What is it about your job that you feel would surprise the public?
How much the lives and clinical needs of my patients are determined not by medical but social factors. So many children I see are experiencing behavioural and emotional difficulties all directly related to the deprived conditions in which they’re being raised. All over the country, paediatricians like me are seeing more and more cases of malnutrition because parents don’t have enough money to feed their children healthy diets. Given it’s the 21st century and that we’re the fifth richest economy in the world, if the general public saw what I see in my clinic, I think they’d be shocked and dismayed.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
The ever spiralling inefficiency caused by increasingly fragmented care. With the introduction of contracting and tendering in the NHS, some things don’t make sense any more. For instance, there’s a hospital in north London where a company in Wales is paid to transport and sort out all their medical records. This is a hospital in London that had managed that service really well in-house until then. All it’s caused is an extra layer of bureaucracy for clinicians, more delays and mistakes for patients, and an increased cost for the taxpayer.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
An end to the unnecessary bureaucracy that underpins the whole purchaser-provider split – that ethos of the ‘market’ has had its day. We need to move to a different kind of framework that provides for a democratically accountable health service, and gets rid of all these really false distinctions between the NHS, public health and social care. There’s a lot been said about breaking down these barriers, but they still remain and are a significant impediment to improving the health of the population, as they are to using our scarce resources effectively.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
That the health service is just one way to maintain and improve the health of the population. Any investment in the NHS will be undermined if children are living in poverty, in poor housing that reduces their life expectancy, and if air pollution is literally poisoning them as they’re walking to school. You can kiss all that money goodbye if you’re not going to take care of the social determinants of health.
On top of that, improving the lives of those working in the NHS and social care is something the health secretary has the power to deliver directly.
What do you wish people at the top of the NHS understood?
They’re not saving money by making cuts. I get that it’s about the bottom line, but that’s not the way to think about running a health service. By making cuts, all they’re doing is storing up really high costs for the future – we’re just putting off dealing with some of the biggest public health challenges of our time and tricking ourselves into thinking that somehow, because some trusts might be in the black rather than the red, that’s the right thing to do. But that’s not how you measure the success and health of a society.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
There has been great work in Scotland around child health and the social determinants of health. Professor Harry Burns has realised you are not going to break the vicious cycle of child poverty and deprivation unless you take a holistic approach. The ‘bedtime reading initiative’ has meant parents getting free nursery books, encouraging them to read with their kids. By providing poor parents and children with the means to develop much needed strong attachment bonds from such an early age, you’re helping to avoid lots of chronic problems that might crop up in future with behaviour and mental health.
What policy have you seen fail, or not be as successful as first intended?
The Private Finance Initiative (PFI). I think it is one of the greatest calamities to have hit the NHS. Trusts are locked into paying off this debt at a really high interest rate despite the time of austerity in which we’re in. You’re making all these promises on repayments, even if you know you can’t afford it. I’m on the Executive Management Team at the Centre for Health and the Public Interest, and our report states that the NHS will lose almost £1 billion between 2016 and 2020 due to PFI. If we were paying normal interest rates, rather than higher PFI rates, we could cut those costs by a third.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
I work in community child health in my role at East London FT, and what I’m trying to do with others is focus on local quality improvement initiatives and improve local services despite constrained resources. I’m looking to embed a culture of change, on which I’m learning a lot – namely how slow change can be at an organisational level! But also how hard-working and creative NHS staff can be if they’re given the opportunity to innovate and try things out.
The NHS is under pressure because...
It’s been chronically underfunded for the past decade, the effects of which have been made worse by the reorganisation of the health service in England. The NHS is also built on a very biomedical model, and if it were to consider all of the many facets of health and wellbeing, we would do much better at preventing disease and reducing costs. But it’s not being run like that – it’s run as a system that’s about fixing problems as opposed to helping people along their journey.
Dr Guddi Singh is an integrated child health quality improvement fellow and a paediatric registrar at East London NHS Foundation Trust.