President's blog. Closing the gap between the aspirations and realities of delivering care

RCP president Jane Dacre provides her reflections on the autumn statement 

Last week I provided evidence to a House of Lords Select Committee. As part of the inquiry I was asked how ‘do we ensure the long term sustainability of the NHS?’ In my opinion, this can only be achieved by ensuring that we deliver the right care, at the right time and in the right place. This is not yet possible because of the growing gap between what we aspire for our health and care system and the reality of the situation. Political developments this week show that we are no closer to reducing this gap.

The NHS is a fantastic institution one which I am incredibly proud to be a part of. It is the envy of the world, but we know it is becoming increasingly difficult to deliver the care patients deserve. NHS Trusts are reporting a deficit of £2.45 billion and the RCP’s own research has found that 40% of advertised consultant posts remain vacant which places increasing pressure on the existing services. 85% of physicians believe that current health service funding is not sufficient to meet the needs of patients.

The NHS is a fantastic institution one which I am incredibly proud to be a part of. It is the envy of the world, but we know it is becoming increasingly difficult to deliver the care patients deserve.

Increasingly there is a consensus building among health leaders, clinicians, commenters and policy formers that the chronic underfunding of social care services is one of the biggest threats to patient care and the NHS. The Local Government Association estimates that social care faces a funding gap of £4.3 billion by 2020.

If you ask any patient about their services no one would distinguish between primary care, secondary care, NHS services or social care. It is all just care. The NHS does not operate in isolation and patients’ needs do not neatly follow funding streams of social care and NHS. The proportion of delayed discharges from hospital to community settings, attributable to social care, has risen from 26 per cent at the end of 2014/15 to 31 per cent in the third quarter of 2015/16. A further 87% of physicians point to the availability of social care services as a challenge to discharging patients from hospital. Is this the best we can offer out patients?

This was the message that the Royal College of Physicians along with a significant representation from the health community brought to the government in advance of this week’s Autumn Statement. Alarmingly during the 38 minute statement, the Chancellor only made two broad references to health care and there was no recognition that underfunding of social care has a profound impact on the NHS and the safety of patients. In March 2016, 5,700 people were in hospital not because they needed hospital care but because they could not be discharged, this is simply unacceptable.

 

If you ask any patient about their services no one would distinguish between primary care, secondary care, NHS services or social care. It is all just care.

Improving the current situation is not solely the responsibility of the government. The profession has a vital role to play: through leading redesigning health care systems; developing new treatments and procedures; ensuring that we as health professionals deliver the most effective and efficient care possible. The Royal College of Physicians has been leading many of these initiatives through our Future Hospital Programme and in particular by creating the leaders of tomorrow through the chief registrar programme. There is a real desire and appetite within the medical profession to continue to deliver on improving the care of patients, just this week the RCP launched Keeping Medicine Brilliant. However, as highlighted in our new report Being a Junior Doctor things are difficult at the moment and there is only so much that the profession can do in the current financial climate. The lack of action from the government in the autumn statement has only increased gap between reality and what we aspire to: providing the best health and care system for all patients.

Follow @RCPLondon on Twitter and @DacreJane to find out more about how the RCP supports trainees, medical leadership and the wider NHS.