Nigel Crisp: Yes, the NHS must change, but these reforms fail to address real problem

These were the things which worried patients – and with good reason. When I was appointed chief executive in 2000, around one in every 25 people on the cardiac waiting list died before they were operated on.

There has been a lot of improvement since then. Patients and the public have responded. The British Social Attitudes Survey in 2009 showed that public satisfaction with the NHS almost doubled in a decade.

As importantly, patients have voted with their feet: the number of people going privately for treatments, apart from cosmetic surgery, began to fall in 2003.

There is more to do in these areas, of course, and the NHS must be constantly vigilant that standards don’t fall back.

However, the biggest issue facing the NHS today is very different. The greatest need now is to improve care for people with long-term conditions such as diabetes, heart and vascular disease, arthritis and dementia.

This group of mainly older people are by far the biggest users of NHS services, with about 10 per cent of the population using around 60 per cent of the NHS’s resources and their numbers and their needs are growing.

The NHS simply isn’t geared properly to their needs. Most services were designed at a time when the greatest need was for good emergency care and for one-off treatments which were provided in hospitals. Fifty years ago, to exaggerate to make the point, we were cured or we died. Now we live with the condition.

People with complex and long- term conditions need different types of services. They need access to continuing help to look after themselves, manage intermittent crises and maintain their health. At different times they may need support from neighbours, friends, family and volunteers as well as from health professionals. Many, of course, have several conditions at the same time.

I know from the experiences of relatives how difficult it is to get to distant departments in large hospitals, to find a wheelchair so you can visit your spouse in hospital and – perhaps most confusing of all – to make sure that each of the doctors treating you for a different condition knows what the others are doing. Getting healthcare can all too often be a worrying, depressing and debilitating experience.

We have a hospital-based system designed for another time and another set of problems that is trying to cope with today’s issues. It is an expensive and inefficient way of doing things and bad for both patients and staff and needs to change.

There are many good examples all over the country of pioneering clinicians and patients’ groups who have designed better services which are delivered at home and in community facilities as well as in hospitals and which offer patients choice over where care is delivered. They point the way for the future.

All this means that the NHS needs to change profoundly and transform itself from being a largely hospital-based and professionally-delivered service to one which is much more community-based and which uses and values the skills of a whole host of people – patients and lay people as well as professionals – and ensures that actions are properly co-ordinated.

This will be a difficult and long journey. The positive side will be the development of new services; but it will also mean that hospitals will change and adapt, some specialist services will merge, outpatient departments will shrink and some services and probably whole hospitals will close. Money that is currently invested in the massive hospital infrastructure will need to be re-invested in a much more mixed range of facilities and services.

Making this change happen will be unpopular with many people but the alternative is worse – continuing to use an out-of-date service model to deal with today’s problems delivers poor care inefficiently. It is unsustainable.

I believe that the current Government can learn a great deal from the last major NHS reforms. In particular it must be absolutely clear about the problems it is dealing with – last time it was waiting times, now it is long-term conditions – and to make sure that the NHS focuses on them.

Secondly, people need to understand the problem and there needs to be a sense of momentum – people knew what was needed 10 years ago and there was enormous local energy and effort put into tackling waiting and improving hospital services.

Thirdly, we were most successful when people worked together – clinicians, patients, managers and politicians, social services and health – and we were least successful when things were done by one group only.

The Government’s current proposals for reform based on GP commissioning haven’t taken account of these lessons and as a result have fallen into controversy and compromise. There is still time, however, for the Prime Minister and Health Secretary to set out a compelling vision for the NHS and focus their reforms on the real problems of today. In doing so they will help make the NHS sustainable for the long term.

Lord Crisp is an independent Crossbench member of the House of Lords. He was Chief Executive of the NHS and Permanent Secretary of the Department of Health from 2000 to 2006. His latest book 24 Hours to Save the NHS – the Chief Executive’s account of reform 2000 to 2006 will be published by OUP on September 12.