2017 started with concerns that the NHS was facing a ‘humanitarian crisis’ and winter pressures really taking hold. While it was not a crisis, I am sure for many January and the rest of the year felt challenging: rising demand, relentless efforts to improve finances and recover performance targets, supporting staff to do what often feels like the impossible. All while trying to transform the system, work together, and ultimately improve patient care.
Here are ten quick reflections on how the main events of 2017 affected the NHS and providers.
- Theresa May took a risk back in June with a snap election, which resulted in a minority government and the reappointment of ‘health-man’ Jeremy Hunt. May is holding her Cabinet – divided along Brexit lines – together but Damian Green’s sacking has left her looking more as we head into 2018. Meanwhile Jeremy Hunt continues to prioritise patient safety, maternity care and recovering A&E targets, but is a move in the offing, as the commentators suggest?
- Once again the strongest and longest financial squeeze in the history of the health service made its mark on trusts’ finances. The combined deficit fell to £791 million - a big improvement on the £2.5 billion shortfall in the previous year – and there were impressive efficiency gains totalling £3.1 billion. The budget brought in some additional funding: less than needed but more than expected.
- Trusts treated more patients than ever, but performance slipped against several key targets. Waiting lists are growing for routine hospital treatment as more energy and resources are directed into recovering performance in A&E, meanwhile trusts have shown good progress in reducing DTOCs.
- Workforce challenges topped the agenda in 2017, with more nurses leaving the profession in the UK than joining and 90% of trust leaders signalling their concern about the national approach. However in December a new national health and care workforce strategy consultation was finally launched - an indication that the centre is taking these challenges seriously.
- Brexit is still happening. In March Article 50 of the Lisbon Treaty was triggered and the government started a two year countdown to reach a deal on the UK’s withdrawal and future relationship with the EU. The divorce bill has been estimated at around £35-39 billion, but parliamentary scrutiny of the final deal remains in question. Meanwhile, high-level agreement on EU citizens’ rights is good news for the NHS as we see an increasing number of EEA nationals quitting the NHS over the past year.
- The national bodies published the Next Steps on the Five Year Forward View back in March, which included an ‘under the radar’ name change and longer-term role for sustainability and transformation partnerships, as well as a pathway to “accountable care”. Nine areas were announced as those most likely to evolve into accountable care systems. Accountable Care Organisations (ACOs) face controversy with a judicial review and concerns about this being a route to privatisation.
- It’s been a busy year for the regulators with changes at the top. After two years in the job Jim Mackey returned to Northumbria and handed the mantle over to Ian Dalton who became chief executive of NHS Improvement in December. Following Ed Smith’s departure Baroness Dido Harding was appointed as NHS I’s new chair, following close scrutiny by the health select committee. We welcomed both appointments and have high hopes for the new leadership team to support the sector this winter and beyond. Meanwhile at the CQC, Professor Ted Baker took over from Sir Mike Richards as chief inspector of hospitals. His mission - to move away from a culture of blame within the NHS.
- Outdated mental health legislation is now under review. At the Conservative party conference Theresa May announced an independent review of the Mental Health Act. The review, led by Professor Sir Simon Wessely, will examine the rising rates of detention, including the disproportionate number of people from black and minority ethnic groups who are detained.
- Social care is still in desperate need of support. Despite the additional £1bn of funding invested this year through the improved better care fund, councils will still need to make around £84m of savings, which is likely to impact on those needing care. Social care was also excluded by Chancellor Phillip Hammond from the autumn budget, which led to further calls for a long term solution for social care.
- Finally, we must applaud the heroic efforts of NHS staff this year amidst terror attacks, the Grenfell Tower fire and winter pressures. In January we saw speculation of a ‘humanitarian crisis’ in the NHS – and one of the main reasons the system didn’t fall over during that challenging period was due to the efforts of NHS staff. In the aftermath of the Grenfell Tower fire emergency staff provided immediate support, and mental health trusts have been offering ongoing help. Following the London Bridge attacks NHS staff were praised for preventing a rising death toll and NHS staff were honoured in HSJ Patient Safety Awards for their response to the Manchester terror attack.
These are just ten reflections. There’s lots I didn’t explore -– the cyber attack on the NHS, that meeting with senior NHS leaders. But these at least give a flavour of the last 12 months. Roll on 2018…
This article was first published by the HSJ.