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Government’s plan to tackle winter crisis lacks concrete proposals to retain staff, say health leaders

The health and social care secretary, Steve Barclay, has announced how the government plans to prepare the NHS for winter and beyond. But health leaders say the plans lack concrete proposals to retain staff, something that is essential to tackling this health service emergency.

The health and social care secretary, Steve Barclay, has announced how the government plans to prepare the NHS for winter and beyond.

In his speech, Mr Barclay said that effective operational management of the NHS will be crucial. In particular, the government hopes to identify where accountability sits for delayed discharge.

A key focus this summer has been addressing ambulance handover delays, after the winter of 2021/22 saw the greatest number of delays compared to any previous years.

This has, in part, been caused by a lack of beds in social care, which has left patients who are medically fit for discharge stuck in hospital. Mr Barclay says the Department is looking at plans to tackle lower weekend discharge rates and create specific action plans for conditions like dementia and Parkinson’s, as well as delivering 7,000 extra beds in the community.

However, the British Medical Association and the NHS Confederation say the plans announced by the health secretary lack concrete proposals to better retain and recruit health and care staff. Until this is addressed, there is a fear that these delays will continue, the backlog of elective care will continue to grow, and patient outcomes will suffer as a result.

Addressing the workforce crisis

Mr Barclay said addressing the workforce crisis is a key objective for the government this winter, and that is why the government has set up an International Recruitment Task Force.

The government also admits it needs to do more to retain staff, and recognises that it is cheaper to retain a clinician than train a new one. So, it has launched a consultation on a ‘retire and return’ easement, allowing retired and partially retired staff to return to work in the NHS or increase their working commitments without having their pension benefits suspended.

“We also need to make sure that we use the workforce we have as flexibly and efficiently as possible. And I’ve been hugely encouraged to see the excellent work being done as part of the forthcoming workforce strategy and workforce plan.

“We need to see new roles such as advanced practitioners embedded in the NHS, and we need to see more staff practicing at the top of their license,” he said.

However, Dr Emma Runswick, BMA deputy chair of council, says the staffing crisis cannot improved without a substantial pay lift for doctors.

“The BMA has warned that years of pay erosion and punitive pension taxation rules are resulting in doctors haemorrhaging from the NHS. Doctors are leaving the profession to better paid roles abroad, moving into other careers, reducing their hours and retiring early to avoid huge tax bills on their pensions. The Health Secretary recognises that the poor retention of doctors is a dreadful waste of resources but the Government still lacks concrete proposals to retain them,” she said.

She urges the government to accept that the Doctors’ and Dentists’ Pay Review Body is not fit for purpose and says it must come to the table to restore doctors’ pay.

“To stop an avalanche of retirements this year, the Government needs to make urgent changes to the Finance Act to fix issues caused by sky-high inflation, and as a long-term solution introduce a tax unregistered pension scheme for senior NHS staff,” she concludes.

Increasing capacity

Mr Barclay says the government is also taking targeted action to tackle specific priority areas, for example, investing 127 million to increase and support the maternity NHS workforce and increase the neonatal care capacity over the next year. This is on top of the £95 million investment in the recruitment of an additional 1,200 midwives.

To address health inequalities, the government will expand the number of community diagnostic centres, bringing treatment closer to home. This is particularly important in communities with poor health outcomes, which often have a significant journey time from their nearest major hospital.

Mr Barclay has also commissioned the Department to consider how to embrace home-testing for a wider range of conditions through a modernised health check.

In addition, the government will attempt to scale up technological innovation, admitting that many successful pilot commissions are not always rolled out quickly across the NHS.

To tackle this, the NHS, together with NICE, are working to develop a policy framework for an early value assessment for digital health technologies, which can also be applied to med tech.

“This policy framework will greatly improve the uptake and adoption of well-evidenced technologies and provide clarity to industry partners on their route to scaling and reimbursement,” Mr Barclay said.

Improved accountability and reduced targets

Mr Barclay also admitted that currently, there are a large number of priorities set by the government and the NHS, however, many are not measured in a way that supports individual accountability.

“We therefore need pure, central priorities, which free up more local decisions with a focus on those that are most impactful and scalable. For example, at the national level, my focus on ambulance handover times will improve patient flow, which will help improve care for anyone in need of hospital treatment,” he said.

He was keen to point out that this is not about relaxing core NHS standards, but clarifying the performance management of those standard to enable meaningful accountability.

While NHS leaders have welcomed the health secretary’s call for a reduction in the overall number of performance targets across the health service, Matthew Taylor, chief executive of the NHS Confederation, said the government “must ensure that it makes good on its promises and allows local leaders the freedom they need to make this a reality”.

“Getting the correct mix both in terms of the numbers and the type of targets ultimately lies with the government as crucially it sets the priorities for the NHS in its annual mandate, something in recent years it has done nothing to redress,” he said.

Greater transparency

The health secretary has also commissioned the first ever digital map of the Department, which aims to provide better transparency about how the £2.8bn a year is being spent on the health and social care system.

In particular, it aims to “empower NHS staff to identify whether this funding is being spent in areas that are most helpful for them in terms of delivery on the frontline”.

Mr Barclay revealed there are 18,600 people working in national NHS management bodies, 26,000 work in the NHS’s local Integrated Care Boards, and 7,000 work in Commissioning Support Units, costing more than £2bn a year.

The majority of these employees do not provide direct patient care, and Mr Barclay says this money could be better spent on frontline services.

For now, Mr Barclay has put in place a recruitment freeze and has asked the Department to review all contracts, with a view of saving 20%, unlocking a further £170 million.

“This is not just an issue of cost, it’s also about effectiveness, because too much management can be a distraction to the frontline. Staff are the need to streamline the administrative burden of those on the frontline and not risk adding to it,” he said.

Mr Taylor said: “The Secretary of State has laid out his ambition to reduce both the overall numbers and the costs associated with NHS management. At best this a false economy and at worse will damage the NHS further.

“Evidence shows that the NHS is under-managed by international standards and employing fewer managers risks pulling clinicians into doing more of this work and away from the frontline seeing patients.”

New government will “inherit an NHS in deep crisis”

Put together, the health secretary hopes these steps will enable the government to finish he summer in a better position for the winter ahead.

Although winter will be challenging, Mr Barclay says we should remain confident that there are opportunities to improve the NHS system during winter and beyond.

However, Mr Taylor says the ‘harsh truth’ is that the new government will “inherit an NHS in deep crisis, with 138,000 staff vacancies, one in seven patients waiting to be discharged from hospital because of a lack of social care provision and severe underinvestment in NHS buildings and estates.”

“What NHS leaders need to see urgently, is a clear and coherent plan that addresses this health service emergency,” he said.

author avatar
Lauren Nicolle
Lauren is a qualified journalist who writes primarily across the health and social care sectors. She is passionate about exposing the injustices faced by people with a learning disability, with a particular focus on equal access to healthcare.

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