“Academic medicine and its career structures are the most neglected aspects of the NHS. This neglect will soon compromise the quality of the next generation of doctors in training. The constant political battle for apparent ‘ownership’ of the soul of the NHS is the greatest impediment to improving the health of the nation. The battle poisons debate about sensible pragmatic solutions to improve the nation’s health that involve the private sector. After the next election, the Secretary of State for Health needs to put the NHS outside the political arena — like the Bank of England’s monetary policy committee — and avoid the temptation to indulge in yet another root-and-branch reorganisation.”

BEVERLY MALONE
General secretary of the Royal College of Nursing

“Public health and chronic disease management have been overlooked for too long. We need to give them much more attention. Community nursing will be central to helping people to better manage chronic illness in the future, and yet the numbers of community and district nurses have actually gone down in recent years.

“We can do so much to improve the health of individuals and communities by tackling poor nutrition, smoking and poor sexual health. School nurses are ideally qualified to help people to learn about making healthy choices from a young age and we want every child to have access to one.

“Having the right staff, with the right skills and the right experience, in the right place, will be essential to secure good health care for the future. Some good progress has been made in recruiting nurses in recent years, but this has to be sustainable for the future and retaining nurses will be key. We are heavily reliant on international recruitment — half of new entrants to the nursing register for the past two years come from overseas — but with a global nursing shortage, we are competing with countries such as the US for nurses. They are also getting older — nearly a quarter are over 50 — and we have to do more to retain the experienced ones if we are to avoid some serious staffing issues in the near future.

“Outdated barriers between the professions have started to come down, but there are still areas where nurses are not being used to their full potential. The RCN would like to see all nurses appropriately trained and limited only by their competence.”

DONNA COVEY
Chief executive of Asthma UK

“The NHS does not address the needs of the 17.5 million people with long-term conditions living in the UK. The lack of a holistic, joined-up strategy is the biggest barrier to improving the health and wellbeing of people in the UK. Within the NHS, this means that people end up having to fit around the fault lines in the structures of the service. For people with long-term conditions, this often means that public services are delivered in a way that does not take account of their lives. This makes it harder for people to gain control over their conditions, and to achieve their full potential in terms of health and wellbeing.

“The real health gains for citizens will come from investing in public health, reaching socially excluded groups and meeting the needs of people with long-term conditions. These will take time to get right and will not capture the headlines in the Daily Mail but will transform people’s lives.”

DOUGLAS SMALLWOOD
Chief executive of Diabetes UK

“From the perspective of people with diabetes, patient empowerment has not improved. People must be provided with the information and education they need to support their own care and self-manage their condition. The NHS is still not good at shaping individual packages of care. Systems need to join up to truly integrate services across primary and secondary care. This will provide quality health care for people with chronic conditions.

“Chronic disease management is one of the first battlegrounds in improving the nation’s health. The majority of GP visits are related to chronic disease. More than 60 per cent of hospital beds are occupied by people with chronic diseases. Early and effective treatment must be the way forward — preventing serious problems rather than treating them. This requires a long-term view rather than political expediency.

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