In the first of a series of articles by University of Exeter experts analysing crucial issues in the run up to the general election, Professor Steve Thornton looks at health
Here in the UK, we have the best national health care system in the world, delivered at a fraction of the cost of alternatives. However, chronic underfunding and increased demand mean the whole system is at breaking point. Dedicated staff often provide this care due to their commitment to public health, despite the fact that the NHS is continually undermined from a number of quarters.
The NHS has been stretched in the past, but its current condition is critical. The predicted increase on NHS demand is simply not sustainable. We will see an exponential population growth in the coming decades: by 2060 the number of people aged over 85 in the UK will have almost trebled, rising from under two million today to 5.8 million.
This will increase demand – but there is an additional problem – those people surviving to old age will have complex diseases, so management costs will also soar. Current efforts to answer this conundrum lead to relatively minor changes in healthcare provision, to reduce costs or increase productivity. Examples include the provision of care by private providers – but this will not enable seamless expensive treatments to be delivered at low cost. Another example is the administration of clinical care in the community, which may reduce costs, but the financial benefits of community care with new ways of working are yet to be conclusively demonstrated.
NHS England has named South Devon and Cornwall pioneers, where schemes to deliver fully-integrated care and support are being trialled, and this may improve care delivery. NHS England has also invited applications to be “vanguard” sites, to accelerate change through the New Models of Care Programme.
This is all a drive towards efficient and joined-up working between acute, mental health, community and social care providers, which should enable patients to be discharged to appropriate care, relieving some of the pressures on accident and emergency departments and the ambulance services. Some basic tasks traditionally delivered by doctors can be provided by non-medical staff such as nurses, pharmacists and radiographers with extended roles, reducing salary costs. Utilising technology at home may yield efficiencies, and Cornwall provides an excellent test bed opportunity with superfast broadband. However, none of these can provide the step change in efficiencies or reduce costs enough to maintain the quality of healthcare that the public deserves.
So, what should healthcare look like in the next 15 years and beyond? Collaboration across the South West is crucial. Patients should be able to access the care they need, when they need it Primary care teams – those on the frontline of service delivery – should be working with acute, social care and mental health providers to deliver efficient care. These teams will need to work hand-in-hand, at times in the same location, with rapid triage, admission, specialised care and discharge. Importantly, the region’s providers need to work together, with particular trusts taking the lead to manage certain pathways of care, while more common treatments are provided in each locality. Such integrated care will improve the patient experience. However, if we are really going to provide the very best care, healthcare providers need to continue to work with universities to ensure that we educate the very best clinical staff.
Medical schools need to be flexible enough to provide healthcare courses that produce staff with the required skills, including increased numbers working in the community and those with a broad-based education. Equally important is our high quality health research.
Data overwhelmingly demonstrates that healthcare providers who are undertaking research deliver better quality care. This is not surprising – one would not expect any industry to produce high quality products without research, innovation and development.
And we have good reason to be proud of our world-leading research at Exeter. Medical-related research has just been ranked in the UK top ten by the Research Excellence Framework.
So, universities and healthcare providers must work together even more closely than we do today. We must also strive to attract external non-commercial and commercial investment in healthcare research with the development of specialised centres, units and institutes.
These attract high-quality staff and external resource, and lead healthcare developments for the future. Already, we have world-leading examples of collaborative ventures between healthcare and the University of Exeter, such as the Research, Innovation, Learning and Development (RILD) building on the Royal Devon & Exeter NHS Foundation Trust site, the Horizon centre at Torbay Hospital, the John Bull building on Plymouth’s Tamar Science Park and the Knowledge Spa on the Royal Cornwall Hospital Trust site in Truro.
These facilities and academic leaders attract further healthcare investment as the Government focuses investment to maximise delivery. One example is that combined NHS and university genetics expertise has led to development of a local hub in Exeter for the 100,000 genome project.
All this demonstrates that the South West is doing well to deliver high-quality healthcare despite underfunding and unprecedented demand. However, if the NHS is going to continue to deliver excellent healthcare into the future, we need to maximise collaboration across NHS trusts, universities and commercial sectors.
We need the public and government to decide whether it wants to fund the high-quality care that the NHS is capable of delivering in a new, seamless vision.
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