President: Professor Christopher Stephens MBA MAEd FRCGP
A meeting of the Southampton Medical Society was held on the 5th March 2025. The President was in the chair. The minutes of the last meeting were approved.
The President introduced the speaker Professor Andrew Duncombe who is now Editor in Chief of the Future Healthcare Journal, but before retirement was clinical haematologist at Southampton General Hospital. The President asked him to deliver the Foott Memorial Lecture for 2025 entitled “Problems and Solutions for UK Future Healthcare”
Professor Duncombe started by saying that he was in medicine to care for patients. However it had to be done within the constraints of the healthcare system and in the UK the NHS is in crisis. We all need to be involved in solving this.
Long A&E waiting times get daily headlines in the press. Why are we doctors not cross about this? Since 2020 the waiting list has nearly doubled, from 4 million in 2020 to 7.7 million in early 2024 reducing to 7.5 million by the end of that year. Ill health affects the workforce. There are 4.6 million people not working due to ill health compared with 3.5 million in work. To try and solve this there needs to be a change in emphasis from treatment to prevention. This is exemplified by the problem of the obesity pandemic. Until the early seventies obesity was an uncommon problem affecting only 1% of men and 2% of women. Since then there has been an exponential increase in the numbers of obese adults which now affects 30% of the population and we now have a population of young people who will become obese adults. In the late 70s there was a change in the food industry with the firms becoming larger and more powerful. It is a sinister industry which aims to make us eat more by producing hyperpalatable foods. He mentioned other large industries that defy regulation: tobacco, alcohol [where the harm costs the NHS three times the amount of tax raised], and gambling where nothing much in the way of control is being done. Professor Duncombe told us that health and social deprivation are linked - the more deprived groups suffering more disease.
Another problem is bed blocking. He was told on the first day of his medical house job about it. He says the problem hasn’t changed in the 50 years since. It has been made worse by the closure of intermediate care units a few years ago. Even recently in the first budget of the new Labour government they allocated 20 times less money into social care than into clinical care even though putting money into social care might help reduce this problem. We could have fixed it years ago when the country was much wealthier. It is a political problem and he mentioned how Manchester and Belfast were dealing with it. In Greater Manchester the NHS is implementing a low cost scheme embedding a multiple health condition approach through population health management (PHM). It focuses on targeted reviews and person centered care to address health inequalities and improve outcomes for individuals with multiple long-term conditions. We should be rolling this out everywhere.
Is the private sector a help or hinderance? It can be helpful for orthopaedics but the problem is that it is not a complete substitute for the NHS. Long term care and emergency care are not covered by the private sector. In other countries the private sector has hospitals offering complete care. If these were to be set up tax incentives could be introduced for younger people to take out a full health insurance..
Professor Duncombe said that doctors and patients have different perspectives on illness. Patients should be more involved in designing medical services. He cited how pressure from patients redesigned the HIV services. There needs to be improved self management of medical conditions. There are good examples in renal medicine and haematology.
Where do patients want their treatment and from whom? Patients want to be seen by senior medical experts in their homes. Multi disciplinary teams of outreach nurse led teaching groups can overcome this problem. It is no good handing out leaflets about the care needed as patients do not read them. The impact of social media is important. The younger population tend to turn to the internet for medical information but they may not have the scientific knowledge and there are no controls. The antivax and anti-immunisation campaigns are cases in point.
Staffing is another area of shortage. There will never be enough money to provide the numbers of staff needed. We need whole system solutions. From the consultants point of view they spend a lot of their time doing things that could be done easily by others. He said physician associates seemed to be a good solution but their introduction was a disaster. They are not popular with either the professionals or the patients. They are paid more than an SHO for very little training. They should have a lot of senior supervision.
Recruitment and retention of medical students and young doctors is important as many do not complete their training. Medical student debt is part of the problem. Professor Duncombe suggested that for every year served in the NHS there could be a percentage reduction of the debt. As to senior doctors he suggested a reduction in their workload proportional to their years of service. He also considered there should be a removal of financial disincentives such as those caused by the rules on pensions. He thought that the idea of replacing a retiring senior doctor with two junior consultants made no financial sense.
Another issue is climate change and its impact on health. For example tropical diseases are moving north, malaria may well be in the UK by 2040, air pollution and shortage of water. Migration as a result of global conflict is also a problem.
The NHS Digital For All aims to improve the NHS and social care and healthcare outcomes by linking data and making it accessible to all. A problem is hacking and also that the NHS areas of greatest healthcare need are the least digitally capable He thought that AI had an important role to play. Improved diagnosis at an earlier stage is one thing but it can be used for many other tasks. However there is a lack of accreditation. At present anybody can produce AI software and sell it to a hospital. There is no requirement for testing this new technology. Both Google and Microsoft are developing programmes to sell to the NHS but Professor Duncombe is worried about bias. Outliers are not represented. No one understands how it works. A regulatory system is much needed. This new technology may affect the selection of medical students. The future doctor is going to have to engage with it so what extra qualities will be needed?
Then there is the very important end of life care. The NHS is farming out the end of life care to the charitable sector. But in comparison it invests a lot of money into the beginning of life care so why does it not invest properly in the end of life? The majority of patients still die in hospital. There is a culture of silence about the system.Our speaker proposed that there should be ACPs trained in this speciality.
He mentioned that as pharmacists are now becoming advanced prescribers their degree courses need to take it into account. Supervision is needed.
The President thanked Professor Duncombe for his thought provoking and wide ranging talk.