What is it about your job that you feel would surprise the public?
My job is a full-time professor at Oxford University. I guess people would be surprised that I spend much of my time writing grant applications to pay other academics on my team. And perhaps that my ‘data’ is mostly text, not chemicals or numbers.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
The erosion of general practice – and it’s not a positive development. Barbara Starfield showed that a strong, accessible primary health care system is associated with four things: lower total health care costs, more equitable health outcomes, less preventable illness and higher overall survival. We are currently seeing what happens when you weaken the primary care sector: rising costs, rising health inequalities, more preventable illness and reduced survival.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
Strengthen primary care – there may be many approaches to doing that. For example, by optimising the input of new professionals such as paramedics or practice nurses with special interests; streamlining referral pathways using evidence-based guidelines (so that care is led and delivered by primary care professionals as far as possible); and (perhaps most importantly) redressing a chronic funding shortfall to reduce stress and burnout among primary care professionals.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
Strengthen traditional-style primary care. All this attention to apps and AI is all very well, but what patients actually want is to be able to get a prompt appointment to see their doctor or nurse!
What do you wish people at the top of the NHS understood?
The evidence base on continuity of care in general practice. A meta-analysis by Sir Dennis Pereira Gray recently showed that continuity of care over years with the same GP has the same kind of survival advantage as many drugs and complex interventions, but nobody has taken this on and sought to protect this crucial aspect of our health care system.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
Athena Swan, which improved the prospects of women academics. It worked (partially) because universities were penalised for discriminating against women! For example Dame Sally Davies, as then director of the National Institute for Health Research, decreed that if a department didn’t have at least an Athena Swan Silver award, it would not be eligible for the big funding streams. That focused a few minds!
What policy have you seen fail, or not be as successful as first intended?
Brexit. You could say this isn’t specifically a health policy but the point is that all policies have knock-ons for health. Brexit, however it unfolds, will make the staffing crisis in the NHS much worse, interfere with the supply of key drugs and isotopes, and increase poverty, which is the biggest social determinant of ill health.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
We’re looking at various initiatives to ‘digitise’ NHS care, including digital histopathology, digital multidisciplinary team meetings, and digital blood ordering. As ever with these complex initiatives, there are successes and disappointments – and nothing happens quite the way it was planned. Adaptive, collaborative learning is key!
The NHS is under pressure because...
Too many people in powerful positions drank the Kool Aid on fragmentation and privatisation.
Trish Greenhalgh is a Professor of Primary Care Research at the University of Oxford.