Abstract
A 10 year NHS plan is expected this year. It is rightly a long term plan, however, it will require a clear sense of hardwired values as well as concrete actions to address the immediate challenges to patient care. Seeing health as an investment should be central to the plan. The UK government has frequently acknowledged the link between a healthy workforce and economic growth. In turn, a healthy workforce is dependent on health in all policies and, importantly, the wellbeing of staff in the NHS. One of the relevant themes is being examined by a government commissioned review into the use of physician associates in the NHS. Gillian Leng, president of RSM, is leading that much awaited review.
However, the external pressures on the health service continue to distort the picture. This issue of JRSM picks up four related themes. Private companies remain keen to exert influence and benefit their shareholders. New data show that pharmaceutical companies paid almost £100m to healthcare organisations over a 6 year period and often the money was used to support events. 1 Apart from the concerns about undue influence any such finding might exert, healthcare organisations tended to struggle with how to handle the resulting conflicts of interest.
Another dilemma is how best to incorporate lived experience into decision making. When lived experience is gathered systematically in the form of qualitative research the value and the provenance are clear. Yet, lived experience can take a less systematic route through committees and special interest groups. Here lies danger. 2 Conflating lived experience with evidence in these circumstances can lead to suboptimal decision making. The process of seeking input matters here, just as it does when rethinking a healthcare regulatory framework that currently pleases nobody. 3
Many roads continue to lead to workforce, which is why the Leng review is so important. How is it possible to expand the workforce, safely, to meet population need? One answer is to allow freer movement of health professionals by easing political visa restrictions 4 to work, learn, share knowledge, and simply to better understand the global importance and resonance of the work that we do. Investing in health also means investing in humanity.