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The government billed this week as ‘health week’ because of the raft of NHS-related announcements that hope to address the Covid-19 backlog and set out ‘big and bold changes’ for an improved health and social care service.
If the aim of this focus on health was for the Prime Minister to win back support from critical Tory MPs, who have accused the government of lacking a ‘sense of mission’ in certain policy areas, then health week got off to a rocky start.
On Monday, the vote of no confidence overshadowed the NHS England announcement that the rollout of new community diagnostics centres had freed up much needed hospital capacity.
The health and social care secretary Sajid Javid attempted to get things back on track on Tuesday when he updated the Cabinet on the recovery of the NHS. In this speech, he said we have a “Blockbuster healthcare system in the age of Netflix” and it was not an option to stick to the status quo.
Change is something NHS staff would welcome along with the promise to create a health and care system where the “public can get the level of service they expect”. The only sticking point was that a government spokesperson later confirmed that “there is no further investment planned for the NHS, beyond the proposed set out by the Chancellor.”
This prompted Labour’s shadow health secretary, Wes Streeting, to respond by saying: “I think it’s slightly absurd that 12 years into a government we have government ministers who talk in the biggest generalities without plans to deliver anything.”
Culture of discrimination, bullying and blame
Next came the publication of a major review of NHS leadership that highlighted a culture of discrimination, bullying, and blame across many areas of the health and social care system. It proposed an overhaul of NHS leadership structures to help trusts emulate those that are performing best. Something the health secretary said would lead to the “biggest shake-up in health and social care leadership in a generation to improve patient care.”
The King’s Fund said this review clarified that collaborative and inclusive leadership is key to successfully delivering good-quality care, especially when many services feel close to breaking point.
Yet, it added that the elephant in the room is the deep workforce crisis that long pre-dates the pandemic and that the government has been reluctant to face up to.
Suzie Bailey, Director of Leadership and Organisational Development at The King’s Fund, said: “Health and care leaders can – and will – work hard to support their staff and get the most out of the resources available, but there is a limit to what a leader can do when faced with an exhausted workforce and chronic staff shortages.”
She also said that the review offers little in the way of recommendations for social care, a sector that employs 1.2 million people, which is also struggling with huge recruitment and retention issues that warrant a dedicated review.
Social care facing a ‘ticking time bomb’
Although the leadership review was thin on suggestions for social work recruitment, a new report from the British Medical Association (BMA) released on the same say did not shy away from it. This perhaps reflects the discord between government promises and experiences of those with feet on the ground.
The BMA report called for “wholesale reform to the social care service” and warned that it was facing a “ticking time bomb” as chronic underfunding, severe staffing shortages and a growing elderly population means that many in the future will not get the care and support they need.
It said huge care gaps would mean that the most vulnerable would be more at risk of seeing their health worsening and requiring care in the NHS.
Chair of the BMA’s committee on community care, Dr Anil Jain, said: “It is alarming that we could see up to 500,000 vacancies in social care by the end of 2030. The government must act now to effectively remunerate and value care workers to ensure that there are enough staff to look after all those in need of social care in the future.
“The current social care system is deeply flawed. As doctors, we are concerned that the government proposals to fix are not sustainable and will risk seeing the health of some of the most vulnerable and elderly populations worsening.”
It recommended that they paid social care workers the Real Living Wage, as a minimum, to improve the status of carers and curb the current high rate of turnover in the sector. It also suggested introducing a standard work contract and improved training opportunities for social care staff with the option for every care worker to move onto this new contract.
£125 million investment in smokefree policies
Today’s (Thursday) announcement from the Department of Health was much more universally received. This was a new review setting out a range of recommendations to support the government to meet its smokefree ambition by 2030.
Led by Dr Javed Khan OBE, former CEO of children’s charity Barnardo’s, it recommends an increased investment of an additional £125 million per year in smokefree 2030 policies, with an extra £70 million per year ringfenced for stop-smoking services.
Cancer Research UK said the review provides the government with the steps needed to close the health inequality gap and make smoking obsolete. With the Royal College of Physicians adding that it could protect the next generation from extreme harm.
The BMA also welcomed the review, but was quick to point out that the Government’s Tobacco Control budget has been cut by a third in real terms since 2015, so to an extent this extra £125m investment would only make up lost ground.
Even with welcome public health news, more headlines about staff shortages came this time from the Royal College of Radiologists (RCR). It warned that a shortage of clinical radiologists and clinical oncologists is having a “devastating impact” on patients.
In two new reports, it revealed that there is a 17% shortfall of clinical oncologists and a 29% shortfall of consultant radiologists. The College is now warning the situation will only worsen.
With one more day left of health week, maybe tomorrow’s announcement will be the one that hits the right mark across the health service and finally addresses the staffing crisis.
As the King’s Fund recently said: “The reality check is that until ministers grasp the nettle on health and care staffing shortages, it will be patients who continue to pay the price by waiting longer in discomfort, pain and deteriorating health.”