NHS chief David Nicholson offers difficult medicine as he stands down

Following 36 many years operating for an employer he joined straight from university, Sir David Nicholson refers to himself half-jokingly as “an NHS lifer”. The lifer, however, is about to gain some new horizons – reluctantly, one particular suspects – after paying the previous eight years as chief executive.

These are his last days in office, as he stands down on 31 March. He gave couple of interviews during people eight many years, in spite of being the boss of a £100bn a yr organisation that has a unique location in British daily life, and grew to become nearly invisible in the wake of final year’s public inquiry report into the Mid Staffs care scandal that noticed him branded “the man with no shame”.

But as he prepares to consider his leave, he is lastly subjecting himself to public scrutiny.

By nature a private man, and someone who for months final 12 months was the concentrate of relentless, almost brutal, criticism by some in the media, MPs and patient campaigners, he is visibly more relaxed.

In Manchester last week he revealed his humourous side by recounting to an audience at the NHS’s yearly Expohow, despite efforts to preserve his anonymity at the diabetes patient group he joined near his home in Birmingham after currently being diagnosed with the condition last year, one more of individuals current appeared to have twigged who he was. “I know you, I’m confident I know you,” she told him accusingly, ahead of dragging her friend more than to verfy her obtaining. “You’re … you are … that butcher from Kidderminster”.

Still only 58, Nicholson gives the impression of becoming nowhere close to prepared to leave his post, of getting a man with unfinished enterprise who, offered his apparent passion for maintaining the NHS as a viable concept in the encounter of acute and expanding pressures – demographic, fiscal and behavioural – would relish the occupation of sticking about to administer the difficult medicine he feels is necessary to make sure the patient survives for many years to come.

He is blunt in his evaluation of the services: “The NHS in its current type is unsustainable.” That is not, he rapidly emphasises, an argument for it undergoing nevertheless another significant reorganisation. Far from it. He described the final 1, the unpopular and barely-understood masterplan dreamed up and implemented by then health secretary Andrew Lansley in 2010-twelve, as “so huge you could see it from outer room”.

In his see the NHS requirements to undergo huge changes, but to the way it delivers care rather than to its complex architecture, if it is to survive as a special model of taxpayer-funded universal healthcare that is free of charge at the point of need. “It is sector-wide alter [that is required]“, he says. “Substantial adjust, on a scale we’ve never seen before, and more than a shorter period of time than we’ve ever observed ahead of in healthcare.” The process, he adds, is “unprecedented”.

Without transforming how it cares for patients it will encounter what he calls “managed decline”.

“I never feel the wheels are going to fall off tomorrow. But we’ll see a position where people have to reduce the quantity of nurses on the wards and have to reduce the drugs that we give to individuals. I can see all of individuals things happening unless we embrace this alter.”

So what adjust, specifically? Amid a blur of bulletpoints typically wrapped in NHS technospeak, a clear program of the Nicholson-envisaged future emerges. There would be huge centralisation of services that are presently presented in numerous hospitals in order to improve the top quality of care. Rather of every single hospital possessing a standard A&ampE unit, for example, there would be “between forty and 70 main emergency centres across the country, with all other centres feeding into them in a network.”

That does not necessarily imply that people other hospitals lose their emergency division altogether, he stresses. They will just no longer deal with the most serious situations. “The others will [nevertheless] consider 70% or 80% of the individuals who currently flip up at A&ampE units and treat them as typical.”

Similarly, the 300 distinct spots which presently give specialised NHS providers, such as cardiac or cancer care or organ transplantation, ought to ideally decrease to between 15 and thirty, he says.

He recognises how controversial any planned change is locally to the assortment of services any hospital gives. But, he adds, “with numerous strokes and heart attacks, ambulances will [previously] go previous their neighborhood hospital [to a specialist centres]. There’ll be a lot more of that.”

He also understands but is frustrated by people’s attachment to the NHS’s bricks and mortar. “For clear factors we get obsessed with buildings in the NHS, but they are not services. Folks are really proud of hospitals and put plenty of time and energy into them. But they want to look beyond them. It’s like hospital beds. Folks are fixated by the variety of them, but I’ve by no means recognized a hospital bed heal the sick.”

A lot much more care needs to be delivered in or close to people’s residences, he says, especially for the 15 million to 17 million individuals with one particular or more long-phrase situations this kind of as asthma or heart difficulty whose care currently will take up 70% of the NHS’s price range. He envisages a long term in which teams of various kinds of overall health and care experts work seamlessly with each other to care for individuals in and specifically out of hospitals, concentrating on assisting them remain well

Technology will be pivotal, as will GP solutions that are obtainable about the clock each day of the week.

It is essential, he believes, for the nation to engage in a serious, urgent and challenging conversation – ideally with medical professionals as the chief persuaders of a reluctant public – about the potential of the NHS.

Without having that, and with out undertaking large alterations, the service’s future might fall into doubt, he says.

“Public support in this nation for our healthcare method is better than in nearly any other nation in Europe, and that is so crucial for a taxpayer-funded technique. My fear is that if it gets worse, just before you know it you get to a place in which a minority of the people help it and then individuals who can afford to [do so] will go elsewhere for their healthcare. In those circumstances the question of how sustainable the NHS is turns into a a lot much more challenging a single to deal with. Which is my be concerned.”

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