Six things to fix the NHS

The government in England is planning the biggest reimagining of the NHS in its history.

It follows a damning report by surgeon and independent peer Lord Darzi, which warned the health service was in a “critical condition”.

The prime minister has said the new 10-year plan will be based on three concepts: greater use of digital technology, more emphasis on community care, and preventing ill health in the first place.

Across the NHS there are already pockets of innovation – and these localised schemes could help the wider NHS in years to come.

Every month the NHS carries out about 2.5 million tests and scans, including for things like cancer and heart disease.

Ageing or scarce equipment, and some hospitals being tricky for patients to access, means the NHS has been struggling to carry out diagnostic tests quickly enough.

More than a fifth of patients are waiting longer than the target time of six weeks.

One solution has been new centres in community locations – including one in Barnsley’s shopping centre, The Glass Works.

The NHS diagnostic centre opened in 2022, providing everything from ultrasounds and X-rays to breast screening and bone density scans.

The centre’s impact was immediate, reducing the waits for bone density scans from six weeks to one, and increasing the uptake of breast screening by nearly 50%.

It is one of 165 community diagnostic centres, with others located on high streets, university campuses and at football stadiums.

The aim is to increase testing capacity by nine million a year – but a shortage of key staff such as radiologists, who interpret and read the tests, may make that difficult.

Virtual wards aim to provide hospital-level care at home.

Using apps and remote monitoring, patients with respiratory problems, heart disease and frailty are kept at home under the care of a hospital consultant. Home visits by nurses can be arranged where necessary.

NHS England has encouraged local services to embrace them over the last few years for those deemed appropriate for the service (patients whose condition is not rapidly deteriorating).

There are now more than 11,000 virtual beds in England, compared to nearly 100,000 real beds. Scotland, Wales and Northern Ireland are also investing in them.

Some studies have suggested that for every two to three patients cared for in a virtual ward, one hospital admission is prevented.

However, unsurprisingly for something that has been rolled out so quickly, there have been teething problems.

Research by the Health Foundation charity has pointed to mixed success, with some areas struggling to access the right technology and one study finding a virtual ward bed costs twice as much as a real hospital bed.

Treating patients six days a week, often late into the evenings, the South West London Elective Orthopaedic Centre’s five operating theatres are among the busiest in the NHS.

The unit is only for non-emergency treatment, such as knee and hip operations, and has a dedicated team of surgeons, nurses, physios and other health staff. It gets through more than 5,000 treatments and operations a year.

The idea is to tackle waiting lists in a venue where beds and theatres are not also needed for emergency care, which often causes operations to be delayed.

Patients are discharged quickly – about 60% leave on the same day – and report back to staff at the centre via video diaries, so their rehabilitation can be monitored.

It is a model that is now being implemented across the country. There are more than 100 surgical hubs in England concentrating on high-volume, low complexity procedures.

The NHS Confederation, which represents health bosses, believes these could play a “vital role” in tackling the 7.6 million-long waiting list. It is calling for the number of hubs to double.

So far, the results appear to be good. Research suggests hubs are increasing the number of treatments being done by more than a fifth in the places where they are being introduced.

However, the sticking point is these units require upfront investment to build new theatres and refurbish hospital buildings.

It was an issue recognised by Lord Darzi when he unveiled the report: “We often have the staff, but not the theatres. It’s so unproductive.”

About one in eight hospital beds is occupied by a patient who is medically ready to leave hospital, but cannot because they need support at home.

In some areas, hospitals are getting round this by creating teams to help rapidly discharge patients and support them at home. These are made up of care workers, therapists and nurses.

Rather than spending time carrying out full assessments on the wards, the patients are sent home in the knowledge there is a team ready to go in and arrange support.

What is interesting is that often the patients – in the familiarity of their own home – are found to have lower care needs than hospital staff initially assume.

Oxfordshire launched its integrated “discharge to assess” team late last year.

During the winter, they were asked to support 105 patients to go home and were in a position to help 91.

Council adult social care director Karen Fuller is delighted with the impact, but she says it has not been without its challenges.

Ms Fuller says teams are now “working seven days a week”.

And this is the main barrier to making more progress. Such schemes rely heavily on councils, and budgets are tight.

The government has promised reform of social care alongside its new plans for the NHS. With extra funding, councils say they could hold the key to freeing up hospital beds.

Mobile lung cancer screening trucks are testing people at supermarkets, sports centres and football grounds.

Invitations are sent to local people deemed at highest risk – mainly smokers and ex-smokers aged 55 to 74.

People get a lung health check and if there is concern, they can have a scan then and there or at a local hospital.

Lord Darzi warned that high cancer mortality rates were a major concern.

Spotting cancer early at stages one and two means it is easier to treat, and chances of survival are higher.

More than 3,000 lung cancers have been identified using the trucks – three-quarters at stages one and two. Others have been diagnosed with respiratory disease too.

The initiative began in Manchester and Liverpool, but has gradually been rolled out to other parts of the country over the past five years.

This is just one of many ways cancer screening is developing.

Bowel cancer screening is being offered to more and more people, after the age at which people are invited to come forward was reduced.

The NHS is not just having to be there for people with health needs, it has also become a crutch for those struggling with other elements of their lives.

Walk into any GP surgery and, alongside those with illnesses and ailments, you will find plenty of people seeking help for the consequences of wider social problems – debt, stress, loneliness and physical inactivity.

In fact, it is estimated that about one in five GP appointments are for non-medical issues.

To address this, the NHS has been investing in social prescribing, where patients are referred to activities and support such as volunteering, arts, gardening, befriending, walking schemes and dance classes.

As well as helping those with non-medical problems, these “social prescriptions” can also benefit others with mental illness, or long-term conditions like diabetes and heart disease.

The Royal College of GPs describes social prescribing as a “vital lifeline” for their patients, particularly off the back of the cost-of-living crisis, and the think tank The King’s Fund has said in the past there is evidence it can lead to a “range of positive health and wellbeing outcomes”.

The concept was championed in the 2019 NHS Long Term Plan. This led to investment in link workers, who help GPs co-ordinate access to activities and services provided by councils and the community and voluntary sectors.