The NHS at 70: The Care Quality Commission view
Professor Ted Baker, Chief Inspector of Hospitals at health and adult social care regulator the Care Quality Commission, tells Sarah Brealey about the challenges and opportunities facing the NHS as it celebrates its 70th anniversary.
My impression is that incredible progress has been made. There are some challenges, but we have hugely improved the quality of patient care. Getting to 70 years is to be celebrated.
The way we treat heart disease, and many other diseases, has changed completely.
Within my own speciality, paediatric cardiology, the outlook for children born with congenital heart disease is now fundamentally improved compared to when I started in the NHS and is radically different from before the NHS, when heart surgery was only available for a very small group of children. The expertise to provide specialist repairs to those very complex heart defects is something that has been developed in recent decades. The BHF contribution to that has been very significant.
What drives quality of care are front line clinical leadership and a strong positive culture
I've seen a great increase in the numbers of interventional procedures for coronary heart disease. When I was a student at Stanford [California] in 1979 I saw some of the first percutaneous intervention (angioplasty) procedures undertaken there and I found it remarkable. Now we can see how since then percutaneous angioplasty has completely changed the survivability of serious coronary heart disease in this country.
From BHF-funded research to Chief Inspector of Hospitals
I owe a great debt to the BHF. I received a research fellowship from the BHF in 1983, and that was the start of my academic career. I was a paediatric cardiologist for 35 years. The research fellowship from the BHF established me in the speciality. It was research around imaging, first radionuclide imaging and then MRI.
I started a programme of cardiac MRI while I was working in Pittsburgh and was later lucky enough to be able to establish a programme of MRI imaging in the heart of very young babies at Guy’s Hospital in London in 1987. The programme has since gone from strength to strength and is still at the forefront of the field.
The reason I moved into regulation was the frustrations I experienced as a clinician and later as a medical director about the all the things in the healthcare system that needed to change to achieve consistently high quality care. I came to the CQC after the Francis report to participate in the inspection of hospitals, to bring my clinical experience to the regulatory environment.
What we have picked up on in our hospital inspections is that to improve care, you have to improve culture and leadership. What drives quality of care are front line clinical leadership and a strong positive culture.
While there is still much to do, I get a sense that the culture of healthcare is changing to one that is more driven by front line staff. That is a notable achievement in the context of the system working under so much pressure.
Challenges facing the NHS
The NHS is facing challenges. The NHS in the 40s had a model of care built around the needs of that time. As the population has grown and got older, people's needs have changed, and the service hasn't changed sufficiently to meet that. The challenge now is to adapt much better to the needs of the population we now serve.
Because of improved treatments, such as those for heart disease, people are living longer. People who are older with multiple conditions have different needs from younger patients with a single acute condition. We need to adapt to meet the needs of this generation. The model of treating many of these people in an acute hospital is wrong – we need to be better at looking after people in their own homes and in the community.
People who are older with multiple conditions have different needs from younger patients with a single acute condition
There is no doubt the pressures are getting greater year on year. The system as it is configured is finding it difficult to manage. This is putting pressure on front line staff who are finding it increasingly hard to work under this pressure.
In our State of Care report last year, we said we were seeing improvements in care, but that more improvements were needed. The system needs to change to meet the challenges it faces.
This last winter has been very difficult. We have seen unsatisfactory care of some patients particularly when they are admitted to hospital, waiting in ambulances and when their discharge is delayed.
What is holding us back is the failure of different parts of the system to work together. What patients experience is often disjointed care. It's not just about the separation of health and social care - primary care, community services, hospital services - the whole system needs to work better together.
What’s next for the NHS?
More investment will certainly help. But we need to get the transformation of how we provide care in place first. You can't just invest in the old approach and then expect it to meet the needs of the modern world. Many hospitals have beds taken up with patients waiting for discharge – people that don’t need to be in an acute hospital, but there isn’t care set up for them at home or in the community. You can't judge how many acute beds are needed when many beds are being used inappropriately.
The biggest challenge is to get the right leadership in place across our services. If we can get that in place then everything else should fall into place.
You can't just invest in the old approach and then expect it to meet the needs of the modern world
There are lots of opportunities, which I think the NHS can rise to. We are at a very exciting stage in terms of technology and science - things like artificial intelligence (AI), digital health and genomics [the study of DNA]. There are real opportunities from genomics in terms of understanding the fundamental causes of disease and tailoring the care to individual patients.
AI will no doubt mean that some of the work currently done by clinicians will be taken over by machines. That will free up staff time – when many services are finding it difficult to recruit staff - and they can spend more time interacting with patients and focus on improving ways of providing care.
Despite the pressures the service faces, I feel optimistic about the future for the NHS. What I have witnessed is the tremendous progress we have made during my time in the service and how successful we have been.
It’s great that we can celebrate the success and achievement of the last 70 years, and we have an unparalleled opportunity to build an NHS that is really fit for the next 70 years.