In a move to develop a more holistic and joined up health service focused on patient need, Sir Nigel Crisp, Chief Executive of the NHS, has challenged senior managers to get personally involved to experience what it is like living in the gaps between services. As an action plan for the year he has asked that they each identify a patient with a long term condition or some sort of more complex need who lives in the community and uses one or more services. He made it clear that this should not be someone who is absolutely dependent and might be looked after by a community matron, but someone with more intermittent needs. He then wants them to follow the experiences of the person throughout the year and at the end of this monitoring to report to their own Boards on what they discovered. This he believes will give Boards a different perspective and maybe help them think and act a lot differently.As an explanation of the challenge he described the case of a man in his 70s. He is diabetic, recently widowed, wants to give up smoking and has a problem with his knees. No one apart from his daughter was concerned about his whole health. No one communicated between all the services – it wasn’t the responsibility of the GP nor of the nurse in the diabetic clinic.

The NHS is now five years into the 10-year implementation of the NHS Plan and indicators of progress, other than the published targets, are beginning to appear. The first is the effect of the NHS on private healthcare. In past years many people opted to pay for treatment and this enabled the private market to grow steadily. This trend has been reversed and private healthcare organisations are revising their plans, scaling down activity and in some cases closing hospitals. The other indicator was the absence of comment in the recent general election about waiting lists, survival rates from cancer or coronary heart disease, about staffing levels or new investment in facilities.