CPF 

EASTERN REGION

Workshop on Fixing the NHS

10 July 2025

Informal Notes Without Prejudice

Introduction

Those present felt that the NHS required considerable reform based on a modern model that satisfied patient demands, best clinical practice, (potential robotic, new R&D medical science) localism, use of AI and overall costs. All the options should be considered with wide consultation.

Although the Labour 10 year Plan may provide “food for thought” it was in many ways not addressing the core issues. It was another document issued without serious consultation with all interested parties and debate. The NHS needed a strategy for the future.

Until social care is strategically reformed (even integrated into the NHS as a whole) the reform of the whole NHS will not be complete. Not until this is done the overall picture both clinically and management activity will not be resolved. A thoughtful debate is required involving a wide participation 

In a modern digital society there could be a tendency to lose direct contact between patients, clinicians, management and staff. The size of the NHS is awesome. Has the time come for the NHS to be broken up on the basis that the current model is to big to reform

The question of funding direct from taxation income based on potential changes in demographics, robotic activity and taxation limits has also to be considered with all the potential options set out and costed. The public have a right to decide which option (s) should be further examined. A major part of that debate centres round the size of state intervention using taxation or other models

Comments

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• The NHS is to large to provide an efficient community service and it should be broken up into manageable units with the emphasis on localism. The abolition of NHS England provides an example how bureaucracy can be reduced by negating a tier in the system 
• The new boundaries for the Integrated Care Boards should also be reviewed. It is understood that little consultation took place
• Reducing a further management and policy strategy tier could reduce bureaucracy. Saying this in context to abolishing NHS England the duties of ICB’ could also be absorbed by the Department of Health

GP Appointments 

• GP appointments are in a shambles and doctors contracts should be reviewed. Telephone software should be introduced in all GP surgeries for patients to make appointments with the right to be seen by a preferred doctor for continuity of care. This last point would save both time for GP’s and patient satisfaction. Any initial consultation perhaps by telephone but future contact with a doctor on the same issue to be conducted in person (or at least online by digital video initiated by the surgery).  Doctors have a responsibility to care for all their patients. 
• All patients should be offered an appointment within 3-4 days. Urgent diagnosis on a same day basis
• GP surgeries should be open longer each day and cover 6 days availability.
• In some areas community centres have been Introduced merging individual GP surgeries which can then justify installing medical devices such as radiology and screening of patients in house. Minor surgery could be undertaken. This could reduce A&E visits

Social Care 

• Social Care continues to be put off for future action but this has to be urgently addressed. We have an ever increasing aged society who need care. The ideal method is providing a system of independence “at home”. Nevertheless with adequate assurances that care can be called on quickly.
• There are various levels of social care for the elderly, each with their own problems. 
• At home care for the aged with prompt access to medical attention. (Often this is subsidised by in house family carers mostly unpaid). Those needing this sort of care should be encouraged to stay at home. Independent and yet assistance provided by the Welfare State moving to:-
• At home with constant assistance ongoing with a care package
• At some point entering a retirement home. 
• At another stage entering a nursing home. 
• All these have implications for the management of medical care and this has to be addressed. 
• In addition the care packages being offered by local social services are patchy in quality. Attendance at odd times and not by a regular carer – not suiting the habits of the patient. 
• Other patients are often blocking hospital beds as there is no facility in the community to provide sympathetic caring
• The cost of nursing and care home care is extremely high
• More training of staff and adequate remuneration to be planned for this future need. 
• The possibility for integration of clinical assistance for the aged into the NHS
• Other aspects of social care under Local Authority control need to be given serious attention especially with so many patients claiming mental health issues

Preventative Care

• Preventing illness must be a priority and emphasis given to annual checks taking place at GP surgeries conducted by trained practitioners. In some cases a simple blood test is required and not to be refused. This surely can be managed on an annual basis 

Dentist Appointments

• The issue with Dentist appointments has been overlooked and yet we are all encouraged to seek preventative care.
• The chance of going onto an NHS dentist list is nearly unheard of
• Recommended that all dental patients, even those being treated by a private practice, should have an annual check up where payment is covered by the NHS

Hospitals

• There was uncertainty in the way management in hospital and Trusts operates. With such a large workforce there is a question whether managers have the capability of knowing exactly who is employed and in what position
• An AI software should be established to oversee all personnel in the individual NHS facilities.
• Better procurement arrangements have been implemented but there is still room for improvement 
• Patient care must be the upmost priority and organisation of staff given more attention. Constant review of data covering such subjects as mortality and patient clinical data

Clinical Hospitalisation

• Attention to use all medical facilities on a full time basis.
• We are told that Consultants are often hampered by staff shortages to clear theatre usage and bring in new patients. Medical staff should not be involved in transferring patients back to a ward. This should be a management priority
• If this is not resolved we will continue to have well qualified doctors sitting around and the use of hospital theatres not fully utilised for patient care. Theatre use should be reviewed.
• Rural areas have specific issues and these should be addressed. (Transport, video diagnosis, visits by district nurses (if they can be identified)
• Those undertaking a medical training by the NHS should be required to sign a 10 year contract. 

Management of the NHS.

• Management of the NHS was discussed emphasising that patient care must take  priority.
• Agreed that the abolition of NHS England would cut out a tier of management bureaucracy in the NHS 
• The new regionalised Integrated Care Boards being proposed seem to spread over a wide area and could negate the immediate best practice for patients. Become out of touch. Boundary review should be reviewed and given more chance for consultation 
• The activity of ICB’s should be  scrutinised and potentially,  like NHS England, their duties be absorbed into the Department of Health
• If ICB’s were abolished this would give each Trust more autonomy in managing funds which could be allocated direct by the Department  of  Health (under Minister scrutiny)
• Do we need an additional tier between Trusts and the government Department. The Management functions of the NHS have become even more bureaucratic with so many tiers established which can hide the necessity of up to date best practices in care. The “leave everything alone diagnosis” not the right way forward
• Costs related to funding should be better analysed
• Best practice to be under the control of clinicians

Conflict of Interests

• This point is rarely discussed in relation to the NHS but we have seen this recently come out into the open. Bullying. coercing and covering up issues have been reported
• Perhaps this issue should be analysed especially in the appointment of senior policy managers and Board members where internal failings have been seen
• Board members of Trusts and elsewhere used to be unpaid. This should be reviewed with a view concentrating the right individuals approach to “public service” with those appointed not getting any payment