I’m a doctor – this is how I’d bring the NHS back from the brink

Crumbling hospitals, outdated IT and burnt out staff - what has happened to our once heroic NHS? With the waiting list for treatment currently standing at 7.5 million and 54,000 people a month waiting more than 12 hours in emergency departments, Health Secretary Wes Streeting’s plan to bring the NHS “back to basics and focus on the fundamentals” should be music to our ears.

“It needs to deliver on patients’ priorities – shorter waiting times, being able to get a GP appointment and ambulances that arrive on time,” he says. While his priorities are targeted at those caught in the backlog and seeking speedier GP appointments, there are concerns that dementia and women’s health could fall through the cracks.

With Mr Streeting standing by his three “strategic shifts” – moving care from hospital to the community, focusing on prevention instead of sickness and going from analogue to digital – what do doctors in A&E and in GP surgeries think must change? We spoke to experts in the field about the mountain of problems ahead for the health service – and what will turn it around.

The surgeon: ‘We need surgical hubs to speed through the waiting list’

Francisca Ferreira is a neurosurgeon in training, a clinical lecturer at Cambridge University and council member of the Royal College of Surgeons of England.

To reduce the backlog of 6.3 million patients in England, who are collectively waiting for 7.5 million procedures, urgent intervention targeted at infrastructure and staffing are needed. This will require investment in the NHS that matches that of comparable countries.

To improve NHS infrastructure, crumbling NHS buildings and outdated IT systems need to be modernised. We also must expand and harmonise digital record systems and their interoperability in NHS services.

The NHS should also encourage better use of surgical hubs, which have been proven effective in bringing down waiting lists. These hubs separate planned surgery from emergency care, ensuring operations can go ahead even during periods of extreme pressures, like this winter.

Our current poor infrastructure is contributing to failing workforce morale, burnout and rising attrition rates. The surgical workforce is also consistently working beyond capacity. The latest General Medical Council data shows almost a third of surgeons are struggling with burnout.

We also need to expand and improve training opportunities for resident surgeons including in private hospitals, which are increasingly delivering NHS care.

If the Government wants to meet its targets of cutting the number of patients who are waiting more than 18 weeks for treatment (which applies to 40 per cent of those on the waiting list), it must back up its ambitions with real investment in infrastructure and training the surgical workforce.

Other areas also need attention. We need to properly fund social care to avoid unnecessary hospital admissions and stays. We need investment in improving public health, nutrition and lifestyle. We need early intervention in chronic health conditions, more investment in GPs to reduce A&E pressures and efficient harmonisation between out-of-hospital services.

Without these changes, both patients and surgeons will continue to face significant challenges, and the Government’s pledge to cut waiting times will remain a likely fruitless battle.

The emergency medic: ‘We need 10,000 more beds to cut long A&E waits’

Dr Adrian Boyle is President of the Royal College of Emergency Medicine (RCEM) and has been an emergency medicine consultant for 20 years.

The problem with emergency care is that we’ve got patients in all the wrong places. Older patients are being looked after on acute medical wards, acute patients are being looked after in the emergency department and the emergency patients are in ambulances waiting to get inside the hospital. So, we’ve ended up with a very inefficient system.

To solve this, we need to increase the capacity within our hospitals by around 10,000 to 12,000, so that we can look after patients properly, in the right places. It sounds like a lot but, actually, that’s one or two extra wards per hospital. This would allow us to sort out the flow through our emergency departments without even hiring any extra staff.

We need more single patient rooms. We’re addicted to open wards in this country but this means that, if there is a flu patient, you need to close that entire bay to new admissions. Not only would more individual rooms improve capacity but patients would have a lower risk of picking up infections and they will sleep better, which will help them recover faster too.

We also need to tackle long stays in emergency departments. The Health Secretary has set a goal of a minimum of 78 per cent of patients seen within four hours of arriving at A&E by March 2026 but this is a low target. It incentivises hospitals to treat patients who are easy to sort out – those with sprained ankles and cut fingers – but when a patient with complex care needs comes in, they get less focus because staff know their case is going to take longer than four hours anyway.

We need to focus on a few key areas. The NHS has been trying to do everything for all people when it can’t. It needs to prioritise.

The dementia expert: ‘We need to diagnose more dementia cases’

Fiona Carragher is the chief policy and research officer at Alzheimer’s Society and former deputy chief scientific officer at NHS England. She holds a visiting professor appointment at the University of Ulster.

The biggest issue facing NHS dementia services is the rise in diagnosis waiting times; the average overall wait time from referral to dementia diagnosis is 22 weeks.

Dementia is the country’s biggest killer and its prevalence is on the rise – 1.4 million people in the UK are expected to be living with the condition by 2040, up from around a million people today. It puts major pressure on our economy, on the health and social care system – and on countless individuals, their loved ones and carers.

But more than a third of people with dementia in England don’t have a diagnosis, which means over 250,000 people have an undiagnosed terminal condition.

Despite rising admissions to memory assessment services (up by 130 per cent per week since 2009), average staffing levels have not increased accordingly. There’s also too much variation between approaches to dementia diagnosis and care, based on differing prioritisation and resources at the local level.

At present, just 1.4 per cent of all healthcare spend on dementia goes on diagnosis and treatment, which is woefully insufficient.

Addressing dementia diagnosis is fundamental in achieving Streeting’s goal of getting “back to basics”. By removing the dementia diagnosis rate target (that two-thirds of people with dementia should receive a diagnosis and support), the Government is missing a vital opportunity to reduce waiting times as well as reduce pressure on A&E.

People with undiagnosed dementia attend A&E, on average, 1.5 times a year, which is more than those who do have a diagnosis. We also know that one in six hospital beds are occupied by someone living with dementia – rising to one in four by 2040.

We also know that the earlier a person receives a diagnosis, the better the outcomes. With early and accurate diagnosis, people can receive the care, support and treatment they need; it reduces unplanned hospital admissions and therefore makes vital savings for the NHS. It also opens up the possibility of participation in research trials and allows people to plan, with dignity, for their future.

The GP: ‘We need thousands more family doctors’

Prof Kamila Hawthorne is chair of the Royal College of GPs (RCGP) and has worked as a GP in South Wales for 30 years.

One of the Health Secretary’s three “strategic shifts” is to deliver more care out of hospitals in the community. This makes sense. Care is more cost-effective in the community – it’s also where most patients want to be treated.

Recruiting and retaining more GPs in the workforce must be a vital component of the forthcoming 10-year health plan, if the Health Secretary’s plan to shift more care into the community and ‘bring back the family doctor’ is to be realised. This in itself is ‘back to basics’: delivering safe, timely and holistic care close to home, identifying health issues and intervening appropriately before they get more serious.

It’s what GPs are trained to do and it’s what we want to do; but we must be appropriately resourced, and have enough GPs to do it.

When properly staffed and resourced, a robust general practice service can alleviate pressures across the health service. GPs and their teams make the vast majority of patient contacts – last year alone, we delivered 367 million appointments (20 million more than in 2023), all with a shrinking portion of the NHS budget and a workforce that has not risen in step with demand.

Despite these efforts and pressures, we still hear too many patients reporting struggling to access GP care and services when they need them. GP workload is growing both in volume and complexity but the GP workforce is not growing fast enough to keep up – and our patients are bearing the brunt.

Ultimately, we won’t be able to improve our patients’ access to appointments if we don’t have the numbers of GPs we need. The Health Secretary has committed to reviewing the NHS Long Term Workforce Plan. This is a necessity for increasing GP numbers, through expanding training places and giving more focus on keeping more GPs at all career stages in the workforce longer.

Another basic necessity for GPs and our teams to ensure patients receive the care they need is decent infrastructure: the buildings we work in, and the equipment and IT systems we use.

Cramped and crumbling buildings and outdated IT systems not only affect our patients’ experiences of receiving care, but our ability to deliver more appointments and train more GPs and medical students. So when we talk about going “back to basics” infrastructure issues must also be addressed.

Across the board, we need to see a guarantee that general practice will see a higher proportion of the NHS budget, and that this is tracked locally and nationally, so we can guarantee our patients the treatment they need and GPs want to be able to deliver.

The cancer doctor: ‘The NHS needs a cancer plan backed by million of pounds’

Prof Pat Price is the chair of Radiotherapy UK and founder of the Catch Up With Cancer campaign. She has been a consultant oncologist for 35 years.

There are a myriad of problems that have brought us to this crisis point in cancer care. We were at capacity before Covid, built up a backlog during the pandemic, and the already fragile cancer pathway has now broken down – we simply cannot cope with current cancer care demands under the existing system.

Above all there has been a failure to accept the scale of the problem and radical changes that are needed to put it right. While the NHS has put a great deal of resources into cancer diagnosis, cancer treatment has been severely neglected, so patients are being diagnosed only to face long delays before receiving treatment.

Radiotherapy is needed in about half of all cancer cases and is the most cost-effective cancer treatment. Rather than sticking plaster solutions, we need a comprehensive, bold, and transparent national cancer plan. Reports have suggested that radiotherapy alone needs £250 million of funding over the next decade. We have a world class front line workforce – but they are stretched to the limit.

I agree with the Health Secretary’s “back to basics” approach because, for many cancer cases, we know what works – early diagnosis, followed by timely treatment using proven methods.

A recent study in The Lancet showed that from 2000-2020, if the UK had prioritised established, effective treatments such as radiotherapy, patients would have collectively gained significantly more years of healthy life. We must also listen to front line staff who know what they need to do to treat cancer patients.

The Government should immediately implement a bold, funded far-reaching National Cancer Plan. Proven, life-saving treatments such as radiotherapy should be given long-term funding settlements. Officials also need to invest in the workforce to increase productivity and improve patient outcomes.

The dentist: ‘The Government needs to get serious about saving NHS dentistry’

Shawn Charlwood is the chair of the British Dental Association’s General Dental Practice Committee. He has worked as a dentist and practice owner in Lincolnshire for over 30 years, previously serving at Manchester Dental School and the Manchester Royal Infirmary.

For a generation, dentistry has been starved of funding, with a budget that’s remained effectively flat for 15 years. The only difference is patients are paying more in charges, while ministers pay less. The result is many practices are delivering some NHS treatment at a loss.

Any credible “back to basics” approach hinges on giving millions the chance to secure dental care when they’re in pain. We’ve heard warm words, but we need detail and dates.

“People are still pulling out their own teeth. But not one of the promised extra 700,000 urgent dental appointments has been delivered. Tooth decay remains the leading cause of hospital admissions among young children, but there’s no progress on rolling out tried-and-tested preventive programmes in our schools that could lower decay rates.

And, crucially, there’s still no timetable for when the discredited dental contract (which does not sufficiently cover the cost of practices to treat NHS patients) fuelling this access crisis will be ditched. A report from Lord Darzi, commissioned by the Health Secretary to diagnose what was wrong with our NHS, stated the service’s survival hinges on a new dental contract. We need Mr Streeting to get on with writing the prescription.

The Government says it wants to make a strategic shift from “treatment to prevention”, from “hospital to community”. But a damning Public Accounts Committee report found that hospitals are getting the cash and attention, when primary care, the supposed “front door of the NHS”, is coming off its hinges.

Instead of any progress on these fronts we’re getting more of the same: a rerun of austerity policies that have brought this service to its lowest ebb. We’ve seen practices clobbered with hikes in National Insurance bills, with no corresponding support. Dentists waiting on a pay rise for a financial year that started last April, have just been handed a real pay cut, the result of a total failure to keep pace with surging costs of delivering NHS care.

Goodwill is now in short supply. So, what is desperately needed is a clear sign that the new Government is actually serious about saving NHS dentistry.

The Health Secretary told Parliament in January that in his view “NHS dentistry is at death’s door.” What we need now is action capable of reviving the patient.