In The Loop: the BIG Questions

In the Loop – the Big Questions 
Anita Charlesworth 
With Niall Dickson and Roy Lilley
Do you regard the NHS as an efficient organisation that provides good value for the huge sums that sustain it? How much bang do UK taxpayers get for their NHS buck? This is the latest topic in the In The Loop podcast series in which Niall and Roy consider the controversial and challenging topic of NHS productivity, the subject of new report from the Health Foundation’s NHS Productivity Commission.  
Their guest is Anita Charlesworth CBE senior economic advisor  at the Foudnation and  co chair of its Commission. Anita is one of the most prominent economists focussing on the public sector having been Director of Public Spending at the Treasury under Gordon Brown, and overseeing the seminal Wanless report into NHS funding;  in 2018 she co-authored the influential study titled "Securing the future: funding health and social care to the 2030s," with Paul Johnson then of the Institute for Fiscal Studies. She is a member of the advisory panel for the Office of Budget responsibility. 
The Commission’s report Breaking the Cycle - how to build a more productive NHS concludes that the NHS in England is simply not set up to deliver sustained productivity growth. The health service, it claims, often obstructs sound decision making and impedes efficient delivery, with local NHS organisations subject to structural instability, competing priorities, and relentless short-term pressures. The commission concludes that significant productivity gains will not come from short term fixes.  And it rejects suggestions that our tax funded system is in any way to blame for our performance against other advanced healthcare system in the OECD.  
Instead it recommends the creation of a system with greater stability, a shared purpose, an engaged workforce, clearer accountability, more freedom at local level and one that can develop the capability to improve care.
Few may disagree with the diagnosis, but as well as exploring why our NHS is not delivering to its potential, the podcast considers the potentially huge impact of AI and technology, the role of professional vested interests and whether Anita and her fellow Commissioners have the right solutions. Crucially, it also considers whether the Commission has worked out how these reforms can be delivered and whether there is the political insight and will to bring them about.
If you want to understand the debate about productivity and how the NHS might be transformed, please do join Niall, Roy and Anita for a fascinating journey In the Loop.   
It’s a great listen – find it now wherever you find your podcasts.

Have you ever wondered what is the reality of working in intensive care? This  is one of the most demanding areas of clinical practice, with staff not only having to manage   organ failure with patients who are so often at the edge of life and death but also families who are anxious and distressed.  
In this their latest In the Loop podcast Niall and Roy explore the modern reality of this highly pressured environment in a revealing exchange with the President of the Intensive Care Society, Professor Shondipon Laha.
Shond is a critical care consultant at Lancashire teaching Hospitals and this is an encounter full of surprises.  While he highlights the continuing shortages of intensive care beds in the UK which was cruelly exposed when Covid hit in 2020 (and remains a challenge today) he also points to the desperate need for social care reform and for rehabilitation services. Both of these he argues are essential if we are to achieve the right outcomes for patients who have been through intensive care.
Shond acknowledges the technical and drug advances that have been made in recent years, ironically helped by the dreadful experience of Covid. Yet for him, the greatest progress in his specialty has been the development of strong multidisciplinary teams in which the key roles of nurses, physios, pharmacists, OTs, dietitians and others are recognised and team working is making care effective. As for doctors, he sees the development of the intensive care speciality and the move away from it being a branch of anaesthetics as vital with the development of education, training and dedicated intensive care posts.
If you want to validate or challenge your view of intensive care, or just develop a better understanding of a unique area of healthcare, please do join Niall, Roy and Shond In the Loop.

In one of the most controversial clinical decisions of recent times, the UK National Screening Committee has ruled against the mass screening of men for prostate cancer. In their latest podcast Niall and Roy question the committee’s Chair, Sir Mike Richards, and seek to understand a decision which has been challenged by former Prime Ministers, high profile patients with prostate cancer such as Sir Chris Hoy, as well as other celebrities. The committee even rejected the idea of screening black men who have double the risk of developing prostate cancer, men with a general family history, and even some with certain genetic factors.
Sir Mike is a former consultant oncologist who became the national cancer tsar and brought about major improvements in the diagnosis and treatment of the disease across the UK.  But when it comes to prostate cancer, while he supports the idea that men who want to have a PSA test should be allowed to have one, he argues that, based on current evidence, a screening programme would do more harm than good.  
This is a complex area which is developing all the time and he concedes that as our understanding grows and as treatment and testing develop, the case for screening may be made. He is also adamant that this is not one of those clinical decisions based on cost.
If you are with or without a view on this topic, do join Niall, Roy and Mike In the Loop, and like men all over the country, make up your own mind as they explore this delicate and difficult topic.