It's been said that the NHS is at its best in a crisis. But after the unrelenting pressures of the last few years, that platitude is being sorely tested. Amid stubbornly long waiting lists, falling public confidence and low staff morale, one thing that we're all agreed on is that "we can't carry on like this."
The hard part is making the transition from firefighting to thinking long-term about what a successful and resilient health service looks like, and how to deliver it. Of course, it will have to be properly resourced, but it will be just as important to make better use of the resources available through more effective workforce planning and the application of technology.
This summer, the government finally made good on its pledge to deliver a detailed NHS Long-term Workforce Plan, which chief executive Amanda Pritchard described as "a once-in-a-generation opportunity to put staffing on a sustainable footing and improve patient care". Addressing three priority areas of training, retention and 'reform' of working practices, the 15-year strategy has been backed with £2.4bn in government funding over the next five years, which will help fund thousands more doctors, nurses and other allied healthcare professionals.
Aims and ambitions
While the MDU supports the ambition of the plan, we question whether it's possible to have a serious conversation about funding frontline care while billions of pounds are diverted from the NHS each year because of the flawed civil litigation system. Equally, how can we retain doctors and dental professionals when we are still waiting for proposed reforms to the outdated regulatory system, which has caused real distress to so many? The MDU's Thomas Reynolds expands on these points in this issue.
We also need to talk about the broader implications of the changes envisaged - first, the introduction of apprenticeships and new roles within an expanded and upskilled workforce to free-up clinicians' time, including surgical care practitioners, pharmacy technicians and mental health and wellbeing practitioners.
As with the introduction of anaesthesia and physician associates, who will be regulated by the GMC, we need discuss how these additional allied health professionals can be effectively and safely integrated into multi-disciplinary teams. There is no doubt, when looking at similar models adopted in other countries, that such roles can play a useful part in increasing the capacity of teams while maintaining high clinical standards.
But in order to gain the benefits, the implementation is key and responsible clinicians within those teams - be they from medical, nursing or other backgrounds - need to be at the heart of the development of any such plans. For example, who will define the scope of practice and oversee the training, professional development and appraisals of those in such roles? And will clinicians be expected to train and supervise - and, perhaps most concerningly, be held accountable - for the decision making and treatment provided by these new colleagues? It would be ironic if measures intended to support overworked doctors end up imposing new strains and obligations on the profession.
Technology and innovation
The second area is the use of new technology to support a 'shift towards better prevention of disease and more personalised care outside hospital', as well as automating administrative tasks. UK healthcare - and the NHS in particular - has always been a hive of innovation, but the pace of technological development means we're on the cusp of something more far reaching, which will transform patients' experience.
The plan includes many references to the potential benefits of technology such as genomics, robotics and artificial intelligence and proposes that "NHS England will convene an expert group to identify advanced technology that can be used most effectively in the NHS, building on the findings of the Topol Review".
We've explored different aspects of healthcare technology in past issues (AI, genomic medicine, digital healthcare and the ethics of medical innovation, for example), showing the huge opportunities and also highlighting potential concerns. We are right to be excited about the prospects for AI applications - such as OSAIRIS to reduce waiting times for radiotherapy treatment, or the Brainomix stroke diagnosis tool to provide decision-support - but we need suitable safeguards in place to reap the benefits.
It would be ironic if measures intended to support overworked doctors end up imposing new strains and obligations on the profession.
We're just starting to consider questions about patient safety, legal liability, data safeguards and responsibilities, which must be addressed to retain the confidence of clinicians and the wider public. Of course, these concerns are not confined to the UK - the WHO has just published a report on the regulatory considerations of AI for health - but they are pertinent given the determination of the government and the NHS to increase the pace of deployment.
The MDU supports changes that we believe will benefit doctors and patients, but we're equally ready to raise concerns when they are being let down by outdated legislation, inadequate systems, poor planning and lack of sufficient resources. The debate about the future of the NHS is no exception, which is why we took the opportunity to meet with MPs, stakeholders and opinion formers during the party conference season.
We wanted them to hear the voice of members who tell us they are exhausted, demoralised and pushing the limits of their working capacity, because without their contribution there is little hope of achieving the modern, efficient and high-quality health service we need. Long overdue regulatory and clinical negligence reform would be a powerful way to show support for doctors and initiate meaningful change.