Kavan Jhaveri’s Post

Lord Darzi's report is out, here are my observations and comments on the document... 🔘 The NHS is facing serious challenges, with significant public dissatisfaction, high waiting times, and overstretched staff. Public satisfaction is at its lowest level since 2009. 🔘 Life expectancy in the UK has plateaued and even decreased during the pandemic. The burden of long-term health conditions and mental health issues, particularly among children and young people, has increased. 🔘 Patients face significant delays accessing GP, community, and mental health services. Over 1 million people are waiting for community services, and long waits for mental health services are normal, particularly for children. 🔘 A&E departments are under immense pressure, with significantly longer waiting times and a reported 14,000 excess deaths annually attributed to delays in emergency care. 🔘 Despite a rise in hospital staff numbers, the productivity of the NHS workforce has declined. There is a critical shortage of GPs and community care staff, especially in deprived areas. 🔘 The NHS budget is disproportionately spent on hospitals rather than community services, with rising demand for hospital services caused by underinvestment in community care. 🔘 The NHS is behind in capital investment and technology. The lack of modern diagnostic equipment, out-of-date facilities, and inadequate digital infrastructure has hampered efficiency. Potential changes? 🔘 Structural changes are needed in the way NHS funding is allocated, with a significant push toward integrated care systems that focus on prevention and community-based services. 🔘 More staff engagement, improved workforce management, and targeted recruitment in under-doctored areas are critical. 🔘 A renewed focus on capital investment in NHS facilities and equipment is needed to address the £11.6 billion backlog in maintenance and provide modern infrastructure. 🔘 Introduce new performance management frameworks that incentivize innovation, collaboration, and improved service delivery. The Private Sector.. 🔘 The NHS has increasingly relied on private insourcing and outsourcing to address long waiting lists for surgeries and other procedures. Insourcing companies have provided services at lower costs (20-30% below the national tariff). 🔘 There is a recognition that the private sector can help alleviate pressures on the NHS by handling elective procedures. Private insourcing providers have been able to mobilise quickly to reduce waiting times, but there are concerns about the long-term sustainability and equity of this approach. 🔘 Although patients in the NHS technically have the right to choose their healthcare provider, including private sector options, this is not consistently offered or communicated to them. ________________________________________________________ Rinnova is pioneering excellence in advisor-driven recruitment www.rinnova.co.uk

Scotland's NHS cannot meet growing demand, warns watchdog https://lnkd.in/ehY_2WJE Stephen Boyle Audit Scotland "annual report ... NHS ... facing soaring costs, patients were waiting longer to be seen and there were not enough staff." "financial pressures on the NHS and, without reform, its longer-term affordability". "Without change, there is a risk Scotland's NHS will take up an ever-growing chunk of the Scottish budget. And that means less money for other vital public services." "investment in measures that address the causes of ill-health, reducing long-term demand on the NHS." Problems include delayed discharge, ambulance crews waiting at hospitals and patient safety. Another story that shows why #prevention and #proactive #services are so important. We have got to identify those who need help and support them before their health suffers and problems are hard, and expensive to treat. It is about #structures and #situations and #behaviours and needs #lifestyle change and #regulation. We know what needs to happen #eatwell #exercise #sleep #mindsets #mindfulness and issues with #vapes #alcohol #tobacco #ultraprocessedfoods and more, But we need to turn knowledge into action. Behaviour change can seem very cheap, we just do something different, but, it often does not happen on its own, it can be hard, need to be initiated, and supported, and that means investment. People need the right help from online support and apps, through groups., to 1:1 support . We need to invest in these services to reduce demand and save at the frontline. We need to change the culture and quickly because increased public spending by any party seems unlikely. And if we can’t spend and tax our way out of this we need behaviour change and regulation of health harms to tackle the causes of ill-health to reduce demand. And, as for structural change, it takes time.... This is not just about the NHS, #proactive services and #prevention is needed across #publicservices with problems costing individuals #society and #taxpayers. The good news is that there are a lot of free resources out there to help people make positive changes. We can use them to build personalised digital support and dashboards to help people thrive. And there are models to identify and help vulnerable people, connecting them with the public, private and voluntary, services, groups and 1:1 support that they need. See the SAVVI process #vulnerability https://lnkd.in/eRSJpCSC and my rough attempt at collating resources for wellbeing and thriving https://lnkd.in/e7vA6Ep2 Shelley Heckman Andrew Humphreys iNetwork Paul Wright - FFPH - FRSPH Andy Milne Tom Morton Ivan Beckley, MD Micha Kämpfer Ashleigh Henderson Felicia Szloboda Audrey Michie, FIPM Gregor Smith Karen Duffy Geoff Huggins Suraj Kika Kate Smethills Nick McCarthy Brian McNicoll Kirsteen Donachie Ben Jones Andrew Howe Cornilius Chikwama

 “The 2010s were a lost decade for our NHS… which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.” These are the words the Prime Minister used following the release of the Darzi NHS report. In it, Lord Darzi has pulled back the curtain on failing services, which he has suggested are as a result of funding shortages that have left hospitals with failing infrastructure, and outdated equipment, but has also spoken about the impact of reduced productivity. Hospital staffing increased by 17% between 2019 and 2023, he reported, yet he also noted that there was no comparable uplift in appointments, operations, or procedures. Both Lord Darzi, and Sir Keir Starmer agree that the NHS is spending in the wrong places, and that there needs to be a shift of care away from hospitals and into communities. But there is a problem here that neither addressed. To create this 'neighbourhood care', funding will need to be moved from Secondary Care and into Primary and Community Care. But while this process is being developed, existing care networks within hospitals will still need to be funded, creating a requirement for 'double funding' at least on a temporary basis. Prime Minister, Sir Keir Starmer, has stated no more funding without reforming, so once again it appears that fixing the NHS has reached an impasse over how to fund it. #nhs #darzi #funding #sirkierstarmer #efficiency #communitycare #hospitals #primarycare #productivity #nursing #doctors #generalpractice https://lnkd.in/e6wTREvS

NHS Leaders Facing “Drastic Measures” To Make Ends Meet Health leaders in England are calling on the next government to protect local NHS organisations from having to further cut staffing levels to make ends meet at a time when the needs of their patients are so high. In a survey of NHS leaders across trusts, integrated care boards (ICBs) and primary care in England, some local NHS organisations are already cutting or freezing posts to balance their books. They fear local services are trapped in a cycle of short-termism where immediate cuts to meet financial targets are having to be prioritised over long term plans to improve and transform local services. The survey was carried out during late April and early May – a time when the NHS has been coming to terms with the “flat” revenue settlement set in the Spring Budget. The NHS has been set an annual efficiency target of 2.2%, despite many organisations starting the financial year in a worse underlying state due to industrial action and other cost pressures. As the NHS Confederation survey shows, many local NHS organisations are facing much higher efficiency targets that will impact on their staffing levels. The rate of NHS productivity growth has averaged 0.9 per cent over the past 25 years, with the NHS often delivering higher productivity improvements than the wider economy. However, the NHS leaders responding to the survey said that they need, on average, to make efficiency savings of 6% in 2024/25, with local services facing targets ranging from 1.6% all the way up to 11%. Recently, the Institute for Fiscal Studies found that real-terms spending on the NHS had risen less quickly than was pledged at the last general election five years ago. This squeeze on NHS spending is likely to be compounded by the main political parties committing this week to no further tax increases, which the IFS say will further constrain spending on public services. In response to this, some health leaders are having to take “drastic measures” to balance the books, with cuts to agency spending, freezing vacancies and cuts to clinical and managerial and administrative staff the most effected. This is to cover what is estimated to be a larger projected deficit in the financial plans of local integrated care systems (ICS) than has been seen in recent years. This could lead to further cuts to capital and other budgets. Cuts to staff come at a time when the latest data shows there are over 100,000 vacancies across the NHS in England, including nearly 9,000 medical posts. This short-term risk to freeze or cut posts could be seen to go against the NHS Long Term Workforce Plan’s commitment to grow the NHS’s headcount so that it can meet the needs of patients and respond to rising demand. The main political parties appear to agree that the NHS must grow its workforce, yet without appropriate levels of funding locally that are matched to the efficiency asks of the NHS, many health leaders feel as though they have no…

Just what is needed : 😖 NHS Funding Set to Dip in Coming Year, Ella Pickover, Press Association | 19 March 2024 The funding pot for the NHS in England is set to “decrease” in the next financial year, leading health commentators have warned. The Health Foundation said the budget for the health service – £164 billion – remains “flat”, but when changes to the population and inflation are taken into account it will be 1% lower in 2024/25 compared with the previous year. New analysis by the think tank also suggests the overall Department of Health and Social Care budget – £192 billion for 2024/25 – equates to an increase of 0.6% in real terms compared with 2023/24 and a real-terms reduction in funding compared with 2022/23. The analysis also suggests that other spending by the Department, including money for healthcare staff education and training and the public health grant, is due to face a 4.7% real-terms funding cut in 2024/25 compared with 2023/24. Hannah Rose Douglas, deputy director for the The Health Foundation’s Real (Research and Economic Analysis for the Long term) Centre, said: “While the additional funding for the #nhs in the recent spring Budget is welcome, when the impact of a growing and ageing population as well as inflation is taken into account, the value of the NHS England’s spending pot will decrease in value by 1% in 2024/25, compared to the previous year. “This underlines the challenges for the NHS to improve care when faced with these ongoing funding and demand pressures. “The Government’s plans to increase capital spending to boost NHS technology is a welcome and significant investment, although it won’t kick in until 2025/26, after the general election. “There is a long history of promises to spend more on NHS capital and technology, with budgets too often raided to pay for short-term pressures, so it’s essential that this money is spent as intended.” Commenting on the analysis, Patricia Marquis, director for England at the Royal College of Nursing - Company, said: “NHS budgets must take account of our ageing population and increasing demand. Failing to do so means stealth cuts for the NHS, which could have profound consequences for patient care. “At a time when there are chronic staff shortages, applications to nursing courses are collapsing, and long waits for treatment have become normalised, this choice to under-invest in the NHS cannot be justified. “This latest analysis comes as reports say local NHS trusts are under pressure to cut staffing numbers to make this year’s budget add up. Cutting NHS budgets, especially on education and training, will push more nursing staff out of the health service and have an impact on the quality of care. “The NHS is in crisis and deserves better than a Government sitting on its hands. The Health Secretary must urgently address why nursing staff should accept being asked to do more with less yet again.”. #nursing #nurses

Let’s get this straight: private healthcare will and must work for the NHS – not the other way around 🙃 “We learned our lesson last time.” Streeting has red lines: - no contract with any private hospitals poaching NHS staff, a tall order since only the NHS trains staff; intensive care beds for difficult cases - no more cherrypicking the easy ones - any deal must be value for money, which they say “it wasn’t in Covid”. - most private hospitals are in affluent areas: they must treat those in hard-pressed places - while the NHS still has capacity to do more if it gets more money, private care would only be short term in some places There are myriad issues here, not least that locking into long hospital contracts defies Streeting’s plan to shift patients out of beds and into the community. #heathcare #healthpolicy #workforce #publicprivatepartnerships https://lnkd.in/dav2Yhrh

It won’t be quick, but we are ready to work with the new government to ‘fix’ broken healthcare system. This is the response from The Royal College of Emergency Medicine (RCEM) as the new Labour government announces an ‘independent investigation’ into NHS performance. 🌐 Read the full story with all the links including to graphs and data here: tinyurl.com/RCEMNews117 In his first speech as Health and Social Care Secretary on Saturday (6 July 2024), Wes Streeting described the NHS as “broken” and has since set his aim of boosting economic growth from within the sector and improving access to primary care such as GPs. RCEM has today (Thursday 11 July 2024) pledged its support to the new government’s aim of ‘fixing’ the NHS but have warned that “efforts must be targeted to where they are most needed.” New data released by NHS England today (Thursday 11 July 2024), shows the scale of the task ahead, with almost one in 10 people waiting 12 hours or longer in A&Es in June. The data also shows in this period hospitals were 93.1% full, far above the level considered “safe” (85%). Difficulties discharging people due to a lack of appropriate social care options also meant a daily average of 21,976 people remained in hospital despite being well enough to go home. The effects of this backlog can also be seen in the ambulance service. Yesterday (July 10 2024), the Association of Ambulance Chief Executives (AACE) estimated that more than 32,000 people may have come to harm due to extended ambulance handover delays in May 2024 alone. Dr Ian Higginson, Vice President of RCEM said: “The Health Secretary was right, the NHS is broken, and the effects are seen nowhere more starkly than in Emergency Departments. RCEM has been clearly articulating the real picture for years, and it is refreshing to see a pragmatic and honest assessment of where we are and the scale of the challenge. “We are ready to work with the new government and we can help provide solutions. Those working on the front line, and those with expertise in the field, understand what is needed to restore NHS performance and the public’s trust in the health care system. “For this reason, we welcome today’s announcement for an independent review of NHS performance, it is a step forward for transparency and we will contribute in any way we can. “The Health Secretary has pledged to fix ‘the front door’ – improving access to GPs, and any improvements in community-based care is positive. “However, it is only part of the answer to improving patient care as a whole. The Emergency Care system continues to be under huge pressure as is clearly evidenced by the latest performance data. To make a significant improvement bed capacity needs to increase, and the beds that we do have need to be used more effectively. People need to be able to leave hospital as soon as they are well enough and... (continued) 🌐 Read the full story with all the links including to graphs and data here: tinyurl.com/RCEMNews117

I’m just a nursing student, but am I missing something ❓Keir Starmer’s claim that NHS agency staff are being paid £5,000 per shift seems a bit exaggerated 🤨Yes, agency workers cost more, but that's because there’s a severe shortage of permanent staff, not due to poor management. Criticising the NHS for using agency staff while ignoring the staffing crisis isn’t fair. As for the idea that the NHS won’t get more funding without reform - come on❕ The system is already underfunded and overstretched, so more money is desperately needed. Sure, funding alone won’t solve everything, but we need real solutions, like free nursing and other healthcare staff training, better working conditions, and ways to retain staff long-term. Blaming NHS staff and the system misses the point 🙄 We need both proper funding and reforms, not just more pressure on an already struggling system. #NHS #HealthcareCrisis #NHSFunding #SupportOurNHS #HealthcareReform #NHSStaff #NHSSupport #StudentNurse Keir Starmer #LabourParty https://lnkd.in/eFJzV3g6

Why have plans to reform the NHS consistently failed? There have been many attempts to reform the NHS in recent years. All have failed to achieve their goals. Why is that? How do we escape the mistakes of the past? All the solutions proposed by Lord Darzi's report into the NHS have been in previous plans. Indeed prevention has been a priority of NHS in every plan since the 1960's. Even the report itself frequently refers to previous plans not being acted on and delivered. But why did the previous plans fail? Well the details may be different, but they all shared the same overriding problem. The thinking didn’t change. To change not only do we have to do things differently, we have to think differently. If a plan is created by a minority of people at the top of a system. Then it can’t be surprising when everyone else has to implement it, they stick to what they know. Without changing our thinking, we are all biased when given a choice, to go to the certainty of the comfortable & familiar. We do this rather risk the uncertainty of change. This is why in reorganisations the NHS leaders may change job titles and sometimes even organisations. But fundamentally it is all the same people thinking & doing things in the same old ways. Even if enormous resources were put into the upcoming reorganisation, the same thinking will mean that the old system will reinvent itself, decision by decision. When the local integrated systems were established, they were told to share budgets and invest on shared work on local problems over several years. Instead they divided money into the same 1 year budgets as before. So we need to change our thinking. Sadly I’ve been struck by the absence of the necessary debate after Lord Darzis damning report: We need to be asking what is the NHS for!? What kind of healthcare do we want? What do we need the NHS to stop doing? What role does wider society have in improving health and wellbeing? Instead of discussion, too much focus has been attributed to not enough resources and magical thinking about the potential of technology. As Darzis report also points out what little new resources that have gone into the NHS have been put into hospitals rather than communities, treatment rather prevention. Directly conflicting with the stated aims of NHS planners. If we don't have the hard conversations about why the preceding plans have failed, we simply doom ourselves to repeat the thinking that has created today’s current situation. We need to have discussion and debate around the NHS. To make sense of the current systems. Challenge our assumptions. Create new ways to do things better. The health and wellbeing of society is everyone's problem and it affects us all. But as Lord Darzi's report makes clear, everything is going in the wrong direction. What do you think we should be discussing to make things better? What fresh thinking do we need? #nhs #changemanagement #decisionmaking #leadership #innovation

Last week LinkedIn told me that I have been a consultant at the Whittington Hospital for 17 years. Having qualified from medical school in 1993 that means I have worked in the NHS for 31 years. After all that time, I still love being a hospital doctor- it’s a label that I wear with pride and that's why I find the present state of the NHS so worrying. But what is the current situation? Good, reliable statistics detailing hospital activity are pretty flaky. Government spending rhetoric is at odds with what we see on the shop floor. Where does all that extra spending go? I have no idea, probably filling debt holes and propping up crumbling buildings. There don’t seem to be more staff involved in patient care, waiting lists are growing and staff morale is very poor. This is all happening on a background of massive spending on software, management consultants and the loss of low-paid, but enormously helpful, support staff like secretaries. Why is it happening? Hospitals and the NHS were never designed to deal with current demands. The NHS is great at dealing with sick people. It’s fantastic in an emergency. However, it was not designed to provide a 360 degree care package for the entire population. So, it’s not surprising that the NHS is struggling.  It’s not only doing what it was intended to do, but it’s also now taking on so much more. Maybe it’s a scale and size thing. I have read that the NHS is the world’s sixth largest employer - behind the People's Liberation Army of China, Walmart and Amazon. I see so many burnt-out clinical staff whose efforts are lost in the enormity of the system, but there are great examples of how small, focused groups with motivated clinicians supported by efficient operational staffing can achieve amazing things. That’s how the NHS got our country through COVID. There are no easy answers to fix the NHS, but we owe it to our future selves to move forward. We need to return to the optimism and hope that used to underpin the NHS. What can you do to help? Society, health, and the NHS are inextricably linked, but we can only control the small things that will hopefully snowball into real changes. ☑ Take care of your own health and encourage others to do so ☑ Support local services ☑ Teach and encourage health at home ☑ Health education and support in the workplace (Fertifa) Elections allow us to hold our government to account, and without social care improvement, the NHS will continue to struggle. So please exercise your privilege to vote this week and let our leaders know what you think can be done 🗳