NHS in crisis: we need your help
Do you have examples in your centre where things work well? This is not about lowering standards but the opposite...
This week’s BMJ and lay press news has been very depressing regarding the performance of the NHS and its staff. All the reports are in response to the Royal College of Nursing’s report, ‘On the frontline of the UK’s corridor care crisis‘ (2025), which is depressing.
Here is an excerpt from the BMJ’s article that sets the scene.
Has treating patients in corridors and cloakrooms become “normalised”? Jacqui Wise reports
“A nurse forced to change an incontinent patient with dementia beside a vending machine and a patient dying from a cardiac arrest who couldn’t be given adequate cardiopulmonary resuscitation (CPR) because of overcrowding in the corridor are just two examples from a stark new report from the Royal College of Nursing. The report is based on a survey of 5408 UK nursing staff carried out from 18 December to 11 January 2025, in which more than two-thirds (66.8%) said they had on a daily basis treated patients in inappropriate settings such as a corridor, bathroom, cloakroom, bereavement room, or converted cupboard. More than nine in 10 of those surveyed believed that patients’ safety was being compromised. Nurses reported caring for up to 40 patients in a corridor but were unable to access oxygen, cardiac monitors, and other vital equipment. The report also highlights serious concerns about infection prevention and control. One nurse reported that a patient vomited on another patient because they were so close together lined up in a corridor awaiting cubicles. The 460-page report contains many examples of patients receiving diagnoses and having discussions in public and being treated, fed, washed, and toileted with no privacy.”
These exemplars and statistics are genuinely shocking. At the same time, you have to imagine what it is like for an HCP to work in this environment. I covered the NHS environment's impact on HCPs in my newsletter, Moral Distress (28 December 2024). Please read people's comments regarding this newsletter; they give real-life examples of how this impacts MS care. This is not only about A&E but MS practice as well.
From an HCP perspective, it is reassuring that the BMJ also addressed moral distress and burnout in the same issue; these crises are the two sides of the same coin.
So, what can we do to address these parallel crises? We had our Barts-MS away day to brainstorm how to improve our offering. Getting more resources would help. But unless we reform our service, getting more staff will be a short-term solution to the crisis. One of our staff members suggested moving patients onto a pathway that allows patients only to be seen by us if they have a crisis, i.e. patient-initiated follow-up appointments or PIFU. This is part of the NHS’s solution to overload. This may work for motivated patients who have self-agency and can self-monitor. Many pwMS are worn down by the system and learn to live with problems we can help with. This is why I am very keen on the annual MS MOT, which goes beyond merely monitoring DMTs and addresses symptomatic problems, including hidden symptoms.
Many of our team members are keen to initiate a ‘Brain Health’ assessment to target all the small things that may impact MS outcomes. However, adding a new service without time and resources would increase our workload. Others suggested using volunteers, i.e., pwMS, who could become brain health champions and support other pwMS in improving their general lifestyles. Who will train the volunteers? Would you want to become brain health champions to help your fellow MS citizens?
I suggested creating MS self-management pathways so pwMS can address their own symptoms. The care pathways will include self-management where appropriate. When input from an HCP is required, pwMS can self-refer to the relevant specialist without going through their GP, MS clinical nurse specialist, or neurologist. This will prevent bottlenecks that are currently causing problems. I have written about this before; please read ‘Why is the NHS not delivering? 15-Jul-2024‘.
I recently wrote an article on MS self-management for the British Journal of Neuroscience Nursing. The following diagram explains how MS self-management may help address our NHS staffing crisis.
Will this work? Please note that self-management is not for everyone. In parallel, safeguards will be needed to ensure that vulnerable pwMS are not disadvantaged by such pathways and that those who don’t adopt self-management can be managed in traditional ways.
Another idea was to use all touchpoints we have with pwMS to educate them. For example, when pwMS come in for an infusion or blood test, we provide information about MS self-management. We don’t want the latter to be intrusive, so they can either engage with and use the information or not. This could be a one-pager with a QR code for online content. The online portal could allow pwMS to ask questions and get answers, albeit asynchronously. For example, we made this MS-Selfie one-page handout for MS clinical nurse specialists to give to their patients in the clinic.
Would you be receptive to the same type of resource when you come for infusions or blood tests? Would you use such a resource? The good thing about MS-Selfie is that it allows you to ask questions and get answers, albeit asynchronous and generic. I suspect that in the future, we may be able to implement some of these ideas in the NHS app to provide personal advice and trigger the necessary NHS management. MS Connect may become a reality. For more information on MS-Connect, please see ‘The future of MS care’ (15-Feb-2022).
We concluded at the meeting that we would ask our patients what they want. So please be prepared for a survey and/or invitation to attend a focus group. In the interim, we would like to hear if you have ideas on improving NHS services so they can do more with fewer resources. Do you have examples in your centre where things work well? This is not about lowering standards but the opposite. How can we revolutionise MS care in such a way that it improves MS outcomes and the quality of life or pwMS, reduces healthcare utilisation and costs and helps improve the satisfaction of HCPs working in the NHS?
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Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.
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Faith groups could help to fix the NHS crisis
Report calls for collaboration between faith groups and the health system
Faith groups can be part of the solution to the healthcare crisis in this country, according to the report Creating a Neighbourhood Health Service. The report contains impressive examples of local faith communities offering holistic solutions to non-medical needs. It has been jointly published by the ChurchWorks Commission and Theos, the religion and society think tank.
Demand for GP appointments is currently overwhelming, yet one in five GP appointments is for a non-medical reason. ‘Social prescribing’, as it is known, plays a vital role in providing practical support for people who are struggling with loneliness, low-level mental health conditions, and financial issues.
Many healthcare settings already employ Social Prescribing Link Workers, and faith groups contribute significantly to local social prescribing networks, with their focus on community, relationship and holistic wellbeing. They can also play a foundational role in preventative healthcare by helping individuals to access the right support early on.
The report reveals a gap between those social prescribing link workers who are aware of activities run or supported by faith groups (85% of those surveyed), and those link workers who have referred anyone to a faith group in the last three months (30% of those surveyed). The report sets out a blueprint to close the gap and makes the case for further integration between faith groups and healthcare provision at a neighbourhood, place and systems level.
Almost half of the link workers surveyed said that they had discovered activities run or supported by faith groups through networking. More proactive networking is needed to improve knowledge sharing between faith groups and healthcare professionals.
Last year, Lord Darzi’s investigation of the performance of the NHS stressed the need to prioritise neighbourhood level care, prevent ill-health and tackle health inequalities. Health Secretary Wes Streeting has outlined his vision of ‘a revolution of prevention’ and a ‘Neighbourhood Health Service’.
Creating a Neighbourhood Health Service calls for the contribution of faith groups to be fully recognised, and for proactive collaboration between faith communities, the voluntary sector, and the NHS. The impact of social prescribing can be seen through initiatives such as Warm Welcome, which provides 4,000 safe community spaces across the UK. Many of them are attached to places of worship.
The Rt Revd and Rt Hon Dame Sarah Mullally DBE, Bishop of London, has written the foreword to the report and says: “Seventy-five years on from the birth of the NHS, the next few years are some of the most pivotal to its survival. In the face of persistent and growing inequalities in health outcomes, and inequitable access to care, this report sets out the prescription for the health inequalities that are pervading so many communities. Indeed, it's a solution that already exists. Social prescribing utilising existing community structures can be transformative in offering affordable, effective care to millions of people. Faith groups in particular have an essential role to play here, and indeed many are already doing just that. I pray that further work can be undertaken exploring the opportunity here, and that it brings us closer to more interconnected, resilient, and healthy communities.”
Dr Marianne Rozario, senior researcher and projects lead at Theos, says: “There can often be a disconnect between health and faith. Yet, as we have set out in this report, linking faith groups into healthcare through social prescribing can improve the wellbeing of individuals. Therefore, relationship-building between faith and health at the level of ‘neighbourhoods’, ‘places’ and ‘systems’ is essential.”
Charlotte Osborn-Forde, CEO at the National Academy of Social Prescribing, says: “There is now robust evidence that social prescribing is an impactful, inclusive and cost effective approach, and it should play a significant role in delivering the government's aims for greater preventative and community-based healthcare. There are valuable and untapped assets in communities across the UK which should be better connected to the health system, and social prescribing should be available in every clinical NHS pathway to enable this. This report provides direction for how we can connect the great community work of faith groups into our health service in order to promote the wellbeing of local communities.”
The report is available on the ChurchWorks website here and is being launched at an online event on Thursday 30 January.
Click here to register for the event: https://www.churchworks.org.uk/event/faith-and-social-prescribing-launch-event
Having had MS for 20 years now I by pass primary care if I need support. I’ve just moved from Hertfordshire to Sussex and along with 2 other chronic conditions that I have the answer to transferring care has been the specialist nurses They have unlocked the tortuous administrative organisation that is the NHS. The NHS really is the umbrella term for individual units that don’t work together and the transfer has required tenacity and project management skills on my part to make it happen. I’m the kind of person who will self refer and self advocate so your ideas are good - but what happens for those who can’t?