London Eye: Two aims

Two aims

“I’ve been at Skipton House for a month now, and we don’t have a clue what we’re doing” – Sir David Sloman was doling out charm and levity at the annual conference of the Londonwide Local Medical Committees last week.

But what is the new regional director going to do? (Assuming he doesn’t become NHS Improvement/England’s joint chief operating officer, as has been hinted.)

In his speech at the Oval in Kennington, he set out three priorities. All but one was heavily caveated.

The former Royal Free boss mentioned workforce but cautioned against chasing staff “that don’t exist” – ie: We’ll try and help with workforce but it’s largely beyond the NHS’ control.

(There is a global shortage of healthcare workers. It’s going to get worse. Plus the crashing of the value of the pound has reduced the attractiveness of the UK as a place to work for foreigners.)

So this means longer waits and worse care?

Hopefully not. People are hoping technology will make up some of the ground, and, in primary care at least, reinforcements from allied health professionals will take some of the strain.

Community pharmacists and “social prescribers” are being deployed, and the British Medical Association’s Richard Vautrey was upbeat about the new GP contract. But fundamentally, the number of GPs in London has gone from roughly 6,000 to 5,200 over the past two years – so we shouldn’t kid ourselves about how much more work primary care is going to be able to do.

Another priority Sir David mentioned was healthcare estate, some of which in London “was absolutely shocking”. London Eye was reminded of when Sir Andrew Morris took over Heatherwood and Wexham Park, having run Frimley Park for decades. He told an HSJ conference audience that he hadn’t realised just how bad the infrastructure was at the neighbouring trust, at developing world levels in some aspects, and that when he’d seen that there was no choice but to act.

Chief executives at more fortunate trusts sometimes don’t realise how bad things are only a few miles down the road.

Sir David admitted “capital is going to be a challenge”, for London along with the rest of the NHS.

So can anything be done in the absence of public money and private investment? He mentioned “driving past empty local authority properties in areas where I know we need out-of-hospital care”, suggesting some kind of greater collaboration with the boroughs.

It’s not without precedent. The One Public Estate team has been working with the local authority and Barts Health Trust on what to do with/about Whipps Cross University Hospital.

But, in the main, London local government has its own problems and its own ideas about what to do with its unused property.

The third priority Sir David mentioned to the Londonwide LMCs conference was technology. There wasn’t much detail to this, but it’s tech that people are pinning their hopes on to reduce the number of outpatients appointments in the capital.

Why does this matter?

Stephen Powis, Sir David’s former medical director and now MD for NHS England, in November said “many” of England’s 118m annual outpatients appointments were unnecessary.

The theory goes that doing these via something like Skype (or maybe not doing them at all) frees up some hospital space, maybe? And then that space doesn’t need to be expensively maintained? And, in fact, could be sold? As care moves not just closer to home (y’know, the way it has been inexorably) but actually into the home via an iPad, perhaps less labour intensive outpatients appointments mean the workforce shortages are less of a problem?

That’s a lot of maybes.

Another one was an eye-catching claim about 10 per cent of London’s traffic being people on their way to or from an outpatients appointment.

This led Sir David to another point about air pollution, with the reduction in outpatient journeys being one of the ways the NHS was going to contribute to London becoming the world’s healthiest city – his stated aim.

The powerlessness or indifference of all levels of government in the face of unlawful levels of air pollution in London is shameful, and it’s to Sir David’s credit that he wants to do something about it. It’s not really NHSE/NHSI core business, though.

Something he, rather than Public Health England or the Mayor’s office, can control is equitable access to care. Sir David mentioned that you don’t hear the term “postcode lottery” much these days but it still exists.

And that was his other stated aim – to make London the best place in the world to receive healthcare.

When asked by chair Ben Goldacre how success or failure on his two aims might be measured, there was no clear answer.

But even if he did nothing but close the District line cancer gap he would have made a major difference.