We're more optimistic about diabetes care in the next five years than we've been for
many years because the leadership of the NHS is taking diabetes, both it's prevention and
it's care, seriously.
But we're optimistic about something no body else is optimistic about and that's the economic
squeeze because we know that diabetes prevention and integrated care with people at the centre
can save huge sums of money for the NHS.
I am optimistic that if we do get the resource and the commitment to general practice, that
we will see things start to turn around and so actually for doctors coming in to the profession
now and other colleagues probably this is the best time in a generation to be entering
into a general practice as a career.
The introduction of a five year task force which will map out the real deliverables for
achieving parity of esteem for mental health, gives me cause for hope that for the first
time in a very long time mental health is at the forefront of NHS thinking.
Drastic changes and more money, the medicine prescribed by NHS bosses to preserve the health
service.
The new head of NHS England wants GPs and hospitals to operate differently and says
people should take more responsibility for their health.
A comprehensive tax funded national health service of the sort the nation clearly wants,
remains entirely doable, despite the difficult economic circumstances that continue to face
this country.
So the NHS we've set out our stool as why change is going to be needed over the next
5 years, and what it's going to take.
The best way of answering the question, how?
Is to go as the people that will make it happen.
So Susan we're sitting here in your new Path lab, very impressive, but what about staffing
pressures, what's the story there?
We've increased our nurses on the wards a lot over the last three or four years and
we have seen reductions in pressure ulcers and falls and that kind of thing, so it has
really been valuable and improved patient safety.
But there is an issue about just being able to recruit nurses and there are concerns about
the inflexibility that just having nurse ratios has.
I think there is something around the blend of staff you have, and just having nurses
as the input is restrictive, I think.
You're a fairly small hospital, do you think district general hospitals have a future?
The only way we, and other hospitals like us can really survive is really becoming part
of a network, part of a system.
And for us, at one end is having tertiary relationships which are very mature and sophisticated,
which means patients can get treated locally, which means tertiary providers which come
and use our facility helping us pay for it, but patients get treated locally � and at
the other end we have relationships with the GP's � and if we can do both, so that you
can get patients treated in the lowest cost and environment, as close as they can to their
own home, you can get specialist support when you need it.
All of this requires hospitals and general practice to work together very closely.
So that we um share information about the patients, we operate a very safe clinical
service, and we deliver care closer to home for the patients for their benefit.
And I suspect that some areas we may find that actually we can deliver vertically all
of the outpatient services.
We worked out that we could change what the front end of primary care looked like in terms
of people accessing things digitally, we could change the back end in terms of bigger scale,
and also we could develop into things like community care so that some of the specialised
services, which would traditionally be delivered in hospitals, would be better delivered to
the patient in our GP practices.
The fact that they can get hold of us relatively easily by phone, means that particularly parents
with young children feel much more confident in their GP practice.
Before the new system, we had to go down there and sit in the surgery, and is was full of
people coughing and spluttering and kids crying and screaming, but it's so much easier now.
The app is a new way for patients to access their general practitioner.
From that screen it will either give you directions of how to get your surgery, you can press
one button and you can call you surgery directly or you can click on a button to enter directly
what your problem is, confirm your details, press submit and we will call you back or
Skype you back from the surgery.
It's ever so simple, I mean I'm 72 and I can use it so anybody can.
The hardest thing usually revolves around making sure people understand where we're
going.
Most secondary providers are keep to have less out patient activity, but how does that
work in terms of their finances?
And how do we make sure we don't destabilise the community care provider as a secondary
care provider, so they're in a win win situation as well as us.
So, this morning I'm off the Manchester to spend time with the NHS and with local government
Devo Manc is an area where people are thinking quite radically about the way to join up services
and to promote healthy communities, and the first person I'm going to be seeing is Howard
Bernstein the chief executive of Manchester City Council.
I think it's very important that we talk about Devo Manc, that we talk about health alongside
work alongside employment transport all the key drivers of growth.
One of the big drivers of growth is how we secure a fiscally sustainable system of health
social care over the next five years or possibly more.
We've got to ask ourselves do we need to do things ten or fifteen times, can we do them
once?
We have to join up, we have to start to break down those institutional barriers between
local government assets and NHS assets and other public service assets and start to address
them as community assets.
We're storing up serious problems with the health of our kids, because one in ten childer,
when they start primary school these days is obese, not over weight, obese.
That�s one in five by the time you get to year six.
So here in Manchester they're getting practical about trying to tackle that.
And so we're now off to the Health Academy in Wythenshawe to hear what they are doing.
All the schools in Manchester have got an agenda to improve student and community health,
so particularly against the agenda of national obesity and child development and so on and
the influence school can have on that, so it's a Manchester one it's a national agenda
as well.
But here we have the benefit of the sponsor of Manchester Central Hospital's foundation
trust and they provide us with opportunities for students to really get into not only the
physical side of health but realise that there's an emotional health to look at, social health,
so various aspects and I think that the links that we have with sponsors enable us to drive
that really effectively.
A health promoting school is one that views their students in a very holistic way we recognise
that students have got all kinds of needs, not just physical, but really around their
emotional health and wellbeing because we know that effects their attainment and their
success whilst they're here.
We've seen all the trends from the days gone old in all the old high schools where it was
chips and burgers and Coca-Cola, so I've seen over the years how it's changed, and it's
good because there is a lot of obesity in Manchester and we have to be responsible for
that.
We have to hide vegetables in cakes, in chocolate and beetroot, we do courgette wands, everybody
is happy.
We make wrapps we put salad in the wraps and that way it's gradually introduced into their
diet.
Hi, Simon Stevens.
Nice to meet you.
Hello Frank you've been looking after your mum I understand for sometime now?
Mum was diagnosed with what's called mixed dementia.
Right.
Alzheimer's and vascular dementia, just six years ago now and I took voluntary redundancy
and looked after her and that's what happened.
I immediately went to the library and started reading up as much as I could dementia and
Alzheimer's and a lot of it is about the clinical side of it but not the practical side of it
about how to look after her better.
But obviously things have moved on a lot in Oldham in those six years and now there is
a lot more available to support carers and to support the people with dementia.
I can make or help make the Chester hospital the most dementia friendly in the world, but
what's the point if the community in which it sits isn't � it doesn't make any sense
to me.
So we need to work in partnership not only with our social care colleagues, but also
our communities too if we want people with dementia to live better with dementia we need
to support carers to care well with their dementia and part of that is sharing our information,
sharing our knowledge.
It's where people in Tesco's people in banks in football clubs everywhere is given a bit
more knowledge about what dementia is.
What does the health service need to do differently to put itself on a sustainable path for the
next four or five years.
I think it needs to be more inclusive, I think it needs to come out behind the walls of it's
own hospital, get out into the community start spreading the wealth of what it does best,
and working in true partnership with people to manage some risks as well.
So Tim you've been visiting just about every hospital in the country, what have you found?
I found that everybody still wants the NHS to provide free care, I've found people are
very committed to the health service.
But I think that having been around the country and seen the variation in practice especially
in orthopaedics that in places there is unwanted variation and we're going to have to make
some changes, we found surgeons having a go at complex work and if you are doing low volumes
you are hiring in kit, we found cost for loaning kit for over a year on average across the
country each trust about two hundred and fifty thousand, but some trusts were spending over
seven hundred and fifty thousand and if you look at just hip an knee replacement, we found
the same implant of a knee in one trust of a thousand pounds and then in another trust
it was eighteen thousand and that trust was doing the highest volume.
And what's been very interesting here around the country is that every hospital I've been
to they all think they're getting the best deal, and they've told me they're getting
the best deal and they clearly aren't.
So huge amount of variation, which if we sort out, we could easily save just in orthopaedics
alone across the NHS 2 billion pounds over 5 years and I think that's a conservative
estimate.