The NHS is indeed broken
Dr Nadeem Moghal
Doctor - Passionate Pastist - CMIO - Director - Advisor - Coach - Mentor - Consigliere ??
Wes Streeting said what many know is true, but are unable to say because the NHS is at its core a national institution born out of politics, politically framed, and dogmatically constrained.
It is tragic to have to say, as a doctor, and a bit more, that I feel lucky to have had my cancer in 2016/17, when the NHS was still able to meet needs, albeit under considerable stress, and accepting my then privileged position, working in the NHS.
It is terrifying to admit that the NHS is broken. The staff know it. The patients live and die by it. The NHS buildings are filled with staff working hard, trying to meet needs, but also filled with harm.
Harm to patients with delayed cancer care, delayed elective care, and delayed urgent and emergency care. Delayed care is harm, and ultimately untimely deaths. Harm also to staff, where strikes are a symptom of that harm, and pay is just one of many workplace needs that need addressing.
Learning from the strikes
The essay attached describes the lessons that are staring us all in the face, but someone somewhere is not taking the courage to challenge how we are organised.
When the junior doctors go on strike, this is what happens:
1. Admission avoidance. Patients who would have been admitted, but should not, are not admitted - because senior experienced decision makers are in front of the patients making decisions. The consultants.
2.? Patient flow flows almost frictionless. In urgent and emergency spaces have almost empty waiting rooms, empty corridors, and no one waiting more than four hours - because senior experienced decision makers are in front of the patients making decisions. The consultants.
3. Wards empty. Patients aren't admitted (see point one), get discharged sooner, even allowing for a broken social care system - because senior experienced decision makers are in front of the patient making decisions. The consultants.
Urgent and emergency care spaces and wards become reliable systems. The patient sees the right person - the consultant, at the right time, in the right place for the right decisions, for the right care, getting the right experience (hopefully), and the right outcome.
Care becomes reliable. Quality care is an outcome of reliable care.
Safe high-quality care. Really?
The NHS speaks of safe high-quality care. The Care Quality Commission assess all this through its domains:
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During the strikes, with consultants directly in front of patients in the wards and urgent and emergency spaces, all the domains were met. Consultants worked as one team. Where are the inspectors, when you need them...
Don't let anyone - consultant, executive, NHS England - ever say we are serious about safe high quality care. How can they be if what they do after the junior doctor strikes, think it is ok to go back to being organised as we have been for the last 76 years?
Ask them. Why Why Why Why Why
The essay and this post do not disregard the junior doctor. They are the next generation of consultants. They deserve better training models that are not about being thrown into the deep end. The surgeons know this where the knife meets the skin; real apprentice learning rarely finds itself in all the other spaces and ologies. The first solution is not a new training model. It is more than just the training needs. It is about resource allocation based on a fit for now and the future business model.
No More More More
The W. Edwards Deming Institute: "Your system is perfectly designed to give you the results you're getting
The answer seems to be more money and more workforce. The answer is yes, because of the way the NHS is organised. The #workforce plan says we need an additional 1.3 million more staff, adding an additional ￡50bn annually to the NHS payroll. Really?
This assumes the now 76-year-old business model is fit for the rest of the century. Really?
Before we run to more money and more workforce, let us think about what the strikes reveal about the idea of how our resources are allocated. What is the business model, based on the evidence before us, that would and could meet patient and staff needs, fit for the rest of the century?
Dr Nadeem Moghal
7th July 2024
Note: Ai has no hand in any of the author's writing. Image creation - sometimes.
General Manager - Out of Hospital Services
1 个月Fabulous words Dr M. I am proud to be championing community services, admission avoidance and compassionate communities in my locality. Plus working with innovative brilliant folk (much like yourself!) to drive forward the future of the NHS. You gave me so much drive and passion from our somewhat challenging work together.....I shall keep on going until I see positive change!
Founder, Health Mutual / HEALTH FUND at Health Mutual
3 个月A very interesting article Dr Moghal – thank you. Whichever way the NHS is organised, the answer and indeed solution does involve money. It also involves properly funding and ‘fixing’ social care. I offer the integrated funding solution required to achieve this – a blended funding model, as variously operated in other countries with better funded, better resourced health and care services, that doesn’t involve raising taxes – a much-needed solution given the scale of the country’s financial challenges. Generating long-term, ring-fenced additional funding, enabling the NHS to remain free at the point of use, and establish a publicly owned, not-for-profit National Care Service, to finally ‘fix’ social care, is more than possible https://www.healthmutual.org/social-care To find out more about HEALTH FUND, a publicly owned, not-for-profit health top-up, please visit https://www.healthmutual.org/ where my contact details can be found. #ukhealthandcarefundingsolved #healthmutual #uksocialcarefundingfixed
Director & Owner-Manager @ MHW PR | PR and communications specialist
4 个月Interesting insight Dr Nadeem Moghal Perhaps focuoand, sensitive NHS reform has a chance of happening under a government that has more of a social and public minded agenda than the last ones we have endured. But Wes Streeting will inevitably face resistance…
Clinical Director at Abingdon and District Primary Care Network
4 个月Agree- initial diagnostic decision done by most experienced clinician ensures patient on correct pathway first This result is huge reduction in resource consumption.
Advisory | Health & Public Sector | Strasys CSSO
4 个月A brilliant piece Dr Nadeem Moghal. Provocative (in a positive way) and thoughtful as ever.