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NHS at 72 years old

NHS at 72 years old

Naked Leader Week 881 –  20 July 2020

Time to read: 8 minutes


Sally Morris, CEO of Essex Partnership University Trust, shares some thoughts on life on the inside of this most cherished institution.

Throughout my career the NHS has gone through more changes than I could ever have envisioned – organisational, structural and process.

What has never changed though, is the commitment of our people, as continues to be demonstrated with Covid-19, and our preparations for a possible Second Wave.

While all the textbooks continue to define and debate innovation, our frontline staff just do it – over many years behind the scenes, and most recently in the very public eye, they innovate, adapt and improve services as needed. It is phenomenal, and the results – saving lives, are astounding.

So much goes on that is unseen, except by those who need it. Many elements of care originally seen as essential to be provided in a hospital, is now predominantly delivered in the community – and by nurses and allied health professionals, not only doctors.  Diabetic care has been transformed and the majority of patients now receive all their care either at their GP practice, or from a community nurse, never going near a hospital. Patients with respiratory problems are supported at home and where hospital stays used to be measured in weeks, they are now down to days (or a day), safe in the knowledge that community health and social care services can support people effectively in the community.  At the other end of the scale, the modern end of life services treat people with dignity and support them to die at home or in a hospice, as most people prefer, rather than in hospital.

It is in mental health services that I have seen the greatest changes, with innovations in this critical area, and community services, being finally recognised.  From being the “Cinderella service” of the NHS – underfunded and largely ignored – the National Service Framework for Mental Health in 1999 finally brought with it the funding to modernise and improve these services.  The creation of new community services, including Crisis Resolution, Assertive Outreach and Early Intervention Teams to build on existing Community Mental Health Teams, meant there was a real alternative now to inpatient admission.

Our inpatient services also modernised; old long-stay institutions were finally closed and “modern” purpose-built facilities replaced them.  Over the past 25 years, these facilities have changed, and changed again.  Now we are in the last throes of removing dormitories, so every inpatient can have their own room.  I look back and wonder why we ever thought it was appropriate for six distressed people to share a room? But then I recall that it usually came down to a choice of a bed in a dormitory here, or an Out of Area placement, or no bed at all.  So there wasn’t really a choice at all.   Our own dormitories will all have been replaced by the end of next year (if not sooner), about which I am most pleased.

There have also been leaps and bounds in the Children and Adolescents Mental Health Services (CAMHS) arena.  If we thought mental health was underfunded, then CAMHS was being especially short-changed.  Over recent years that has started to change and we are beginning to reach those who need help earlier.  This will, inevitably, assist positively in their long-term prognosis, but there is still a way to go.

One area which has received significant investment during the past 12 years is IAPT (Improving Access to Psychological Services), aimed at treating adult anxiety disorders and depression.  This service reaches over one million people each year and helps fill the gap between specialist mental health services and primary care.  My personal reflection is that although this is a very worthwhile service it has, sadly and through no fault of the IAPT services themselves, meant that investment in specialist mental health services has been reduced or delayed.  The new mental health investment standard seeks to address this anomaly going forward and, finally, we are seeing new perinatal mental health services, and 24/7 crisis intervention services being developed to meet the needs of people in extreme distress.  I look forward to more mental health services flourishing in this way in the future.

Which leads neatly to my final reflection:  the NHS would not be the amazing organisation it is now without the people who work in it.  Frontline clinicians, nurses, doctors, allied health professionals, social workers, as well as support staff in a huge range of disciplines,  all work together to deliver care to the public.  The NHS is the biggest employer in the UK, and fifth biggest in the world, with staff from diverse backgrounds with different perspectives and aspirations.  It feels as though we are now really trying to understand that diversity and to value and support all NHS staff to maximise their potentials – to have real equality in our services for staff and patients.

I will finish by recognising the way NHS staff have responded to the current COVID-19 crisis – it truly has been amazing.  Coping with uncertainty and putting patients first is second nature to them and has continued to be so despite so many across the world losing their lives to this horrible virus. I know that I and my colleagues have personally felt the loss of our own staff.

Throughout its 72 years, the NHS has provided healthcare to people of this country – regardless of financial status.  I recall vividly visiting America and needing their health service once.  I sat in a waiting room and a man was brought in with an injured eye.  Before he was seen by a clinician, he was asked for his insurance details. He had none, so had to pay $250 up front.  He only had $180, so he was turned away without any treatment.  I don’t know where he went, or if he received care, but his experience stayed with me and, if possible, made me value our NHS even more.  We don’t charge for most healthcare services we provide and I sincerely hope we never do. Free at the point of delivery healthcare should be available for everyone who needs it, especially the most vulnerable in society.

This is my 25th year of full time service in the NHS. It is also my last, as I retire (early !) this year.  So much has changed during this time and, despite the ups and downs along the way, I am grateful to have been part of this grand British institution.  I am especially proud of our own Trust and grateful to colleagues who support me and to all the staff who work in it.  I honestly couldn’t have worked in a better organisation.

Happy Birthday NHS and here’s to many more !

Thank you Sally for sharing your thoughts on this most loved institution, and for all that you and your team do.

 With my love and best wishes to you all




* This is an adaptation of an article that has previously only appeared within NHS publications – thank you to Sally for sharing it with a wider audience.

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