So, the election has been called, the political parties are piling on the announcements, and activity is ramping up for the 8 June vote. We might all be referring to it as a snap election but the campaign already feels like a long old haul.
If the pundits are right we are unlikely to see a change in administration, but we may well see a change in personnel in government and parliament. In among those polling predictions and manifesto commitments, the election is an important opportunity to restate what is needed to keep the NHS ship afloat. Its continued success needs investment in current services and the capacity to reshape them to meet 21st century needs. Without this, patients, service users and staff on the frontline will feel the impact, and trusts will struggle to deliver service improvements.
This is set against the backdrop of one of the longest and deepest financial squeezes in NHS history, with demand for services going through the roof and every type of trust running at capacity levels way beyond the recommended levels.
NHS Providers has set out seven priorities for the new government to help future decision makers and current opinion formers understand where they should focus their attention. One of the most important of these priorities is workforce.
Every organisation depends on its workforce – it is only as good as the staff it employs and keepsDirector of policy and strategytweet this
Every organisation depends on its workforce – it is only as good as the staff it employs and keeps. The personalised, caring and highly specialised nature of health care means this is particularly the case for the NHS. The huge gap that is growing between the supply of trained staff and the increasing demand for services has set the NHS on a collision course in terms of the timeliness, quality and safety of care patients receive
It is particularly concerning that NHS trust leaders now report that tackling this issue is one of their top priorities alongside and sometimes, ahead of the NHS’s finances.
So where did these challenges come from and what is the impact on the frontline? There are a number of reasons. First we simply need more staff to deal with the growing demand and the increasing complexity of patients’ needs, but the staff are not there.
However this is compounded by the fact that we are still in a period of substantial pay restraint. Trust leaders tell us that seven years on, this is now preventing them from recruiting and retaining the staff they need to provide safe, high quality, patient care. The NHS can't carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.
Pay restraint must end and politicians must be clear about when it will happen and howDirector of policy and strategytweet this
Pay restraint must end and politicians must therefore be clear about when during the lifetime of the next parliament it will happen and how. The NHS obviously has to stick to the budget the government sets and we will therefore need difficult discussions about how this pressure fits alongside the other priorities the NHS has to deliver.
It’s not just that salaries are less competitive. Recent reports on the pressure on A&E departments over winter have shown, the working conditions are becoming ever more stressful. Trusts are consistently reporting that stress and burnout lead to retention problems.
If we then layer Brexit on top of this the staff shortages worsen further: EU staff already working in this country have not been reassured about their current or future status, and the flow of staff being recruited from the EU is slowing.
But what does this mean for the frontline? In short it makes harder to ensure patient safety. Every type of provider – hospitals, mental health trusts, community and ambulance services – are all seeing rota gaps opening up that cannot be filled, and on occasions whole services closing unnecessarily. Understaffing has a direct impact on quality and a longer term impact as staff who are happy and motivated provide better care.
Clearly we need resolution on the status of EU nationals and a focused conversation on when and how we end pay restraint to support recruitment and retention. However we also need a strategic solution. So, whichever party is in government needs to work with the NHS national bodies to agree and fund a long term approach to workforce planning, which is currently lacking.
The other priorities for the new government, which will help it invest in the success of the NHS are:
- funding which allows trusts to deliver the standards expected by patients and enshrined in law in the NHS Constitution
- investing in social care: ensuring the extra money in the budget is used to ease pressure on the NHS, alongside a sustainable long term funding solution
- action to ensure words promising parity for mental health are matched by deeds. That means higher levels of investment and, critically, making sure that investment reaches the frontline
- supporting new ways of working and closer collaboration between health and social care so more people can be treated and supported closer to home. The priority must be quality of care rather than saving money, and the timetable must be realistic
- establishing the long-term funding needs of the NHS to ensure it can meet the increasing demands of an ageing population, as more baby boomers move into their seventies after 2020
- recognising the economic value of the NHS as an organisation that protects health, provides employment and promotes research
Delivering on these will support the NHS’s quest to serve the rapidly growing healthcare needs of today and tomorrow. Roll on election day!
This article was first published by the Guardian Healthcare Network on 8 May 2017