Forward view analysis: Don’t rely on the banks

It is well reported that in the developed world we are facing significant demographic challenges - more people living to extreme old age, often with several chronic diseases. This is creating a challenge for both health and social care.

We must remember that this is in fact a success story and is testament to the advances in society, public health and medicine in recent decades.

‘We need to train more staff to continue to deliver high quality care in a variety of settings in the future’

We recently had an incident in the trust where a junior doctor did not recognise a heart attack. It turns out that this particular doctor had never seen a patient who had had a heart attack.

Thirty years ago when I was a junior nurse, it seemed almost every other patient came in with a heart attack and almost everybody in the ward could recognise changes on the electrocardiogram.

Impact of new treatments

Due to the introduction of legislation such as the ban on smoking, the impact of new procedures such as angiography and the use of new drugs such as statins, no longer do we have large numbers of people dying suddenly in their 40s and 50s from a heart attack.

This is good news both for the individuals and for society as these people can now continue to work and contribute to society for another couple of decades.

However, they will now live to be older, perhaps developing a chronic disease later on in life.

These changes have taken decades to emerge and make an impact and it is right that we plan our health and social care system accordingly, for the long term. These problems cannot be addressed by single issue, short term fixes.

Successful strategies to cope with these demographic developments will take years to implement and we need a political accord for a long term plan to deliver the healthcare we know we will require to sustain us through the next decade and beyond.

The model of healthcare needed at the inception of the NHS has served us well but it does need redesign for the 21st century.

‘Short term savings today are going to lead to greater problems in the next 3-5 years and beyond’

Because the problems in healthcare are complex and numerous, we need a variety of solutions if we are to continue to provide the excellent services the NHS currently delivers.

The NHS Five Year Forward View recognises the need for a long term plan, underpinned by a sustained period of stability with reasonable assurance over finances.

It further recognises that a variety of solutions and models are going to be needed to reflect local needs and local situations.

The issue I think we still need to address is staffing.

The necessity of the right numbers of staff with the right qualifications and training for the delivery of high quality care is well recognised.

This is evidenced by the increased numbers of staff of all grades now employed in the NHS in response to the increased focus on quality of care.

However, this has led to a problem in itself in that in order to meet the need for more staff, more and more organisations are relying on bank and agency to fill gaps. This is not a clinically or cost effective solution.

We need to train more staff, including doctors, if we are to continue to deliver high quality care in a variety of settings in the future.

Saving money by not training more healthcare staff is a false economy in terms of both quality of care and finances. The savings in not training a doctor are more than lost in the cost of locum provision being incurred across the NHS.

Need for investment

Short term savings today are going to lead to greater problems in the next 3-5 years and beyond.

To combat these potential issues before they arise, I think we need to invest far more in the training and education of our next generation of healthcare professionals.

Dame Julie Moore is chief executive of University Hospitals Birmingham Foundation Trust