Doctors must fight for the NHS

VIEWPOINT Dr David Levy Consultant oncologist and government adviser on cancer

Health staff face profound change

The National Health Service faces an uncertain future with budgets likely to be very tight.

Dr David Levy argues that doctors must take a lead role if essential services for patients are not to suffer.

What will the NHS be like in 2012 after the impact of the financial crisis and reduced health budgets?

Will it be savaged by indiscriminate cuts?

Will patients be on a waiting list to be referred to hospitals, in order to manage demand and balance budgets?

Will hospitals be sacking staff - including doctors and nurses - because patients in need are not being referred?

Will expensive treatments - like IVF or new cancer drugs - be stopped on the NHS?

Or will we be in a position where health services do look a bit different, but patients in need continue to receive appropriate care, when they need it, close to home?

Famine

After several years of plenty within the NHS, when directors of finance got out their cheque books to solve problems, we are now about to have six or more years of famine.

The health budget of £110 billion needs to find £20 billion of savings.

Why is there is a lot of waste in the NHS? Mainly because we have always done it that way. Read your comments

The answer lies with consultants in hospitals and GPs in primary care.

They need to recognise there will need to be significant changes to the provision of healthcare to ensure patients do not suffer.

The current model of delivery of care is still the one which was formulated in 1948: GP refers patient, patient is seen in hospital and then, after some treatment, is probably followed up forever.

This is an unsustainable, wasteful model of care.

For instance, patients often come in for surgery the day before their operation.

And most surgical patients have no idea exactly how long they will stay in hospital prior to their admission - would anyone go on a holiday without knowing when they would come home?

History of waste

Why is there is a lot of waste in the NHS? Mainly because we have always done it that way.

There are lots of unnecessary follow-up appointments, patients being admitted to ensure compliance with A&E waiting time targets, and patients with back pain being seen by highly skilled consultant surgeons, when they could have been assessed by a specially trained nurse or physiotherapist in the community - closer to home.

Part of the problem is that consultants complain about the problems they have: patients not being able to be discharged from hospital, clinics so busy they cannot give time to see patients properly and inappropriate referrals from GPs.

The solution is in their own hands and now is the time for them to act before we hit the years of famine - and managers decide what to cut.

Health managers and commissioners in primary care trusts have the patient's best interests at heart - but they do not understand the impact on care of difficult decisions.

Costs driven down

One example of commissioning community care by a "Dutch Auction" is chilling.

Senior doctors in hospitals and GPs need to act now

Panorama reported in May of this year that community services for the elderly and those near the end of life went to auction with the lowest price winning.

Cheap, low quality services resulted, budgets were balanced but patients suffered. This is unacceptable.

Senior doctors in hospitals and GPs need to act now.

They must start working with their managers, with social care services and together across organisational boundaries.

They need to review current models of healthcare and come up with solutions which benefit the patient and get rid of waste.

An example might be the greater provision of social care to ensure patients can be discharged promptly, the extra funding coming from hospitals that save money from an earlier discharge.

Collaborative approach

Doctors and managers need to recognise that the survival of quality health services when budgets are restricted can only be achieved by both sides working together to assure each other's survival.

The alternative is Mutually Assured Destruction - MAD.

Now is the time to act, to work collaboratively to pick up the flag of quality.

They must get rid of wasteful practices in the NHS and strive to deliver more effective patient-focused models of care.

Failure to do so will condemn the patients of tomorrow to an uncertain, unresponsive poor-quality healthcare service.

It will also condemn many doctors and nurses to unemployment - and guarantee misery for all.