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Winter and workforce woes: challenges facing the new Secretary of State for Health and Social Care

For the third time this year, the NHS and social care has a new Secretary of State. The appointment must now signal stability following a period of political turbulence, as we head into what health leaders are describing as the toughest winter to date. Backlogs, delayed discharges, ambulance and A&E pressures, and crumbling NHS estates will remain top of Steve Barclay’s priority list in the coming weeks and months ahead. However, he will also need to address the longstanding workforce issues that hold back both the NHS and social care sector. Only dealing with these structural challenges will ensure the health and care system is operationally fit for winters to come.

James Mole - Director of Healthcare Communications, Hanover London

The NHS is one of the new government’s top priorities and rightly so. A high-performing NHS is the foundation of good public health and a driver of economic progress. The performance of the health service and people’s access to safe, compassionate care, is consistently high on voters’ worry list

During the brief, ill-fated Truss administration, government’s only intervention of note on the NHS was to publish a winter plan. It focused on access to GPs, with a pledge to tackle the “8am scramble” which will resonate with millions of households. And its commitment to bolster social care - important in itself, but crucial too in steadying the NHS - is the right place to direct energy.

The same-day GP appointment guarantee for urgent need, and two-week deadline for routine consultations, grabbed the headlines. But NHS leaders and other commentators rightly pointed out that, for the target to make a difference to patients, it will require significantly investing in the workforce, not just in primary care but across the NHS and social care.

NHS challenges: from immediate to long-term

There is a limit to what can be done now to gear up for the next few months. But in that context, the focus on mitigating immediate challenges: emphasising speeding up discharges from hospital and improving access to primary care, was a reasonable place to start.

However, as has been the case for some years now, the biggest returns will be found in tackling the long-term operational issues. These will be the factors determining whether the NHS works for patients in the future winters and decades to come.

The winter will see a renewed focus on levels of staff pay, but for the long-term, addressing the workforce challenges means filling the tens of thousands of vacancies in NHS staffing and easing the burden on existing staff through making social care work. It also requires investment in new, advanced capacity in areas like diagnostics, medicines and prevention services, and ensuring the service is equipped and ready to use new technology and therapies as they are developed.

Delivering on these long-term challenges would make the service more efficient, improve public health, and reduce the chances that people need to seek help from the NHS in the first place.

Emphasis on infrastructure

Ultimately, what is needed is more available capacity within all parts of the NHS: GP teams, ambulances, A&Es, mental health care, diagnostic technology, surgical time, dentistry and much else besides.

Many health leaders argue that any additional resource and funding will achieve most if directed towards social care rather than the NHS. Too many people end up staying in hospital longer than they need to because they can’t be discharged into community care. This means hospital beds are taken up by people who don’t need to be there, which is bad for that individual’s health and takes away space to treat others.

Continued emphasis on fixing this ‘delayed discharge’ issue is essential.

Addressing this challenge would create space in hospitals, allow more people to be admitted where they need to be, ease pressure in emergency departments, help patients off ambulances more quickly, get paramedics back on the road and free up more staff time to focus on addressing the backlog in routine treatments.

Creating new capacity requires investment in buildings and equipment like cancer scanners, but also investing in people: bringing in more staff to plug the gaps, supporting those already working in the system, and setting out a long-term plan for the workforce.

For pharma, understanding these infrastructure challenges is critical.

To bring new therapies into the NHS, the right referral routes and diagnostic capacity, particularly in community and primary care, must be in place. This means that any firm that is looking to make inroads in the UK in the coming months or years will need to be aware of how their therapy can support the bigger operational challenges facing the NHS, and think about potential solutions to delivery limitations within the system.

NHS at 75

Next year will mark the 75th anniversary of the NHS’ founding.

Nearly five years ago, the now-Chancellor Jeremy Hunt gave the NHS a ‘70th birthday present’ of significant multi-year investment to back-up a long term plan for the health service.

Underpinning this plan was that in order to deliver on its commitments, there would need to be similar investment and thinking going into social care too, alongside investment in the health workforce.

Neither of those supplementary commitments has been delivered on.

And while the NHS’ critics will reasonably ask questions about the scale of NHS funding ahead of the upcoming Autumn Statement, the reality is that until social care and workforce fundamentals are corrected, the health service will not be able to operate as efficiently for taxpayers, supportively for industry and effectively for patients, as we all would like to see.

7th November 2022

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