The high drama of election night is over. Dawn has broken over #GE2017, a surprising and tumultuous election from start to finish. We know that we have a hung parliament and the Conservatives are seeking a ‘confidence and supply’ arrangement with the Democratic Unionist Party.
Whatever this means for the day to day business of government, whatever shape the new administration takes, the reappointed health secretary and his new ministerial team need to get down to business, fast.
The reappointed health secretary and his new ministerial team need to get down to business, fast.
director of policy and strategy
There are two urgent issues that need to be addressed, and thinking needs to start now on a number of longer term issues which, if they aren’t tackled, will quickly move from being challenges to crises.
Top of our list for Jeremy Hunt is to make some urgent decisions about how we handle demand for NHS services in the coming winter. We saw record demand last winter: NHS providers treated more patients than ever before, performance against the four hour A&E target deteriorated, the number of long trolley waits rose, as did ambulance handover delays, and the risk to patient safety risk increased. This is our biggest current risk. If, as we suspect, the extra social care money announced in the Budget doesn't deliver the extra capacity the NHS needs, we'll have to find another way to create it so that winter can be managed safely. Proposals need to be developed and communicated to the NHS frontline over the next six weeks.
Hot on the heels of winter is the need for extra capital investment in the NHS. There have been repeated raids on the capital pot to reduce deficits instead of spending the money on maintaining buildings, modernising facilities and investing in the IT infrastructure. The budget announced £100m extra for A&E departments, and the Naylor Review, reflected in the Conservative manifesto, concluded that £10bn was needed to support transformation and clear the maintenance backlog. However, to implement this we need a robust, convincing NHS capital plan, created by national system leaders and local NHS providers working together. This is a plan that can't wait as it has to be ready for this autumn's Budget.
Longer term challenges
Maintaining an affordable, effective workforce is one of the biggest longer term challenges that trust leaderships face. The new health team’s work here is to understand the scope of this problem and to grasp that it is on a par with the well rehearsed financial challenges. We are seeing a rapidly growing gap between the demand for and supply of suitably trained staff. This is exacerbated by increasing numbers of staff leaving the service, an issue driven by ongoing pay restraint and increasingly pressured working conditions, along with insufficient newly trained staff to replace those who are retiring.
Maintaining an affordable, effective workforce is one of the biggest challenges facings trusts.
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Brexit, which was a key feature of the election campaign, is a major contributor to workforce challenges. The continued uncertainty around EU nationals’ right to remain means that some staff are voting with their feet and returning home, or they are deciding not to come at all. A recent survey by the Health Foundation shows a 96% drop in the number of EU nurses registering to practice in the UK. Brexit and tougher language tests may well be part of the issue here.
The current workforce planning system has broken down, and no one appears to be replacing it or fixing it. Although some trusts are developing innovative solutions – such as growing their own workforces in partnership with local universities – the national nature of the NHS means they need more support and a better country-wide framework so that they can develop the required long term strategic solutions. The work here is complex, and it needs to be near the top of the list.
The current workforce planning system has broken down, and no one appears to be replacing it or fixing it.
director of policy and strategy
Providers of NHS care are facing a huge task over the next five years. If they are to deliver what is required of them – to drive up efficiency and drive down unwarranted variation – the new ministerial team needs to consider two things. How do we maximise the gains from this efficiency and, critically, how do we ensure more money is spent closer to the patient? On this last point, we believe there must be scope to reduce non patient facing spend currently dedicated to commissioning and other system administration, rather than treatment, costs. A formal review, led by the ministerial team, could target a specific proportion of administrative costs to reinvest in patient care.
The hard work really begins again
These are the priorities for the health secretary. But of course he must also continue the all important business as usual. Mental health has been a high profile and welcome priority for the last seven years, and it has transcended coalitions and changing administrations. However, it is critical that we don’t substitute profile for action. Attention really needs to focus on where the additional money is being spent, making sure that it consistently reaches the frontline.
The drama of election night is over, the hard slog of campaigning is receding, and now the hard work really begins again.
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