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The President Writes - January 2017

The NHS Under Pressure

“The pressures facing the NHS have been clearly highlighted once again, with winter bringing them sharply into focus. This has translated into newspaper headlines and parliamentary debates, but for you, our Fellows and Members, for everyone who works in healthcare, and for our patients, it is more than that, it is our stark reality. As an organisation which represents many thousands of professionals working in the NHS in all four devolved nations, we have been approached on many occasions for our views on these pressures. Recently we have also been asked to comment particularly on how we think NHS Scotland is doing in comparison to NHS England. However, I do not feel such comparisons are helpful, nor will they address the issues which are faced across the UK.

“The NHS in all four devolved nations have much in common. All face turbulent times with increasing demand, rising costs and the needs of an aging population with multiple co-morbidities. On the face of it, the data would seem to imply that NHS Scotland is doing better than NHS England in meeting A&E targets but, in reality, it is not quite so simple. Failure to meet targets is multi-factorial and represents increased pressure on the service. In England, there has been a 30% increase in unscheduled care since 4-hour targets were introduced in 2000, which is very significant. Another pressure is the difficulty in moving patients out from hospital and back into their homes and communities, due to the under-provision of social services. This has a knock-on effect of delays to elective services. As a College, a further concern is the provision of training and education to the next generation of surgeons. As service delivery and emergency care is so reliant on trainees, it diverts them away from access to important training opportunities and activities in elective surgical practice. This damages their training and will damage patient care in the long-term.

“We also need to move away from a culture of blame and ensure that the public are able to take some responsibility for how they use our healthcare systems by ensuring they are directed to the right level of healthcare provider for their needs. This is why investment in primary care is so important. Ultimately, we should not be trying to compare our national services and compete over who is ‘doing better’ but concentrate on fixing the issues which are faced by them all.

“Over the coming weeks I will have the privilege of meeting our membership at a series of RCSEd Forums at which we will be able to discuss and debate not just these pressures, but the future of the NHS as a whole. I hope as many of you as possible will be able to attend but, for those who can’t, I encourage you to contact the College by email or through social media, to share your thoughts and experiences.

“There is no doubt that the NHS faces multiple pressures, and that finding solutions to alleviate these pressures will involve healthcare practitioners, patients, the public, and politicians alike. As healthcare professionals, our final consideration must be always the best interests of our patients now and in the future. We will therefore have to ask serious questions of ourselves, and of others, and face difficult choices and decisions, but it is in the interests of all that we do so.”

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