“The object of a New Year is not that we should have a new year. It is that we should have a new soul and a new nose; new feet, a new backbone, new ears, and new eyes. Unless a particular man made New Year resolutions, he would make no resolutions. Unless a man starts afresh about things, he will certainly do nothing effective.” GK Chesterton
I love fresh starts, and the New Year is definitely a fresh start. But 
specific predictions are a mugs game. The great scientist Niels Bohr was right when he said that “prediction was very difficult, especially about the future”!
So generally speaking, we know once the Lords have finished their therapy sessions on the Health and Social Care Bill, it will go through, amended, and followed by more legislation in response to the nightmare Mid-Staffs inquiry and challenging Social Care White Paper. Much heat will be generated by politicians as they discuss dealing with lifestyle issues (alcohol, obesity, diabetes) and whether they believe the communitarian, moral construct of freedom is more or less important than the individualistic, anarchic ways of license. And while Andrew Lansley is SoS, negotiations will continue on changing the way we price medicines and whose definition of ‘value’ applies (the patient, the manager, the clinician, the family?)
In the meantime, as the NHS is still taking resources for granted – still suffering with affluenza – there is little urgency evident when it comes to radically changing the way they do things and also considering what is done by the NHS. Admittedly the enormity of the upheaval to NHS organisations will continue to distract those at the front line trying to improve care and outcomes. Every re-organisation distracts. The difficulty this time is that huge amounts of money need to be saved through systems and pathway redesign in order to meet growing demands, and this is taking second place to office moves and personnel changes. Staff roles will change, and as the PM talks today about what we expect from nursing, something is going to have to give as adopting essential telehealth (remote monitoring and consultations) will require workforce changes that we cannot afford to be stifled by union protectionism.
Most importantly, the public increasingly want to know how to make things happen. Having been passive recipients of healthcare whilst taking more initiative in other areas of our lives, we are waking up to the fact that if we fund the NHS, then we should have more authority to challenge the status quo when things don’t pan out as we expect. Unreal expectations aside (another blog-post subject), if we are refused an appropriate medicine approved by NICE, we want to know how to reverse this decision; if we want a second opinion, there should be a straight-forward way of getting one; if we want to know how carefully our NHS Trust is spending our money, we should be able to see what their losses are; if we want to have copies or access to our hospital or GP health records, we should be able to.
So a sure fire prediction is that the year ahead will be eventful and challenging. What I hope will also happen is that the public will become more actively involved in their own healthcare and expectations of what the NHS can really deliver are more realistic, whether you are a patient, professional or politician.
