS is committed to providing best value for taxpayers’ money.
  7. The NHS is accountable to the public, communities and patients that it serves.2

But since 1948, the political, social and medical landscape has changed. If the NHS in its current form is unable to meet these standards, is it still fit for purpose? Two immediate solutions present themselves: does the NHS need to radically change or is it time to re-evaluate which of these principles are still a priority?

Recurrent restructuring and use as a political football has prevented long-term, cross-party planning since its inception. Sitting separate from both public health and social care, it is no wonder that current services are reactive and focused on acute secondary care that may not be appropriate in a number of cases. How can we flip the system and put the patient, local communities and preventative medicine at the heart of a truly National Health Service?

With an ageing population, the increasing cost of novel treatments and chronic real-time underfunding of health and social care, we are struggling to cope. The RCP wants to begin an honest discussion about what we can do, where we should allocate our clinical resources, what we should expect from the future, and where we should spend our money. Over the course of the year, we’ll start addressing these dilemmas faced by physicians on a regular basis in areas of innovation, clinical resources, investment, education and practice. Here are just a few examples of some of the debates we’re hoping to spark with Our Future Health:

What would you prioritise if you had £1 million to spend on your local NHS?

With many hospitals running at untenable levels of bed occupancy for large proportions of the year, patient flow has ground to a halt and emergency departments are failing to meet 4-hour targets. With political and media pressure focusing on the perennial winter, not to mention the risks to patient care, is your £1 million best served addressing the front door? We have all seen the problems at the back door with elderly patients deconditioning in hospital beds and delayed discharges due to a lack of carers, care home beds and support services in the community. Is the money better spent here? Or do we need to spend your £1 million on preventing patients needing admission in the first place? Integrated teams of health professionals working across primary and secondary care can facilitate keeping people with chronic conditions healthier and at home. The RCP will address balancing the urgent financial needs of today with what is best in the long-term.

How can we justify the paradox that in the last year of life, many elderly patients undergo multiple tests, procedures and acute admissions only to die in hospital?

Many of us will have seen the frail, bedbound nursing home resident admitted acutely for a non-specific deterioration and wondered whether this was due to poor community provision, lack of advance care planning or a real clinical need. We share concerns this is not in the patient’s best interests or a good use of resources and is likely to be futile in altering prognosis. One size will not fit all so person centred care and good communication is crucial here. The RCP is committed to an open discussion with the public about their priorities at the end of life, what medicine can realistically achieve, and how this affects our decisions to resource our health care system.

When everyday clinicians are running in order to just stand still, how can we harness their experience and expertise to promote useful research, innovation and digitalisation of the NHS?

 At a time of crisis more than ever, research and innovation is essential to transform services and increase efficiency. Not only do shop floor NHS employees have an unparalleled knowledge of the inner workings of the system but, as a collective, they have an abundance of qualifications and skills. The RCP wants to support clinicians to balance time for innovation with the competing demands of unfilled rotas and service provision.

Our Future Health will lead the debate on these issues, and other dilemmas faced by doctors, patients and the NHS. Through a campaign of online opportunities, podcasts, articles and face-to-face events, we will create a forum for doctors, stakeholders and the public to share views and best practice to identify pragmatic, relevant and achievable solutions. We look forward to engaging you in ths conversation, which will shape the

direction of future RCP policy. To get involved, share your thoughts and opinions by emailing ourfuturehealth@rcplondon.ac.uk.

References

1 Royal College of Physicians. Underfunded, underdoctored, overstretched: The NHS in 2016: London, 2016.

2 Department of Health. Guidance: The NHS Constitution for England. London: DH, 2015.