ABSTRACT
The NHS works very efficiently in a number of settings and for a number of conditions. Accident and Emergency departments work very hard but as the pandemic has shown often not being able to unload ambulances and not being able to discharge patients when they are ready but because they need social care support and may have nowhere to go adds to the stress experienced by the frontline staff. Solving social care is crucial in the future of the NHS. Integrating commissioning and how integration is thought of is crucial so that patients can move between services readily and easily. A combination of public and private funding may be a potential option. Integrated care systems are supposed to be looking at the health of their populations, but they may end up focusing on managing alone. We need to rethink the primary care model and the distinction and barriers between primary and secondary care. Over-investigations add to the cost when resources are not enough. Workforce planning remains a major issue and needs to be prioritised. There is an urgent need for joined up working.
