The problems facing the the NHS (National Health Service) in the UK are pretty similar to ours in Canada — family physicians leaving practises, long surgical wait times, poor access to primary care, backed up ambulances at the ER (emergency rooms or A&E’s as they call them).
The Times and Sunday Times (of London) established a Health Commission a year ago to investigate and make recommendations on England’s health and social care crisis. Their report and 10 recommendations have just been made public (Feb 5, 2024).
It has always been my belief that “all of us are smarter than some of us,” and that we can learn valuable lessons from other nations — both rich and resource challenged ones.
The UK report has valuable evidence based findings and its authorship was truly multidisciplinary with expertese from many fields. Here in Canada (and here I am also thinking of my home province of PEI), we need similar multidisciplanry dialogues. And those dialogues can utilize much of the work and research already done by think tanks such as the Times Health Commission and institutions like the Fraser Institute.
The Times Commission has posted their full report without any paywall. The PDF report can be downloaded here.
Here are the main 10 recommendations (some of which are applicable here):
- Create digital health accounts for patients, called patient passports, accessed through the NHS app to book appointments, order prescriptions, view records, test results or referral letters and contact clinicians.
- Tackle waiting lists by introducing a national programme of weekend High-Intensity Theatre (HIT) lists once a month in 50 hospitals to get through a week’s worth of planned operations in a day and create seven-day surgical hubs.
- Reform the GP contract to focus on wider health outcomes rather than box-ticking, ensure patients get prompt appointments and restore continuity of care. Encourage more super-practices and create community health centres.
- Write off student loans for doctors, nurses and midwives who stay in the NHS to improve retention as well as recruitment. Debt should be cut by 30 per cent for those who stay three years, 70 per cent for seven years and 100 per cent for ten years.
- Introduce no-blame compensation for medical errors with settlements determined according to need to ensure families get quick support and encourage the NHS to learn from mistakes.
- Establish a National Care System giving everyone the right to appropriate support in a timely fashion. Equal but different from the NHS, it should be administered locally and delivered by a mixture of the public and private sectors.
- Guarantee that all children and young people requiring mental health support can get access to treatment within four weeks and rapid follow-up appointments. Publish data on waiting times for all mental health services.
- Tackle obesity by expanding the sugar tax, taxing salt, implementing a pre-watershed ban on junk food advertising and reducing cartoons on packaging to minimise children’s exposure to unhealthy food.
- Incentivise NHS staff to take part in research, and put the case for research to their patients by giving 20 per cent of hospital consultants and other senior clinicians 20 per cent protected time for research.
- Establish a Healthy Lives Committee empowered by a legally binding commitment to increase healthy life expectancy by five years in a decade and reduce health inequalities to encourage a long-term approach with cross-party agreement.
PEI health reform progress
We are already tackling several of these (similar) recommendations here and I am grateful for leaders who have a vision for sustainable and equitable healthcare for all.
# 1 is well underway with the Electronic Medical Record (EMR) rollout (all functionality is still pending). Our version of # 3 is also underway with current negotiations for a new contract for PEI Medical Society physicians (hopefully with an emphasis on primary care). Youth mental health services are also recognized as a significant area of need.
#’s 8 and # 10 are under the leadership of the Deputy Chief Public Health Officer. A Live Well PEI website is active. I have been told that there are plans to share a provincial wellness action plan in 2024. I have written about # 8 here.
Reports of progress in the rolling out of Patient Medical Homes are positive although the patient registry has not reduced.
Further PEI dialogue is needed
Recent crises in PEI’s second largest hospital have led to public debate with politcal and healthcare leaders. While this crisis must be resolved, it really only represents an iceberg tip of deeper unsustainable problems.
I encourage wider multidisciplinary rounttable discussions to build on reform advances, lessons from other nations, and our own unique “out of the box” thinking. We must address the US versus THEM criticisms highlighted in recent publicized comments from former leaders.
Having served as an occupational medicine physician, I have firsthand knowledge that healthy workplaces (all sectors, but especially health) are essential. Workforce resilience needs to be addressed beginning in childhood with parenting and educational strategies.
I have previously written my opinion on efficient use of non-physician primary health clincians (mostly NPs here, but includes PAs (physician assistants), pharmacists, and now also midwives). The gap left by exiting family physicians needs a sustainable long-term solution.
Please don’t hesitate to contact me if you would like to participate in further dialogue.
Hendrik Visser, MD