1. Act early in time critical conditions to prevent expensive disability and costs of long term care. Ensure equitable & rapid emergency access to STEMI PCI, stroke thrombolysis, prehospital critical care in trauma & cardiac arrest to stop secondary harm after primary damage.
2. Investigate possible new cancer in days, not months to reassure most and intervene at stage 1 for those that need treatment before social and NHS costs mount up managing metastatic disease.
3. Protect ED capacity to rapidly rule out or treat NSTEMI, surgical abdomens, sub arachnoid bleeds, head injury, limb/mobility threatening fractures, complex wounds, poisoning, delirium, DKA, sepsis. Acute timely care with scanners & specialists, not fob off, redirect, and hope expensive procrastination does not lead to an adverse event and costly legal settlement.
3. Rehab the shit out of all admissions from day 1 to save money. Intensive and relentless focus on speech, mobility, ADLs, psych, diet. Maximise potential to get the patient home, looking after themselves, or even back paying taxes and caring for their dependents.
4. Prevent delays to social care. Empty out people lying about in wards losing muscle, confidence, & social networks. Pay carers properly, encourage overseas workers to come and stay, nationalise care homes. Way cheaper than blocking hospital beds, hobbling ED, & cancelling electives.
5. Support primary care as a medical home for long term care of chronic conditions with clinical continuity and regular medication review. Mental health, COPD, diabetes, frailty, arthritis, renal failure. Nip deterioration in the bud, keep them out of hospital. Clear, pre-agreed, treatment escalation plans for those approaching end of life.
6. Insist private hospitals doing the quick and easy electives compete on same field as NHS by charging for clearing up their messes and half-arsed referrals to ED. And subject them to same critical governance and scrutiny. And charge a levy for using NHS trained staff. And legislate no exclusion clauses from health insurance policies.
7. Ban all NHS meetings that last more than 1 hour, or involve more than 7 people, or recommend setting up a SLWG to report back, or use the phrase "moving forward". Remind senior NHS managers that fixing problems is better than looking for who is to blame.
Summary: Early definitive & intensive interventions in acute problems. Continuity, stability and vigilance in chronic problems. Staffing, flow and urgency in hospitals. Make costs of private care realistic to prevent parasitism on public, universal healthcare. Cut out all the bullshit meetings, directives, zombie ideas given birth on post-it notes, hobby horse re-organisations and DO THE REAL WORK.
💙 NHS.
You're welcome.
https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england/summary-letter-from-lord-darzi-to-the-secretary-of-state-for-health-and-social-care
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