Prime Minister Boris Johnson has made the NHS one of his top priorities. In his nine weeks in office, Johnson has already pledged £1.8 billion to fund capital works and equipment in hospitals, announced the creation of a £250 million AI lab and committed to supporting the healthcare workforce through greater investment in training and education. He also confirmed that this money would be provided in addition to the £20.5 billion per year by 2023/24 NHS funding settlement announced by Theresa May last year.
With extra funding and a ten-year Long-Term Plan in place, does this mean that the future of the NHS has been sorted? Well, not quite. The NHS still faces unprecedented financial and operational challenges as a result of mounting demand for care and resource constraints. These pressures are further exacerbated by the social care crisis, cuts to public health budgets and the UK’s impending withdrawal from the European Union. So, where should the Prime Minister focus his efforts?
First and foremost, the Prime Minister must address the growing workforce challenge facing the NHS. Staffing rates are failing to keep up with the pace of demand for services, with over 100,000 vacancies across the whole Service and over 40,000 in nursing. The uncertainty posed by Brexit is creating further challenges for providers, with 57% of Trust leaders worrying that they will not be able to maintain appropriate levels of staff to meet their patients’ needs. Staff satisfaction is also low, with 40% of staff feeling stressed and 20% experiencing harassment bullying and abuse at work. Failure to support the workforce risks impacting patient safety. Data from the Care Quality Commission warns how staff shortages are preventing Trusts to keep people safe from harm and abuse.
There are signs that the Government is waking up to the fact that a capable and appropriately skilled workforce is critical to delivering the Long-Term Plan and creating a sustainable NHS. The Chancellor’s commitment to increasing Health Education England´s budget for 2010/21 and reversing the cuts to the NHS Continuing Professional Development Programme is a welcome step towards up-skilling and developing key nursing and midwifery staff. Yet, it does not provide certainty over future funding for staff training and will certainly not solve the endemic staff shortages across the NHS. Worryingly, social care continues to be overlooked despite facing 110,000 unfilled staff vacancies and turnover rates as high as 30% per year. The upcoming NHS People Plan publication will provide the Prime Minister with the opportunity to put forward more ambitious policy proposals and provide clarity on the future of the NHS workforce.
Secondly, greater attention must be given to the delivery of an integrated, place-based system of care. The Long-Term Plan sets out bold ambitions for patients to access care in the community, with Sustainability Transformation Partnerships/Integrated Care Systems and Primary Care Networks playing a crucial role in supporting the wider reconfiguration of services and the delivery of new models of care. Yet, despite years of sustained effort, progress continues to be piecemeal and slow. Hospitals activity is increasing, with A&E attendances soaring by 22% between 2008/09 and 2016/17 and providers consistently missing targets for waiting times. In many parts of the country hospitals at operating at full capacity and a lack of alternative provision is leaving patients with no alternative but to turn up at A&E. Johnson has made it his responsibility to ensure that no patient waits 3 weeks to see their GP, yet in July only 62% of those who wanted a same-day GP appointment got one. To deliver integrated care, the Prime Minister must address the pressures facing acute services, but also prioritise investment in community services and primary care. Despite commitments, Johnson has so far failed to do so, with only 6% of the £1.8 billion for capital investment in the NHS going towards primary care.
Finally, the ambitions of personalised, joined-up and high-quality care outlined in the Plan will not be realised unless decisive action is taken regarding future funding for social care. While the Prime Minister has said that he wants to fix the social care crisis “once and for all”, he has yet to commit to delivering a long-term funding solution. With the much-touted Green Paper further delayed, and the latest spending round yet again delivering short-term funding to keep services afloat, the future of social care looks bleak.
The Prime Minister has the tools to reform the system for the better. Whether he can overcome short-termism and seize the opportunity remains to be seen.
Claudia Martinez is Research Manager and health policy lead at Reform think tank. Views expressed in this article are those of the author, not necessarily those of Bright Blue. Image licensed under the Open Government Licence v1.0.
