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Over the last years, I have travelled the country and discovered innovation wherever I have been in the NHS. I visited hospitals in Liverpool and met neurosurgeons who talked patients through the risks of surgery and decided they outweighed the benefits, in a significant number of cases. At Alder Hey Children’s hospital I met chefs who were personal nutritional advisers to the children. The children had the food they wanted and it was nutritional. Children who were having chemotherapy were offered curries – a food they could taste. We know from the Marmot principle the NHS is responsible for 30% of a patient’s wellbeing, and that the remainder is environment, employment, education and our creative life. Just walking into the reception area made you feel better. Children had helped design it.
The issue of the social determinants of health has been increasingly on the NHS radar. We now have a social prescribing network of 600 organisations. All the new model of care vanguards have social determinants at their heart as well as traditional clinical quality improvement.
All this comes from the Five-Year Forward View – supporting patients to invest in their health improvement and shifting NHS care into the community. A shining example is the Airedale NHS Trust in West Yorkshire, which is reducing hospital deaths in patients with terminal care. Typically more than 50% of patients with terminal illness are dying in hospital, when nearly all would want to die at home. These vanguards are showing not just that this is possible but that it improves morale in staff and is value for money in the NHS.
I have been a GP for 28 years and have never known a more financially challenged time. We need to persuade the Government and society to invest more but I want to share just one idea.
Flu creates havoc every winter, particularly in the elderly and the chronically ill. The NHS has a programme to vaccinate them but stops short of herd immunity. Typical immunisation rates are 75% in the elderly and 40% in NHS staff. In childhood vaccinations, we aim for 95% coverage and in many regions illnesses have been eradicated. Why not aim for this with flu? The answer is cost. But is it not time to have an annual campaign to urge everyone to be vaccinated? Those in low-risk groups can go to a pharmacist and have the vaccination for £10-15. This will reduce their risk of flu significantly, save them a fortune on things that have no impact on the illness and will pay for itself in lost wages and time off work.
Finally the main lesson I have learned is the abundance of good ideas in the NHS and the willingness of NHS staff to give their expertise freely. But there is also a lack of connectivity, which leads us into the hands of consultancies that charge £1,000 a day. Is it time to set up
a ‘dating agency’, connecting people who have ideas with those who want to hear them, perhaps paying for the travel? It would be far cheaper than the alternatives and a great way to create leaders and relationships and real change in the NHS.
Dr Sam Everington is chair of Tower Hamlets clinical commissioning group, NHS England’s advisor on new care models and chair of the Healthcare Leader editorial board