Transformation, terrorism and trauma in the NHS

With only 31 days to go until the UK leaves Europe, we were very lucky to welcome Professor Keith Willett, the newly-appointed Strategic Commander for the EU exit process for the NHS, to our latest Science on Your Doorstep event last week. Keith joined us at St Andrew’s School in Headington to talk about his career and involvement with trauma care in the UK.

Back in 1992, when Keith first arrived at the John Radcliffe Hospital (JR) in Oxford as an orthopaedic surgeon, he quickly grew frustrated by the way that trauma patients were being treated. At that time, most surgical consultants worked 9 to 5, Monday to Saturday, and so wouldn’t be present for many operations on trauma patients – often seriously injured after a car or motorbike accident that had happened at night or on weekends. Unbelievably, without the expertise of a specialist surgeon, one in four trauma patients would die of their injuries.

Keith realised radical thinking was required and so, in 1994, he co-founded the then unique 24-hour consultant-resident Oxford Trauma Service at the JR. Top surgeons were available 24/7, seven days a week, and support services were extended. This resulted in patients having better care and shorter stays in hospital, which also saved money for the NHS.

His hard work didn’t go unnoticed and, in 2009, Keith was appointed National Clinical Director for Trauma Care in the UK to implement the 24-hour care model on a national scale. By 2012 he had set up a regional network of 22 trauma centres across England and increased survival rates for trauma patients by 25 percent.

Further accolades followed; in 2012 Keith was appointed Medical Director for Acute Care at NHS England and in 2013 he undertook a review of the whole NHS urgent and emergency care system for Sir Bruce Keogh (NHS Medical Director). Unsurprisingly, given his transformative impact on acute care in the NHS, he was appointed a CBE in the 2016 New Year’s Honours.

Now Keith has been assigned to work on Brexit – creating plans for medicines, medical devices, the NHS workforce and reciprocal healthcare arrangements. During his hour-long talk to a packed school hall, he readily admitted that the NHS is under strain. Despite the often-Herculean efforts of hospital staff, the proportion of patients waiting longer than four hours in A&E has steadily risen over the past few years. This is due to increasing front-end demand and the difficulty in discharging people due to strained social services.

The number of emergency calls has doubled over the same period to 8 million per year, while paramedics and GPs are seeing a record number of patients. With that has come a growing trend for many patients to turn to A&E or call ambulances when they don’t need such advanced emergency treatment; or going to see their GP when they would be better seeking advice from NHS 111, or remedies from their pharmacist. It’s tough on every part of the NHS.

Then there is the additional issue of an ageing population. People using health services have also changed: they are older, many have multiple age-related diseases, they survive more episodes of illness; frailty and dementia are common. Our health and care needs are on the up.

However, the current NHS model has an in-built default that, when care needs can’t be met in our homes, our care is moved, usually to a hospital setting at higher cost to the taxpayer. That’s not good for patients or for the NHS.

But what, asked Keith, if the NHS could meet people’s needs in a different way, one that shifted care out of acute hospitals? The current reality is that many of the millions of patients who receive help for their urgent care needs in hospital could have been helped much closer to home or with technological advances in their own homes. Keith is not championing more hospital beds. He says what we need is to provide more care in the community. The opportunities for bringing about a shift from hospital to home are enormous, but the NHS needs to convince the public of the advantages of its new vision of care.

With that and Brexit, Keith has certainly got his work cut out for the next few years. Thank you for taking the time to talk to us!