Dr Marina Soltan, NIHR academic clinical fellow in respiratory medicine at the University of Birmingham, outlines a vision for the future of healthcare, in which physicians need to be more prepared and equipped to manage the needs of an ageing population and increasing pressures on acute services.
NHS services are under more demand than ever before. To meet this challenge, we must embrace a focus on disease prevention, investment in the NHS workforce and the digital revolution. But above all, doctors need to take a central role in leading health education for the public to promote good public health and prevent the rise in comorbidities.
The NHS Long Term Plan encourages a focus on promoting good population health and preventing comorbid illnesses, including obesity, hypertension and diabetes. Comorbid burdens of disease cost the NHS £8–13 billion per year1 and result in increased pressures on acute services, prolonged inpatient stays, adverse complications, and worse patient outcomes.
To optimise population health and preserve resources, doctors need to become health promotion ambassadors and empower the public with practical ‘DIY’ skills to lead a healthy lifestyle. However, doctors should not just sit and wait until it is too late! Most doctors encounter patients when they have already developed multiple comorbidities. To address this, our role needs to adapt and evolve beyond the direct clinical environment, working on the front line in the community including in schools and other public organisations. Health education needs to be broad, and include diet, lifestyle, exercise, asthma, allergies, immunisations, drugs, alcohol, eating disorders, mental health issues and healthy use of social media. Above all, health education needs to be equitable and accessible to everyone in all regions regardless of deprivation.
A multi-dimensional approach is needed when it comes to disease prevention. I founded #CPRinSchools, an initiative for postgraduate healthcare professionals in training to go out into schools to teach about Basic Life Support, and how children can live healthy lifestyles, with the aim of preventing cardiovascular risk factors leading to a cardiac arrest. The project has been a huge success, and I am exploring how we can sustainably expand this programme to incorporate other key healthcare areas. Support to sustain such initiatives is essential, and I am grateful to Professor Carrie MacEwen (chair, Academy of Medical Royal Colleges), Professor Colin Melville (GMC medical director and director for education and standards) and Dr Tony Choules (chair, Foundation Programme Curriculum, Academy of Medical Royal Colleges) for their support to develop this work more sustainably.
At the other end of the spectrum – at the molecular level – the Academy of Medical Royal Colleges are working to help embed genomic medicine into clinical practice within the NHS, with the aim of improving patient care and outcomes long term particularly for those with cancers and rare diseases.
Investing in the workforce
Effective clinical leaders and educators are required more than ever before, and investments in medical education and simulation-based technology are needed to train the next generation of clinicians. More staff will need training on how to use high fidelity simulation to deliver the highest quality of medical education. Postgraduate doctors will also need training in leadership and opportunities to lead in practice. Leading healthcare education in schools, for example, is an excellent way for postgraduate healthcare professionals in training to develop their leadership skills in line with the Medical Leadership Competency Framework. Resilience training for NHS staff is also likely to be beneficial for training the workforce on how to prioritise workload and manage challenging situations effectively.
To recruit and retain the staff we need, the workforce must represent the diverse range of patients it serves. In June 2018, 107,743 NHS job vacancies were advertised and unfilled across the UK. £480 million pound was paid by the NHS on hiring locum staffing.2 In future, more resources need to be invested into highlighting the opportunities that exist when working for the NHS, enhancing recruitment with the aim of developing a sustainable workforce. Schools are able to increase awareness about health and career choices and I have found that a big bonus to delivering healthcare education in schools is children’s increased aspirations to apply for NHS careers.
Embracing the digital revolution
The secretary of state for health and social care, Matt Hancock, is committed to revolutionising technology within the NHS. In the era of smartphones, smart watches and tablets, archaic fax machines and pagers are being phased out. NHSX, a new joint organisation for digital, data and technology, launched earlier this year, with the aim of revolutionising how patients receive care in the future. The system will aim to join up patient information across the NHS and empower patients to take greater control of their own health. This will save clinicians’ time, and allow patients to access the best and safest treatment pathways. As healthcare professionals, we must come together to modernise and support the digital revolution, setting the NHS on track to become the world-leader in innovative healthcare.
1 Department for Health. Comorbidities: A framework of principles for system wide action. https://bit.ly/30n27T5
2 NHS Improvement. NHS could free up £480 million by limiting use of temporary staffing agencies.https://bit.ly/2VBumP0