This week the health and select committee within Parliament confirmed what everyone working in the NHS already knows – it has a major staffing crisis, The Tory leadership candidates are not offering any new policy ideas, but a new NHS plan is desperately needed, covering all the major factors that affect the capacity of our NHS.
- Pressure on hospital beds – hospital activity is lower than before the pandemic, whilst the number of Covid in-patients has risen sharply recently. The trend in the total number of hospital beds has been downward and historically the UK has worked with a smaller stock of hospital beds than most other countries, leaving dangerously low spare capacity.
- An inadequate workforce strategy – a decade without the proper NHS workforce planning has been exposed by the current staffing crisis. There are 106,000 unfilled posts across the NHS, so retaining the current staff must be a priority. NHS staff are already demoralised – another real-terms pay will not help. Delays in immigration visas for staff is also not helping. In the short term, efforts to fund extra staffing were made more difficult after the insistence from government that the cost must come from existing budgets. Judged by a panel of experts to be “inadequate”, the current strategy should be rewritten to include a major step change in training and recruitment across the NHS. This is crucial to meet projections of high future demand. So far a funded plan has not been produced.
- Underinvestment – Despite raised funding in the spending review settlement analysis viewed it as not enough to expand activity. The upsurge in inflation will devalue budgets further, leaving no room to settle crucial pay negotiations. A further rise has so far been refused and instead ministers have imposed demands for what seem to be unachievable efficiency savings, a controversial tactic which has previously led to service cuts.
- Problems with buildings and equipment – Government will spend 3.7% more annually by 2023/4 on capital, but these rises come after ten years of underfunding led to a £9bn backlog in hospital repairs, so the new funding is a welcome start, but more is needed upfront to deal with £4.9bn of urgent repairs.
- Growing reliance on private sector – the published NHS recovery plan places heavy emphasis on support from private hospitals, but they have a relatively small number of beds and share many surgeons with the NHS, giving limited scope for expanding capacity this way. Longterm, outsourcing lowers standards according to a recent study, a view supported by 200 0phthalmologists who wrote jointly concerned about affects on eye patients.
- Pressure on social care – After years of neglect by all governments, the recent changes to limit the individual care costs do nothing to attack the major supply-side issues – chiefly, the reliance on a shrinking commercial home care sector. The care sector has its own staffing crisis too, short of a 100,000 care workers. An already overstretched NHS has become the prop for the lack of care services.
- The neglect of prevention – public health services have endured real terms cuts of 24% per capita in the funding paid to local authorities to prevent obesity and smoking, and to pay for children’s services (2015-21). Current funding still falls well short of the projected need.
Policy makers have consistently failed to address these key factors. Without adequate action on them, bringing the NHS out of crisis so that it can provide timely, high-quality care to the whole community will be impossible to achieve.
Full article on The Lowdown, 28 July 2022