Anushka Mehrotra talks about the future of the NHS, and the role young doctors and students can play in shaping it.
A surgical registrar, while discussing an interview for a job at a main hospital in Newcastle-upon-Tyne a few years ago, described how challenging the interview was. The question that stumped him was not about the details of thoracic surgery, patient outcomes, or best clinical practice. It was far simpler and far more complex. ‘What is the future of the NHS?’
”How was I, a simple houseman, meant to answer that?” In fact, this is the exact question I was asked during my undergraduate interview, around the same time. It is a key question, which all healthcare workers in this country need to ponder and address.
When I heard that The Lancet was holding a conference, The Health of the Nation, at the Royal College of Physicians, London, I took the opportunity to attend, feeling that it was my duty as a future doctor in the NHS to understand the current running and future changes and challenges the institution may have. Hopefully I would gain a better understanding of what it is to be a good doctor and what the needs of my future patients might be.
Set in a stunning location overlooking Regent’s Park, snow slowed London’s normal hectic pace outside, but Richard Horton’s opening address brought energy to the room of doctors, journalists, students and healthcare professionals. With the current NHS system under review, what would the future bring? A potential change in government, internationally recognized research, and greater importance put on healthcare professionals such as nurses and pharmacists could change the face of the NHS.
Medical Director, Bruce Keogh, discussed areas in which the NHS has excelled, and areas that need further improvement. The UK has the lowest cost at point of care in Europe. Waiting lists have also decreased dramatically after the pressure felt over the last decade. However, although the NHS provides easy access and a full range of services, Bruce Keogh emphasized that quality of care needed to be improved, as well as patient-centered care. Inequalities in healthcare and the rich-poor divide have also increased, not to mention changes in lifestyle choices leading to problems such as the obesity epidemic and increased smoking in young women. Keogh felt that junior doctors were the key to change and increasing quality of care, with their daily patient contact in a clinical setting. It also up to us, as future doctors, to be aware of the potential changes we can make to clinical guidelines and quality of service for patients.
A panel’s discussion on the performance of the NHS brought up issues such as the massive reduction in waiting list times, and our slightly decreasing productivity in terms of money spent and outcomes gained. Martin McKee, from the London School of Hygiene and Tropical Medicine, told us that in comparison to the rest of the original European Union Countries we have the lowest female life expectance and highest perinatal mortality. However, there is a lack of comparable data across the EU, and more is needed before we can jump to conclusions about the state of our health service!
Allied professionals in the NHS also have a growing role in our healthcare. Catherin Duggan, clinical pharmacist, talked about the move of pharmacists in their role as shopkeeper and academic to active member of the clinical team, working on the wards and trying to reduce medication and prescribing errors as well as increasing quality, safety and access to care. Peter Carter, Chief Executive of the Royal College of Nursing, discussed the variety of nurses, ranging from specialist to community, and the need for further practical training, especially for healthcare assistants. There are many challenges faced by the NHS but patients will benefit from increased multi-disciplinary teams and professionals working across the board to increase standards in training and quality of care.
Speakers re-iterated the need for young clinicians to be more involved in research, and the limits the current fast track training system puts on young and future doctors. Research is one of the key methods of increasing quality of care, but funding and public expectation may hinder its advance.
The potential of the electronic health record, web based information databases for patients and evidence based collations of data for clinicians all highlighted the information technology revolution, and how this may change the NHS and the health of the nation. Increased patient choice will come hand in hand with this increased access to knowledge, with many patients currently self-diagnosing. This in turn leads to the tricky question: is there a role for the present doctor in the future patient-centered system?
After many heated debates and discussions, and listening to statistics and opinions of varying professionals at the top of their fields, I feel that the answer is YES. The role of the doctor is changing within this changing system, but our role will be important nonetheless.
As future doctors, we must be aware of the changes around us, the importance of patient choice, evidence-based practice, and increased quality of care. This can be done by engaging in research, working with policy makers, and informing the media about important public health issues as a means of education. Even with the limitations of the new working time directive and fewer training possibilities, we must still take every opportunity we can, as students and doctors, to be active members of the NHS, and help to maintain and improve the quality of care we bring to our patients.
Anushka Mehrotra is a 4th year medical student at Newcastle University, UK
