The NHS in England: Running to Stand Still?

By John Tingle

The Health and Social Care Regulator of the NHS in England, the Care Quality Commission (CQC) has published its latest annual report on the state of health and adult social care in England 2016/17.When reading the report ,the reader is left wondering whether the NHS as currently established can cope adequately with current future health and social care demands. The NHS turns seventy years of age next year and there is much to celebrate but there is also a lot of increasing concern about NHS efficiency, sustainability, safety and quality. The number of people aged 65 is projected to increase in all regions of England by an average of 20 % between mid-2014-and mid-2024.People are also increasingly presenting with complex, chronic or multiple conditions. The total number of people with Dementia is projected to reach one million by 2027.We are also living longer. Life expectancy at birth, 2013-2015 is 79 years for men and 83 for women. All these factors test the model of NHS care that we have and its long-term sustainability.

Like the previous year’s annual report,this year’s warns that the health and care system is operating at full stretch and that care quality in some areas is deteriorating. The situation can only get worse unless more resources are made available or new ways of the NHS operating are devised. The NHS faces an infinite public demand for its finite resources.

The System Pressure Points

System pressure points are stated in the report. Patients are being kept too long in acute services because the system flow is not working and people are being cared for in the wrong places. There are continued delays about transferring patients from hospitals to their home or community care. The pressure and demand on emergency and secondary care has continued to increase this year. Other pressures also exist. However most people in the NHS receive good or outstanding care at the core service level.The safety of NHS acute hospitals remains the CQC’s biggest concern with 7% rated as inadequate for the safe key question asked by the CQC in its inspections. Ratings have improved,as last year 9% were rated as inadequate for safety.

Primary Medical Services

The CQC state that of all the health and care sectors that they regulate and rate, general medical practitioner services have consistently received among the highest ratings. Given the pressures, general medical practitioners face in increasing demand and workforce recruitment problems, this is in the words of the report, ‘commendable’. The proportion of practices rated as good has increased to 89% and 4% were rated as outstanding overall.

Safety in General Medical Practice

One in eight practices still need to improve the quality of care for their patient’s. Almost 650,000 people are registered with practices rated as inadequate overall. Overall performance for the safe question continues to be the poorest of the five questions the CQC ask of providers. The CQC report provides a lot of information that we already know. Every day we hear and read stories in the media that the NHS is working to full capacity. That the system is creaking and some areas of care are deteriorating in terms of health quality. All however is not doom and gloom in the report. Most people in the NHS are receiving good and safe care and are happy with the services provided. This is a testament to the very hard and good work of nurses and doctors and their commitment to the NHS founding ideals and principles. That the NHS:

  • meets the needs of everyone;
  • be free at the point of delivery;
  • is based on clinical need, not ability to pay.

We wish the NHS a happy seventieth birthday next year.

John Tingle

John Tingle

Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I teach tort and medical law on the LLB at Nottingham Trent and global patient safety on the LLM in Health Law and Ethics. I have published over 500 articles and a number of leading texts in patient safety and nursing law . I am also a regular contributor to the Harvard Law School, Bill of Health Blog. I am a Visiting Scholar at Harvard Law School in November 2018.My current research interests are in global patient safety, policy and practice particularly in African health care systems.My most recent publication is: Global Patient-Safety Law Policy and Practice edited by John Tingle, Claytion O'neill and Morgan Shimwell, Routledge 2018.

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