The NHS at 70: The view from a hospital

Daniel Elkeles

Daniel Elkeles, Chief Executive of Epsom and St Helier University Hospitals NHS Trust, speaks to Sarah Brealey about the challenges facing hospitals as the NHS celebrates 70 years.

I imagine the founders of the NHS would be pretty impressed by where we are. What has stayed the same is that it’s still free at the point of delivery. If you are ill, you don’t have to worry that you will have to pay. But a lot has changed. The quality of care is way better than it was in 1948. Life expectancy has increased, survival from heart attack and stroke has dramatically increased. And there’s the sheer number of people working in the NHS – well over 1 million; a much bigger scale than could have been envisaged in 1948.

For all the pressures there are, if you are really unwell, you will get first-class treatment almost anywhere in the UK

For all the pressures there are, if you are really unwell, you will get first-class treatment almost anywhere in the UK. The NHS is a brand – wherever you are in the country, you know what you are going to get. The NHS is the most valued institution for the people of the UK. It makes us feel British. It is something special.

What is also special about the NHS is general practice, the fact that when you are ill you can phone your GP and see someone that day or the next day, you don’t have to pay and the GP is the one orchestrating your care as you go through the system.

And there is the speed with which you can get seen. No-one else has the four-hour standard in accident and emergency or gets close to meeting it. If you separate out last winter, which was unbelievably hard, for the most part we have been meeting it.

But there are big challenges, to do with the buildings issue, rising demand, and not enough money.

The problem of old buildings

There are specific issues for this hospital about buildings which are not in a good condition to look after patients in, and we’re not alone in this. Over the last 20 years a number of hospitals have been replaced, but there are still others that I think everyone would say are in urgent need of replacement. Just in London there are four – St Helier hospital, Hillingdon, Whipps Cross and the old part of St Mary’s. In St Helier we still have Nightingale wards [wards of about 20 patients in one long room] we don’t have enough single rooms, to give more privacy and to look after people who are infectious or who are dying. We have services in the wrong places, you have long walks between critical care and out patients and A&E. There’s a rat run of corridors leading in different directions.

We need more money, but we also need to think what we need to do differently. The budget will never be limitless, but the demand is potentially limitless

We are a large district hospital but we don’t have a fixed cardiac catheter lab [for treatment such as planned angioplasty and stent, or pacemaker insertion]. People have to go to St George’s in Tooting or St Peter’s in Chertsey for this. We don’t have one because we have spent so much money repairing our buildings. We don’t have much money for equipment. Luckily, we have a legacy left to us for cardiology, and because of this we hope that by 2020 we will have a cath lab.

Beds in a hospital corridor

The problem of rising demand

Demand is rising. There are more patients requiring emergency care than ever before. There aren’t enough staff to look after patients safely or enough doctors to fill the rotas.

I think almost everybody now acknowledges that we haven’t had enough money in recent years into the NHS. The impact on patients is we haven’t spent enough money recruiting people to keep up with demand, so staff are working under a lot of pressure. We need more money, and definitely more money to fund replacement buildings and equipment, but we also need to think what we need to do differently. The budget will never be limitless, but the demand is potentially limitless.

Most of what a district general hospital does is outpatients and diagnostics – only a small amount is acute care for people who are very ill. We should join up better with community and primary care, and increase the expertise in primary care, so that more of the tests and outpatient appointments can be done outside of hospitals, so care is joined up and closer to where patients live.  Then hospitals can really focus on specialist skills. This is already happening with heart care, for example if you have a heart attack you go to a specialist centre.

It cannot be right that we have the most obese children of any western country, and that older people are living in homes they cannot afford to heat

I think that all the political parties have begun to realise we need a debate about the NHS needing more money than it currently has. I believe we can get out of austerity for the NHS.

How we can help ourselves

We also really need a mature conversation about looking after ourselves more. There are a whole lot of self-help things we should be doing. We have fewer people smoking, but more people who are obese, and more people not taking enough exercise.

For Epsom and St Helier I am optimistic. I think we have made the case pretty coherently that we cannot carry on as we currently are and still have hospital services. We need £400 million to build a new specialist acute facility for people who are acutely unwell. I am feeling optimistic about that happening.

The thing I am pessimistic about is we are only going to get the NHS to be sustainable if we have a conversation about how we look after the elderly and how do we get people to take more responsibility for looking after themselves. It cannot be right that we have the most obese children of any western country, and that older people are living in homes they cannot afford to heat.

We need to be more proactive and pre-emptive. Imagine if all older people had an hour’s consultation with their GP once a year, to properly go through their needs, what might go wrong, what can be done for them. It involves more money being spent, on falls prevention, exercise classes, dealing with loneliness, looking after people’s mental health better. But it would save money and improve people’s wellbeing in the long run.

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