|
London's Cavendish Square is a complex contradiction.
Its elegant, mature Plane trees reach for the sky. In the summer, workers from the nearby offices take breaks, in their cool shade. In the autumn, a blaze of colour, where lovers tryst in dappled sunshine.
On the southern side, John Lewis the middle-class Mecca for stylish living. Napkin rings and satin sheets.
In the square, homeless people collapse on the benches, dissolving their troubles in beer-can oblivion.
To the west, the opulent HQ of the RCN with its hidden trompe-l’œil staircase. Deep inside, innovative architecture that creates shafts of unexpected light and the biggest library of nurse education in the world.
To the north, we are reminded of No11’s history as a convent, by the Madonna and Child statue, hovering over the entrance arch.
Whenever I pass beneath it I feel the urge to shine my shoes and scrub-up. It’s the King’s Fund.
Last Thursday Lord Darzi published his list of NHS omissions and shortcomings and the King’s Fund elite swooned…
… the Prime Minister turned up at their conference.
They were too polite to tell him his speech was folderol. Alliteration is not policy and similes are not strategy… however florid.
A service in crisis. Waiting numbers the size of the entire population of Baghdad… all we’ve got is Streeting’s, ‘let’s all do a bit of overtime’, wheeze.
This was a bank-manager speech; ‘No more overdraft unless you reform your life-style, my boy’… no more NHS funding unless you do things differently. As the NHS is unable to reform itself, it’s meaningless.
He trotted out the tropes; moving stuff out of hospital and stopping people getting sick in the first place. No thought as to why, in 76 years the NHS hasn’t already done it.
What can we safely move out of hospital? Three things, tests, treatments and diagnostics.
Near patient blood-testing is a real thing. The kit is fairly cheap… the reagents aren’t.
Workaround? Tricky...
... not, by issuing an FP10 for the juice, turning it into a prescription, like a pregnancy test, because the patient cannot ‘own the item’… it’ll involve money and changing the rules.
Treatments? If an anaesthetist is not present a GP is left with light sedation, minor bits and pieces, pain-control injections and without surgical training, not much else. Relax the rules? Too dodgy, and ...
...right now there is a shortfall of about 1,900 anaesthetists across the UK.
Anyway…
.. Darzi had the dealbreaker… capital expenditure going to primary care has shrunk since 2020… almost half of practice premises are unfit for purpose,
Mental health... 90% of MH cases are already dealt with within primary care. To do more, better, they need time and that means money.
Diagnostics? Consultants could do out-patient clinics in a practice… but it’s more efficient if people go to them.
Think FaceTime.
Diagnostic kit is getting smaller. MRI machines, for specialist use are the size of a tumble-dryer. Technology will mature. CAT scanners can be small enough to sit on a table. Pocket-size ultrasound is here already.
There remains the issue of image interpretation and duplication of the kit in hospital. Bring money.
Stopping us getting sick in the first place?
For their entire population the Japanese do ‘kenkō shindan’; check-ups, focussing on early detection, annually. They’re rigorous and employers can insist employees take part. Per-head of population they spend $4,150 on health. Here it’s about $4,500. Something’s working in Japan.
Invest in better chronic disease management? Why not. Hire loadsa community and specialist nurses.
More Tech, yes… older patients with multimorbidity are the consistent higher users of primary care… and seldom tech-savvy. The John Lewis generation and the working-well are already using it. It creates system-headroom to spend time with those who cannot. Invest in the NHS App.
All this is possible; reform the rules, regulations, payment structures and fees but…
… it’ll take years and ££££’s and the 7.6m people waiting, worrying, don’t have years.
Starmer became labour leader four years ago last April. He’s had four years to commission a Darzi report and four years to get ready for office.
Four years to hit the ground running with a plan. Instead, he’s hit the ground. Now he's deep in a crater of his own making.
He was elected on a tide of hope and optimism, talk of black-holes and cutting yer granny's winter allowance means we might as well have stuck with the other lot...
... international investors will be cautious.
More dither, more delay undermines confidence in his leadership, deflates morale in the NHS and threatens the belief that solutions can be found .
He is making a bad situation far worse.
| 
