ABSTRACT
All sectors of the NHS from primary care (including general practice), community services to secondary care (hospital and specialist services) are facing a mismatch between the demand on the service and its capacity. Capacity in the NHS is currently inadequate to meet the needs of the population as a result of historic lack of funding, insufficient human resources and infrastructures such as buildings, hospital beds and equipment. Fewer staff across various professions and also shortage of beds and diagnostic tools such as CT and MRI scanners compared to equivalent nations contribute to longer waits for treatment and a backlog of care. This in turn leads to stress and low morale on staff affecting recruitment and retention. Setting up a vicious cycle. These pressures are compounded by growing demand from people living longer with increased illness, long term conditions and multiple morbidity. The NHS has an ethnically diverse workforce where more than one third of doctors have come from abroad, and over four in 10 are from ethnic minority backgrounds. There is evidence of race discrimination in the health service, which is preventing ethnic minority doctors from achieving their full potential and succeeding in career progression, which in turn is not allowing the NHS to make full use of the talent of its workforce, in which patients lose out. It is vital that the NHS is driven by principles of equality and inclusivity for its staff, which needs to be a priority for government cascaded through all NHS leaders in the system. The NHS has also been afflicted by a negative blame culture, where healthcare professionals often feel unable to speak out, or face recrimination if they do so. There is a pressing need for a supportive learning culture where raising concerns should be embraced as an ongoing means of improving quality and safety. The organisational divide between primary and secondary care has created artificial and unnecessary barriers for patients who expect their care to be in a coordinated whole system. And this inevitably results in fragmentation, duplication of effort and leads to resource wastage and affects patient care. Another major issue for the NHS is that it is a healthcare system that is driven by politicians, who are in turn driven by electoral timescales and motives. One potential solution is setting up an independent Board (as is for the Bank of England) to set national policy based on objective health needs and without political interference or short term electoral timelines. The strength of the NHS is that it provides comprehensive care and is free to access for all citizens. Not having to pay for a consultation or care generates trust between a patient and a doctor, taking away any suspicion that the healthcare professional caring for them could potentially financially gain from any treatment decisions. This is not the case in many other healthcare systems around the globe where patents make a direct payment to a doctor or healthcare provider for episodes of care.
