We have had worrying items in the news about the state of the NHS. A hospital in Lincolnshire had to suspend A&E at night, and in the North East we have had warnings about a shortage of GPs.

So what is going on? Let us look at the facts. We all know the population is ageing, and older people tend the use the NHS and social care more than younger ones. New technologies are also more expensive, although they often result in better outcomes. The NHS needs an increase in real terms funding every year simply to stay where it is. Health and Social Care are closely linked, because if people can be properly looked after in the community then this takes pressure off hospitals, and frail elderly people can be discharged without the worries that they will not be cared for properly and have to return to hospital. Proper social care arrangements reduce the pressure on hospitals.

Before 2010, successive governments had increased spending on the NHS every year by an average of 4%. Since then this has averaged less than 1%. At the same time there is a shortage of trained staff. Many GPs are reaching retirement age and there are not enough candidates to replace them. There is also a shortage of nurses, and hospitals are having to recruit expensive agency staff to maintain the necessary staffing levels. That is why hospitals are frequently running up deficits. It is easy to find scapegoats for this situation. This and previous governments may not have trained enough professionals, but “we are where we are”, to quote a phrase.

Even without these financial pressures the NHS has been looking at ways it can deliver better services for patients in a more efficient way. The term for this is “transformation”. Put briefly it means aiming to provide as much care as near home as possible. Hospital visits should only happen when necessary, and those who need long term care and support should receive it in the community. This means closer working between the NHS and social care, and more care in the hands of GPs working with other professionals in the community. This sort of arrangement is sometimes described as a “hub”. Although patients spend far more time with GPs than they do in hospital, the amount of NHS funding (about 10%) going to GPs is far less than that going to hospital care.

The NHS is currently looking at hospital provision across the North East and how to use it more effectively. The North East has more hospitals per head than most other parts of the country (and some of the best as well), but it is simply not practical to expect each hospital to provide a full range of specialisms. There simply are not enough specialists, and in any case it is far better for professionals to work together to learn from each other and maintain their skills than in isolation. The reason, incidentally that some services have been withdrawn and A&E provision concentrated on fewer hospitals is usually because there are not enough specialists available to staff a unit safely. There is no secret conspiracy to close things. In my experience the NHS has kept facilities open as long as it can.

So what is to be done? The NHS is trying to be open about the situation and is planning a massive engagement exercise in which I hope as many of you as possible will participate . But I do not think we can escape the fact that transforming services and training more professionals will cost money. It is no good politicians coming up with clever wheezes to find some money this year or next year. What is needed is a sustainable long term way of funding the NHS, a system which makes sure that the money needed continues to be available, and we cannot escape the fact that we will all have to pay more one way or another. It is no good thinking someone else will. The NHS belongs to all of us, and we all need to be part of the solution. That is what the debate should be about.

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  1. Irwin says:

    Excellent summary.
    Two comments. There can be no NHS solution any more – has to be for a care system not just NHS. And just more money in itself is problematic in the short term as it is not clear how it would be spent – there are not lots of extra doctors, nurses and other staff available to employ and workforce is the key.

  2. Alan Rogers says:

    The article applies to the NHS England. There are some generic problems shared by England and Wales (eg aging population, recent lack of trained doctors and nurses). We share the recent financial restriction since overall budget for NHS Wales is determined by Westminster funding levels. But more effort has been made here to reinforce social care and a major administrative reorganisation in 2008 make adaptation much easier. Relations with staff, particularly junior doctors, is better by far. Hopefully more junior doctors will wish to work in Wales under the existing contract rather than the one which will be forced upon them in England by the Tories.
    Don’t believe the Daily Mail lies I have recently beet treated by the NHS Wales the service was superb. However I still think that spending £1.3 million of NHS Wales budget (over £20 million in England) each and every year on religious care (hospital chaplains) is utterly unjustified and this service should be run by the NHS but funded by charitable trust.

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