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Calls for high-intensity theatre and protected research time in major new report

Introducing a national programme of weekend high-intensity theatre lists to reduce backlogs and offering hospital consultants protected time for research are among the recommendations outlined in a major new report.

In its ‘Report into the state of health and social care in Britain today’, the Times Health Commission called for high-intensity theatre lists to be launched once a month in 50 hospitals to get through a week’s worth of planned operations in a day and create seven-day surgical hubs.

It also outlined incentivising NHS staff to take part in research, and put the case for research to their patients, by giving 20% of hospital consultants and other senior clinicians 20% protected time for research.

These two recommendations form part of the report’s 10-point plan for the Government to transform the NHS.

To support the plan’s development, the Times Health Commission visited hospitals, care homes, GP surgeries and research laboratories in the UK, Japan, Denmark, Israel, Ireland and Spain to source examples of best practice.

The commissioners then established three core principles to underpin the report and recommendations, which they said are ‘pragmatic, practical, deliverable and could be taken up by any political party or government’.

The principles are rebalancing the health system away from hospitals and a putting greater emphasis on prevention and community care, reforming social care to reduce overcrowding in hospitals and give patients better support, and enabling the system to become more personalised and predictive through the use of technology.

Supporting the workforce

The Commission called for doctors, nurses and midwives who stay in the NHS for three years to have their student debt cut by 30%, rising to 70% for those still working after seven years, and 100% after 10.

It said the health services must become a ‘much better employer’ in ways that go ‘beyond health settlements’, including affordable staff canteens, night transport and on-site childcare.

The requirement for junior doctors to rotate across the country must also end to better balance work and family, it said.

Other recommendations included creating digital health accounts or ‘passports’ for patients to book appointments; order prescriptions; view records, test results or referral letters; and contact clinicians.

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And establishing a National Care System with the aim of giving everyone the right to appropriate support locally and in a timely fashion. This should be delivered by a mixture of the public and private sectors, the report said.

The report‘s 10-point plan

  1. Creating digital health accounts for patients via the NHS app
  2. Introducing weekend high-intensity theatre lists to get through a week of planned operations in a day to reduce waiting lists
  3. Reform the GP contract to focus on wider health outcomes
  4. Write off student loans for doctors, nurses and midwives who stay with the NHS for a decade
  5. Introduce no-blame compensation for medical errors with settlements determined according to need to ensure families get quick support
  6. A National Care System, equal to but different from the NHS, to administer care locally
  7. Guarantee mental health support is timely for children and young people
  8. Expand the sugar tax to cover salt and institute a pre-watershed ban on junk food advertising
  9. Incentivise NHS staff to take part in research
  10. Establish a Healthy Lives Committee legally bound to commit to increasing healthy life expectancy by five years in a decade.

Chair of the Times Health Commission Rachel Sylvester said: ‘Despite its huge challenges, there is enormous cause for optimism for our health service. The NHS and social care system must seize the extraordinary opportunities on offer in the modern digital world to empower patients, liberate clinicians, improve services, drive efficiencies and create a healthier Britain. Other countries have done it and so could we.’

The sector responds

Commenting on the report, Royal College of Physicians president Dr Sarah Clarke said: ‘At a time when the NHS faces significant demands, we welcome the Times Health Commission’s report. Its 10-point plan places an important focus on increasing and supporting the medical workforce, fostering an environment where existing staff can flourish, and taking an important preventative approach to tackling health inequalities and ill health.

‘We also welcome the inclusion of social care within the report’s recommendations for reform – social care must be staffed and funded as an equal partner to the NHS to deliver optimal care for patients.’

Also responding to the report, Professor Philip Banfield, British Medical Association council chair, welcomed its focus on staff retention and supported the student loan write-off recommendation.

However, he said: ‘The Commission sadly fails to make the obvious recommendation of restoring doctors’ pay, which would have a real impact on retaining clinicians. 

‘Without this, any meaningful hopes of addressing the near record-waiting lists will be dashed. Indeed, accelerated weekend theatre lists are all well and good, but the premium required to fund such activity risks detracting from essential investment elsewhere; doctors are already exhausted after working beyond their hours all week, already spread too thinly.’

Professor Banfield added: ‘There is a lot to unpack and consider in this report and its recommendations, but ultimately the ability to improve the state of the country’s health and services is bound by the Government’s will to act, and crucially, invest. This change must come from listening to the doctors and colleagues that give their all on the front line every day. We are the solution, not the problem.’

Matthew Taylor, chief executive of the NHS Confederation, who was a commissioner involved in the report, also called for greater Government funding to align with the report’s recommendations.

He said: ‘The NHS is recognised as one of the most efficient healthcare systems in the developed world, but we know that more can be done to improve productivity, and health leaders and their teams are always looking at ways to generate even greater efficiencies.

‘One of the crucial ways that this productivity challenge can be addressed is by providing the NHS with the capital investment it needs, which has not been covered in this comprehensive report. Specifically, in England, capital funding needs to increase to at least £14.1bn annually, a £6.4bn increase from the current level of £7.7bn. This is vital if we are to increase productivity and reduce waiting lists.’

In January 2024, a surgical workforce census report found that over half of the UK surgical workforce face problems accessing theatres, which is contributing to long waiting times for hospital treatment and excessive workloads.

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