The key challenges and opportunities facing the new secretary of state

NHS Providers had a good working relationship with Jeremy Hunt during his tenure as secretary of state, and we look forward to working with his successor, Matt Hancock. Here NHS Providers’ deputy chief executive Saffron Cordery offers 10 quick reflections on some of the key challenges and opportunities he faces in his new role.

1. The prime minister’s announcement of a new funding settlement for the NHS has the potential to be a turning point for the service. We are ambitious for the NHS, and see that the increased settlement brings opportunities for a national conversation about our priorities for the NHS. Health services need to be rebuilt around today’s patients and service users, making full use of the range of possibilities: from harnessing new technologies and embedding a digital culture, to empowering the frontline and streamlining national and local structures.
   
   
2. But we are starting from a very difficult position. Patient need has grown while funding remained flat, leading to structural deficits in the sector, a capital maintenance backlog and under-investment in integration between primary and secondary care, and between health and social care. Our research shows that filling the gaps that have opened up after almost a decade of austerity could account for much if not most of the money announced by the prime minister.
   
   
3. The NHS now has the task of setting out how the new settlement will be used. A ten-year strategy will be underpinned by a five-year delivery plan. Hard choices lie ahead as we seek to strike a balance between recovery on performance and finances, keeping up with rising costs and demand for care, transforming the way the NHS delivers care and offering improvements in key areas such as cancer and mental health.
   
   
4. To ensure the best use of the extra money it is vital that we see close collaboration between the Department, the NHS arm’s length bodies, and NHS trusts. The provider sector will be responsible for delivery, and must be sure that it is able to fulfil expectations and keep staff, patients and service users at the heart of the changes. It is vital that frontline trusts have a strong voice in shaping and agreeing to all new commitments in the 10-year plan and how they are delivered.
   
   
5. As the membership organisation for 100% of NHS acute hospital, mental health, community and ambulance trusts NHS Providers’ unrivalled intelligence and insight into what is happening at the frontline supports our work with national system leaders to respond to health and care challenges. We have a central role in developing credible and realistic plans for the future.
   
   
6. The NHS is privileged to have a talented and dedicated workforce, but the staffing challenges facing trusts have grown considerably. There is a vacancy rate of 8%, reflecting a supply shortage, increased work pressures and decreased morale, and pay and reward tensions. Trusts have told us that workforce is their single biggest risk. The upcoming health and care workforce strategy will be vital to establishing a credible and sustainable approach. Alongside this, the pay award is a key consideration: both the Agenda for Change pay award and the expected pay rise for doctors loom as significant additional cost pressures.
   
   
7. There are important elements of health and care that fall outside the NHS funding settlement, including investment in prevention, workforce training, and capital spending on facilities and technology. These have a clear impact on overall NHS performance and cost effectiveness. Cuts to public health in recent years have taken their toll on crucial services for many NHS trusts and patients, particularly those such as community and mental health providers which run school nursing, health visiting, drug and alcohol and sexual health services. If the new 10-year plan for the service is to be credible, it will need to properly fund services which help people live healthier lives.
   
   
8. We look forward to the forthcoming social care green paper as a long-term vision for social care.  But we cannot ignore the fragility of that sector and the interdependence of health and social care. They are two sides of the same coin. For the NHS plan to succeed, so must social care.
   
   
9. Ahead of the funding uplift, this year will be challenging, particularly winter. Last winter was a watershed moment for the NHS with an overwhelming lack of capacity across the country. The NHS is beginning its preparations for this winter, but additional early investment will be necessary to avoiding another crisis, particularly in light of the continuing widespread gaps in staffing, services and bed capacity.
   
   
10. We face immediate challenges, but also the opportunity – through the five and ten-year plans – to lay the foundations of the NHS for the coming generations. The NHS is at a critical juncture, and we look forward to working with the new health and social care secretary to meet these challenges and secure a bright future for the health service.