A glimpse of the NHS’ future – Gordon Hector
Everyone can see the NHS is in trouble. But what do we do? Answers seem in short supply.
Last week the Scottish Government put out a press release, announcing a new urology hub near Falkirk. It was a bit of summer fluff and it’s a relatively small facility. But it’s more interesting that it first looks. It has three ideas which give us a glimpse of the NHS’ possible escape from its crisis.
First, this hub creates new kinds of job.
There are Surgical Care Practitioners. This role is about repeatable, relatively simple and safe surgery, much of which was previously performed by surgeons. They do that in a room in a clinic, not an operating theatre. At the same time, new Advanced Nurse Practitioners are deployed. These are nurses with extra training, particularly in diagnostic technology.
We need to be clear what this is – it’s removing doctors from some procedures. But it makes total sense. Swapping a consultant for another clinician, and a theatre for a clinic room, saves a lot of money. It focuses the doctors’ time and overnight beds on the patients who really need it. More procedures can be done, reducing waiting lists and speeding up diagnosis. And these new roles create new avenues for progression for nurses and allied health professionals, which supports staff retention.
Second, the hub puts urology diagnostics and treatment into one place, in a newly-built facility. This is easier for patients to navigate and means the NHS can offer exactly the kind of facilities they need – in this case, changing rooms are pretty important for a urology patient. But again it’s more efficient. On average, a service which is consolidated into a single place is going to spend proportionately less on clinical staff, admin staff, porters, energy, IT and buildings than one distributed across lots of different places.
The bigger impact of this consolidation is longer-term. With all due respect to Larbert, it is not one of the world’s great medical research centres. But concentrating services creates a critical mass of clinicians and patients. That usually makes for a greater sense of a team, usually means higher-quality care and makes it much easier to start doing proper research and innovation work. Healthcare is a global staff market and most of the NHS’ staff could work anywhere: so offering camaraderie, quality, and an outlet for research ambitions is a good way of keeping them here.
The final part of the equation is cash. It’s difficult to understand the sums for this kind of thing: the press release says the wider programme in which it sits costs £70m – but obviously services would have to be paid for anyway. So it’s not clear if there is actually a saving. Still, the concept is to spend a bit of money rearranging the service in a way which, over the long term, represents good value compared to the previous model.
These are three hints on where the NHS is heading: standardising as much care as possible into higher-volume, higher-tech, less-consultant led formats; concentrating specialties in a single place; and spending a bit to save a bit. It’s sensible stuff and done enough times, represents a decent response to the challenges of staff shortages, increased demand, and covid catch-up.
There are just three niggles.
First, all of this takes time to implement. Meanwhile the system is in meltdown. The NHS needs to execute this kind of new project while also putting out shorter-term fires. That’s quite an ask.
Second, this is all about freeing up patient flow in medical care. There are many bits of the system where that’s impossible without also fixing social care. It’s not like Ministers won’t be busy on social care, but the approach taken there is far from the kind of practice improvement the urology hub represents: instead they are focused on national structures and changing the law, with the National Care Service Bill. The clear risk is that we get a nice shiny law while the on-the-ground practice has deteriorated. If I were sitting in St Andrews’ House advising ministers, I’d want to be confident that the bill is worth the opportunity cost in time, political capital, and headspace to do other things.
And finally, above all else – what do patients make of this? Better outcomes in a cheaper system is a good deal for patients, on average. But people are not averages. Most places in the Forth valley are pretty close, so I’d be surprised if there is a concern about this model centralising services. That will feel different in other parts of Scotland, where this model could be much more controversial. This kind of project needs clarity of thought to make sure it genuinely speaks to local needs, as opposed to just serving the needs of the system.
These are pretty big niggles. Still, this is a snapshot of the kind of change that we can expect from the NHS in the years ahead. The questions facing the NHS remain massive: but this little hub near Falkirk might show at least part of the answer.
Gordon Hector is a policy consultant and former Director of Policy and Strategy for the Scottish Conservatives