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Hopes and Fears: The Lord Darzi Review of the NHS

Read what our Healthcare System Council has to say on this hot topic…

Following our successful inaugural fireside chat in the summer, Vision4Health’s Healthcare System Council met again on 8th October to discuss another hot topic. There has been lots of chatter and speculation following Lord Darzi’s Independent Investigation into the NHS in England, but we wanted to ask healthcare system stakeholders working at the NHS coal face what this means in reality – what are their big hopes and fears? And how will these be reflected in the 10-year plan, due to come out soon with an expected focus on analogue to digital; acute to community; and reactive care to proactive care.

The Healthcare System Council panellists on this occasion included a:

  1. GP Partner/PCN Clinical Director/GP Federation Founder and Director/ICS Place Deputy Clinical Director
  2. Digital and Informatics Specialist Pharmacist
  3. Oral and Maxillofacial Surgeon & Head and Neck Surgeon/National Clinical Lead GIRFT Head and Neck Cancer Programme/Divisional Medical Director

The overarching message is that no matter where an NHS stakeholder sits within the system, they all want to achieve the same outcome of system integration. However, their hopes and fears very much reflect where they work. For example, those in Acute Trusts have hopes and fears around performance measures and digital interconnectivity, while those in primary care have a focus on capability and capacity to achieve the shift away from acute centered care.

Ardent Hopes

There is an appetite to support a prevention agenda. The community is keen to deliver against the broader productivity and PCN infrastructure, which will help achieve the neighbourhood NHS that Lord Darzi refers to in his report.

There is a lot of opportunity for ICSs to work at a system level. Secondary care hospitals are still working in isolation and there needs to be a switch from focusing on where the patient should be seen based on capacity and demand, to where is best for the patient.

Pressing Fears

Prevention is hard to do. ICSs are looking at the healthcare system through the lens of the hospital as their challenges are more acute and high profile. Prevention therefore becomes less of a focus. Added to that is the workforce/skill-mix challenge.

Balancing spend vs investment. A major financial challenge that healthcare system leaders face is how to balance spend/investment on conflicting priorities – the long-term ‘prevention vision’ for primary care versus addressing hospital waiting lists, backlog recovery, etc. In 22/23 the NHS budget was £180bn, with primary care getting 9.5% (down by 2% since 2015). There is less money coming into primary care despite the demand growing significantly, and more pumped into hospitals.

Poor interconnectivity within the NHS. Historically the NHS has operated in silos, and procurement of IT systems/products has not been streamlined to support communication between different organisations causing digital hindrance, not help, to clinical practice e.g. electronic prescribing system.

Politicising the 10-year plan. The NHS always have 10-year plans aligned to political parties, whereas it should be cross-party/apolitical. The system needs to be empowered and equipped to deliver on the upcoming plan, otherwise its aims will not be achieved within the timeframe.

Hopes Disguising Fears

The role of AI and robotic automation. The rapid technology evolution has the potential to transform how the NHS works e.g. AI in radiology has improved triage patients and improve the diagnostic pathway, especially in breast cancer. However, the system is struggling to keep up with the pace of change. Consideration for patient safety is imperative, which slows down adoption.

Let’s work with what we’ve got. The current ICS infrastructure may not be perfect, but another system reorganisation would be unwelcome. Systems would hope to be able to get on with transformation of services without the disruption caused by further reorganisation.

You can read our more in-depth analysis of Lord Darzi’s independent investigation into the NHS by visiting here.

What is a Visions4Health fireside chat and how can I participate?

First launched in the July 2024, Visions4Health will be hosting an ongoing series of virtual fireside chats – informal yet structured discussions between a Visions4Health moderator and specific healthcare system stakeholders that sit on Visions4Health’s Healthcare System Council. At each session, a ‘hot topic’ relevant to both the NHS and life sciences sector will be discussed under Chatham House rules. Selected industry attendees will have the opportunity to debate, question, challenge, ideate and gain real world advice and insight from those at the ‘coal face.’

If you would like to join future fireside chats, please complete the Contact Form on our website. Visit here to find out more about the Visions4Health Healthcare System Council.

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