The NHS could do better

Abstract

The National Health Service (NHS), mostly free at the point of need, is greatly valued by the UK population and is admired in many other countries. Lengths of stay in NHS hospitals have fallen and outcomes have markedly improved, even though there are fewer hospital beds, doctors, nurses and funding than in comparable countries. The continuing triumphs of the NHS should certainly be recognised. However, the gigantic machinery of the NHS is out of control, and the good intentions of Government and management to maintain quality of care and contain costs have failed. Thus, it continues to stagger from crisis to crisis. Advances in medicine and the increasingly elderly population make it likely that the financial demands will always exceed the available funding and so compromises will be needed. When the NHS cannot afford a service, then patients and the health professions, as well as management and Government, must all be involved.We make a number of suggestions to improve the NHS, which together could improve patient care, often at less cost, improve management and raise professional staff morale without any major new legislation. To put patients firstThe primary focus of the NHS is to serve patients in need. Thus, the mutually trusting relationship between the patient and doctor becomes critical. 1 Continuity of care should be a smooth pathway for patients between primary, secondary and tertiary services, but many complain of disjointed care between hospital, community and primary care. 2 Integration would also allow general practitioners (GPs) and hospital consultants together to improve transfers of care, exchange information and postgraduate experience and provide supervised experience for those in training.Patients want early diagnosis and referral for treatment, which can save short-and medium-term costs. 3 Often, specialised clinical experience and diagnostic facilities can only be organised cost-effectively in hospital centres. Current misguided attempts to save costs through limiting the number of referrals from primary to secondary care are fruitless and morally wrong. GPs should be facilitators rather than gatekeepers for access to secondary care.A serious and unresolved problem is the tight restriction on the working hours and rotas of trainee doctors imposed by European law 4 and by the socalled New Deal contract negotiated with the British Medical Association. 5 Clearly, tired doctors should not work excessive hours, but the restrictions have forced 'shift work', which damages the continuity of acute care. 4 Patients also recognise many distressing examples of poor care in both primary and hospital settings, many due to multiple failures of systems, equipment and staffing, rather than to a single individual. A more open culture of recording and learning from errors would help.Successive governments have been frustrated because they have little influence on what goes on in the workplace. Therefore, they fall back on unhelpful public criticism of the overworked professional staff, rather than partnerin...

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