. Aside from the need for an insurance-based funding model for elective care, the NHS needs to improve on prevention and pace. In most acute medical situations, time matters and pace pays. Delays beyond the 'golden hour' cost lives for major trauma, neonatal distress, stroke and acute coronary syndrome. The elderly patient retrieved from a kitchen floor after a six-hour wait has already started to become a more complicated case as body systems sequentially fail. By the time they are seen by a triage nurse in A&E, their chance of returning to independent living has probably slipped away. The middle-managerialism that impedes rapid care through multiple gateways, placing first contact often with the most inexperienced (cheapest) staff, must be swept away, and replaced with systems-thinking focused on pace and flow. Likewise, understanding how we managed to end up with so few beds, scanners and staff while spending above the OECD average is a task that Steve Barclay, the Health Secretary, must address. Prevention and pace save money and deliver a better service. I commend them to the Government. Andrew Roberts FRCSOswestry, Shropshire SIR – I'm one of the over-70s who tripped and broke my hip ('Falls are the health problem no one is talking about', Features, October 28). For the past six months I haven't had any NHS physiotherapy apart from a sheet of paper. I've made several phone inquiries. Promises to get in touch with me have come to nothing. I think there is a masterplan to reduce the numbers of elderly people and cut hospital numbers. Am I being a cynic? Angela HayesWetheral, Cumbria SIR – Where are all the cottage hospitals and convalescent homes? Janet StukinsWigton, Cumbria SIR – I have recently been diagnosed with high cholesterol. I was recommended by my doctor to go to a lipid){kind=link}
SIR – Allister Heath is right to identify the NHS as a major problem for the Government (“The NHS is slowly suffocating British conservatism – and Sunak knows it”, Comment, October 26). Aside from the need for an insurance-based funding model for elective care, the NHS needs to improve on prevention and pace.
In most acute medical situations, time matters and pace pays. Delays beyond the “golden hour” cost lives for major trauma, neonatal distress, stroke and acute coronary syndrome. The elderly patient retrieved from a kitchen floor after a six-hour wait has already started to become a more complicated case as body systems sequentially fail. By the time they are seen by a triage nurse in A&E, their chance of returning to independent living has probably slipped away.
The middle-managerialism that impedes rapid care through multiple gateways, placing first contact often with the most inexperienced (cheapest) staff, must be swept away, and replaced with systems-thinking focused on pace and flow. Likewise, understanding how we managed to end up with so few beds, scanners and staff while spending above the OECD average is a task that Steve Barclay, the Health Secretary, must address.
Prevention and pace save money and deliver a better service. I commend them to the Government.
Andrew Roberts FRCSOswestry, Shropshire