The future for the NHS in England – why a radical rethink is required

Founded in 1681, the Royal College of Physicians of Edinburgh supports and educates doctors in the hospital sector throughout England, the devolved nations and the rest of the World. We are proud to have over 12,000 Fellows and Members in over 91 countries, covering 54 medical specialties and interests. A significant proportion of our Members and Fellows work in the NHS in England.

Working with our England-based members, we have identified four priority areas that will improve public health, and which will ensure safe, patient-centred, high quality medical care. Our health priorities are informed by the expert opinion and experience of our Fellows and Members, who can have a constructive role in delivering real and positive change, which will ultimately improve patient care.

Our key policy priories are as follows:

• Funding for a sustainable future is vital. A working group should be set up as a matter of urgency to find solutions to alleviate the pressures faced across the NHS, and help address the complexity of management systems.
• Investment in our current and future workforce is essential both financially and to create a culture where colleagues have the time to care, train and research.
• Progress must be made towards health and social care integration, to improve flow and hospital discharge and ensure that patients receive the most appropriate care for their needs.
• Finally, the Government must prioritise the prevention of obesity through measures such as the reduction of food portion and pack sizes; stronger controls on price promotions; and promotion of the sugary drinks tax.

The NHS has faced intense pressures this winter. The combination of cold weather and a significant increase in cases of flu has made care more complex, therefore exacerbating the challenges that winter typically brings. NHS staff have worked exceptionally hard and it is important that we support them through such demanding periods, and beyond. It is vital that NHS leaders and government learn from what has been a particularly challenging winter, to ensure that the system is better equipped to deal with extreme circumstances in future. This would ultimately benefit patients, but also overworked NHS staff who need to feel valued for their dedication and hard work.

As the NHS turns 70 this year, the College sees an opportunity to reflect and to think about the future of how we deliver healthcare in England, and in the devolved nations. Decades of reform in the NHS in England have resulted in a very complex management system plagued by many costly initiatives that are not based on evidence and do not have a clear strategic plan. It is time for a radical rethink to declutter these initiatives and address the unprecedented challenges that are impacting on the workforce and, ultimately, on patient care. We therefore call on the UK Government to implement measures to simplify the complex NHS landscape in England.

Workforce planning needs a clear strategic direction to tackle the recruitment and retention issues that exist. There are workforce shortages across the country with rota gaps creating additional pressures in an already difficult environment. We must value healthcare professionals at every stage in their careers to ensure medicine remains an attractive career choice and offer support for medical professionals as they progress throughout their careers. The UK Government must also value the role of EU nationals as Brexit negotiations continue, as well as recognising the contribution made to our NHS from healthcare professionals from other overseas countries.

All healthcare initiatives must have strong evidence to support them, be thoroughly evaluated for outcome, and lead to solid and sustainable improvements in the long term, particularly as we move towards further integration of health and social care. Whilst we acknowledge the funding challenges that the NHS faces, we believe that by rethinking the approach to focus on long-term and sustainable solutions, we can achieve a world-class workforce delivering the best possible patient care safely.